Concierge Medicine Law - Legal Developments

Here are some items of general importance on the legal front

        Final Rules
        Application Form

_______________________________________________

June 25, 2010, CMS issued proposed rules relating to the new Health Care Act and the new 3P Services for Medicare patients. Go HERE for the rules.

_____________________________________________________

 

In January 2009 the Maryland Insurance Commissioner Issued the report referred to below.You can find it HERE.

_______________________________________________
 

WJZ, Channel 13, in Baltimore reported recently that: “A Howard County medical office has reversed plans to stop accepting insurance and move to a retainer-style practice, also known as concierge medicine. In October, the Charter Internal Medicine in Columbia announced plans to cut the number of patients and stop accepting private insurance and Medicare, moving to a model where patients would pay $2,000 a year for care. Some officials had expressed concern that the move by the primary care medical office with 9,000 patients would leave thousands without a doctor. On Friday, the Maryland Insurance Administration held a hearing on whether such operations should be considered insurance carriers. In a letter posted on its Web site, Charter says it will not make the change until the state government makes it clear whether it would be subject to additional regulation.” And also see account in the Baltimore Sun HERE.

Medicare Improvement for Patients and Providers Act of 2008
 

As you may know by now, the recent Medicare Bill passed by Congress extended the “welcome to Medicare physical” from the first six months of eligibility to one year. This all starts January 1. If you are operating a concierge practice you need to make sure that any physical you give a Medicare patient, whether or not that patient has paid in advance for the physical, within one year after the patient becomes eligible for Medicare, is to be billed to Medicare, with the applicable co-pays and deductible paid by the patient. Here is the exact text of the Amendment in this regard:
 

EXTENSION OF ELIGIBILITY PERIOD FROM SIX MONTHS TO ONE YEAR- Section 1862(a)(1)(K) of the Social Security Act (42 U.S.C. 1395y(a)(1)(K)) is amended by striking ‘6 months’ and inserting ‘1 year’.

You can go here for the text of the entire paragraph dealing with physicals. There are some other changes that might be of interest to you.

_______________________________


New Washington State Legislation Introduced 2007 - This is essentially the same legislation that was introduced last year but failed to pass. See the following link.

Failed State of Washington Legislation - 2006.

New (3-11-06) West Virginia Legislation.

Final GAO Report.

Massachusetts Senate Bill 1295 (2005) requiring a study of concierge medicine.

The now infamous March 4, 2002, Waxman Letter to HHS Director Tommy Thompson challenging the MDVIP concierge model.

The equally infamous May 1, 2002, response from Secretary Thompson.

The March 31, 2004, Fraud Alert issued by the Office of the Inspector General describing a settlement reached with a Minneapolis physician in the summer of 2003. Most newspaper accounts of this Alert assumed that this was a "new" case, not one concluded almost a year before.

The 2004 Medicare Act, Section 605, called on the General Accounting Office to undertake an investigation of concierge medicine and report to Congress within a year. To date no report has been filed.

In March of 2002 HHS issued a field order to its agents regarding the procedure to be followed when inquiries are made about concierge medicine.

In April of 2004 the New York State Department of Health issued a letter critical of concierge physician practices.

In August of 2003 the New Jersey Department of Health and Senior Services issued a letter critical of concierge medicine.