1. Tort Reform
2. Prescription Drug Competition and Choice
3. Competition between States and Monopoly Power
4. Earned Credit and Accumulated Good Health Coverage
5. Legal Requirements for Doctors under Public vs. Private Tort Reforms
6. Reform and Word Searches Must Contain SPECIFIC REFORM TOPICS ESSENTIAL TO HEALTH CARE COST CONTROL
a. Prevention
b. Co-pay or multiple flexible cost to service obligations
c. Generic vs. Brand Name products and regulation
_____________________
_____________________
_____________________
The 2009 Baucus Health Care Reform Bill in the Senate: Analysis and a Compare and Contrast Revision; October 20, 2009
__________________________________________________________________________________________________
Part 1: Tort Reform (Patient v. Doctor Relationships and Legal redress; Power of Attorney for Doctors vs. Patients; Insurance Requirements Standardization):
‘‘(c) CONTINUED APPLICABILITY OF STATE LAW WITH RESPECT TO HEALTH BENEFITS PLANS.—‘‘(1) IN GENERAL.—Subject to paragraphs (2) and (3), this title shall not be construed to supersede any provision of State law which establishes, implements, or continues in effect any standard or requirement relating to health benefits plan offerors in connection with a health benefits plan that offers more protection to consumers than the protection offered by any standard or requirement set forth in this title. The standards or requirements referred to in the preceding sentence shall include standards or requirements relating to— (Page 55)
‘‘(A) consumer protections, including claims grievance procedures, external review of claims determinations, oversight of insurance agent practices and training, and insurance market conduct;
‘‘(B) Premium rating reviews;
‘‘(C) solvency and reserve requirements relating to the licensure of health insurance issuers operating in the State; and
‘‘(D) The assessment of State-based premium taxes on health insurance issuers.
‘‘(2) SPECIAL RULE FOR RATING REQUIREMENTS.—For purposes of paragraph (1), in the case of the ratings requirements under section 2204, a State law shall not be treated as offering more protection to consumers than the protection offered by such requirements if the State law imposes ratios that are greater than the ratios specified in section 2204(b).
‘‘(3) CONTINUED PREEMPTION WITH RESPECT TO GROUP HEALTH PLANS.—Nothing in this part shall be construed to affect or modify the provisions of section 514 of the Employee Retirement Income Security Act of 1974 with respect to group health plans. (Page 56)
‘‘(v) REVISION FOR 2012 AND SUBSEQUENT YEARS.—As a result of the analysis described in clause (iv), the Secretary shall, not later than January 1, 2012, make appropriate adjustments to the practice expense geographic adjustment described in subparagraph (A)(i) to ensure accurate geographic adjustments across fee schedule areas, including—“ (Page 882)
(2) CONFORMING AMENDMENTS.—Section 1814(i)(1)(C) of the Social Security Act (42 U.S.C. 1395f(i)(1)(C)) is amended— (Page 929)
Insurance Portability and Accountability Act of 1996 and applicable State and local privacy regulations.
‘‘(b) RULE OF CONSTRUCTION.—Nothing in this subtitle shall be construed to interfere with or abridge an elder’s right to practice his or her religion through reliance on prayer alone for healing when this choice—
‘‘(1) is contemporaneously expressed, either orally or in writing, with respect to a specific illness or injury which the elder has at the time of the decision by an elder who is competent at the time of the decision;
‘‘(2) is previously set forth in a living will, health care proxy, or other advance directive document that is validly executed and applied under State law; or
‘‘(3) May be unambiguously deduced from the elder’s life history. (Page 530)
__________________________________________________________________________________________________
Part 2: Use of Generic or Foreign Made Drugs:
Generic Drug Section: Example @ $2 dollar pill and the same $30 dollar pill:
SEC. 1654. STUDY OF BARRIERS TO APPROPRIATE UTILIZATION OF GENERIC MEDICINE IN FEDERAL HEALTH CARE PROGRAMS.
‘‘(f) CLARIFICATION REGARDING AVAILABILITY OF OTHER COVERED PART D DRUGS. (Page 1024)
SEC. 1150C. PHARMACY BENEFIT MANAGERS TRANSPARENCY REQUIREMENTS. ‘‘(b) INFORMATION DESCRIBED.- page 1330 (Only Section which mentions the substitution of generic and name brands based on supply and distribution; however it is listed as PBM and advocates rebates and discounts).
"for which a generic drug was available and dispensed (generic dispensing rate), by pharmacy type (which includes an independent pharmacy, chain pharmacy, supermarket pharmacy, or mass merchandiser pharmacy that is licensed as a pharmacy by the State and that dispenses medication to the general public)." (Page 1330)
__________________________________________________________________________________________________
3. Competition between States and Monopoly Power
Sec. 3113. Revision to the Medicare Improvement Fund.
Sec. 3129. Extension of and revisions to Medicare rural hospital flexibility program.
SEC. 3102. EXTENSION OF THE WORK GEOGRAPHIC INDEX
EXPENSE GEOGRAPHIC ADJUSTMENT UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE. (Page 879)
‘‘(i) FOR 2010.—Subject to clause (iii), for services furnished during 2010, the employee wage and rent portions of the practice expense geographic index described in subparagraph (A)(i) shall reflect 3⁄4 of the difference between the relative costs of employee wages and rents in each of the different fee schedule areas and the national average of such employee wages and rents.” (Page 880)
__________________________________________________________________________________________________
4. Earned Credit and Accumulated Good Health Coverage
SEC. 3022. MEDICARE SHARED SAVINGS PROGRAM.
Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by adding at the end the following new section: ‘‘SHARED SAVINGS PROGRAM
‘‘SEC. 1899. (a) ESTABLISHMENT.— ‘‘(1) IN GENERAL.—Not later than January 1, 2012, the Secretary shall establish a shared savings program (in this section referred to as the ‘program’) that promotes accountability for a patient population and coordinates items and services under parts A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery. Under such program— (Page 749)
__________________________________________________________________________________________________
5. Legal Requirements for Doctors under Public vs. Private Tort Reforms
SEC. 1704. INCLUSION OF INFORMATION ABOUT THE IMPORTANCE OF HAVING A HEALTH CARE POWER OF ATTORNEY IN TRANSITION PLANNING FOR CHILDREN AGING OUT OF FOSTER CARE AND INDEPENDENT LIVING PROGRAMS. (Page 451)
‘‘(vii) steps to ensure that the components of the transition plan development process required under section 475(5)(H) that relate to the health care needs of children aging out of foster care, including the requirements to include options for health insurance, information about a health care power of attorney, health care proxy, or other similar document recognized under 453 State law, and to provide the child with the option to execute such a document, are met; and’’. (Page 452-453)
__________________________________________________________________________________________________
6. Reform and Word Searches Must Contain SPECIFIC REFORM TOPICS ESSENTIAL TO HEALTH CARE COST CONTROL
www.townhall.com
How Much Obamacare Costs the Average Family
Dick Morris and Eileen McGann
Monday, October 19, 2009
What's In and What's Out of Health Care Legislation
Phyllis Schlafly
Tuesday, October 20, 2009
a. Prevention
SEC. 1202. APPLICATION OF STATE AND FEDERAL LAWS REGARDING ABORTION. (a) NO PREEMPTION OF STATE LAWS REGARDING ABORTION.—Nothing in this Act shall be construed to preempt or otherwise have any effect on State laws regarding the prohibition of (or requirement of) coverage, funding, or procedural requirements on abortions, including parental notification or consent for the performance of an abortion on a minor. (Page 144)
‘‘(d) EXISTING PROGRAMS OF HEALTH PROMOTION OR DISEASE PREVENTION.—Nothing in this section shall preempt any State law related to programs of health promotion offered by a health insurance issuer that offers health insurance coverage in the individual market in such State that was established or adopted by State law on or after the date of enactment of this Act." (Page 520)
PART III—ENCOURAGING DEVELOPMENT OF NEW PATIENT CARE MODELS
SEC. 3021. ESTABLISHMENT OF CENTER FOR MEDICARE AND MEDICAID INNOVATION WITHIN CMS.
(a) IN GENERAL.—Title XI of the Social Security Act is amended by inserting after section 1115 the following new section: ‘‘CENTER FOR MEDICARE AND MEDICAID INNOVATION
‘‘SEC. 1115A. (a) CENTER FOR MEDICARE AND MEDICAID INNOVATION ESTABLISHED.—
‘‘(1) IN GENERAL.—There is created within the Centers for Medicare & Medicaid Services a Center for Medicare and Medicaid Innovation (in this section referred to as the ‘CMI’) to carry out the duties described in this section. The purpose of the CMI is to test innovative payment and service delivery models to reduce program expenditures under the applicable titles while preserving or enhancing the quality of care furnished to individuals under such titles. In selecting such models, the Secretary shall give preference to models that also improve the coordination, quality, and efficiency of health care services furnished to applicable individuals defined in paragraph (4)(A).
‘‘(2) DEADLINE.—The Secretary shall ensure that the CMI is carrying out the duties described in this section by not later than January 1, 2011.
‘‘(3) CONSULTATION.—In carrying out the duties under this section, the CMI shall consult representatives of relevant Federal agencies, and clinical and analytical experts with expertise in medicine and health care management. The CMI shall use open door forums or other mechanisms to seek input from interested parties.
‘‘(B) OPPORTUNITIES.—
b. Co-pay or multiple flexible costs to service obligations
‘‘(3) BUDGET NEUTRALITY.—‘‘(A) INITIAL PERIOD.—The Secretary shall not require, as a condition for testing a model under paragraph (1), that the design of such model ensure that such model is budget neutral initially with respect to expenditures under the applicable title.
‘‘(B) TERMINATION OR MODIFICATION.— The Secretary shall terminate or modify the design and implementation of a model unless the Secretary determines (and the Chief Actuary of the Centers for Medicare & Medicaid Services, with respect to program spending under the applicable title, certifies), after testing has begun, that the model is expected to—
‘‘(i) improve the quality of care (as determined by the Administrator of the Centers for Medicare & Medicaid Services) without increasing spending under the applicable title;
‘‘(ii) reduce spending under the applicable title without reducing the quality of care; or
‘‘(iii) improve the quality of care and reduce spending. Such termination may occur at any time after such testing has begun and before completion of the testing. (Page 743-744)
(c) BUDGET-NEUTRALITY ADJUSTMENT.—Section 1848(c) (2) (B) of the Social Security Act (42 U.S.C. 1395w–4(c)(2)(B)) is amended by adding at the end the following new clause: (Page 811)
SEC. 3142. APPLICATION OF BUDGET NEUTRALITY ON A NATIONAL BASIS IN THE CALCULATION OF THE MEDICARE HOSPITAL WAGE INDEX FLOOR FOR EACH ALL-URBAN AND RURAL STATE.
In the case of discharges occurring on or after October 1, 2010, for purposes of applying section 4410 of the Balanced Budget Act of 1997 (42 U.S.C. 1395ww note) and paragraph (h)(4) of section 412.64 of title 42, Code of Federal Regulations, the Secretary of Health and Human Services shall administer subsection (b) of such section 4410 and paragraph (e) of such section 412.64 in the same manner as the Secretary administered such subsection (b) and paragraph (e) for discharges occurring during fiscal year 2008 (through a uniform, national adjustment to the area wage index). (Page 955)
c. Generic vs. Brand Name products and regulation
‘‘(c) EXPANSION OF MODELS (PHASE II).—Taking into account the evaluation under subsection (b)(4), the Secretary may, through rulemaking, expand (including implementation on a nationwide basis) the duration and the scope of a model that is being tested under subsection (b) or a demonstration project under section 1866C, to the extent determined appropriate by the Secretary, if—
‘‘(1) the Secretary determines that such expansion is expected to—
‘‘(A) reduce spending under applicable title without reducing the quality of care; or
‘‘(B) improve the quality of care and reduce spending; and
‘‘(2) The Chief Actuary of the Centers for Medicare & Medicaid Services certifies that such expansion would reduce net program spending under applicable titles. (Page 955)
________________________________________________________________________________________________________________________________________________________________________________________________________________________
SUMMARY OF THE BAUCUS HEALTH CARE BILL OF 2009
Summary: There is more rhetoric in this bill and the reallocation and future allocation of medical care or one sixth of the US GDP than any other bill in history. Words such as “budget neutrality” actually suggest “bias” and names such as “Secretary” refer to the President or an assigned dictator of the problem. When it comes to abortion and illegal aliens; words are used like a caricature to imply rhetoric and state rights; although the funding is from the US Federal Government; the implementation suggest State’s allocation. Then the breaking point is the terms used “expansion of program” and “budget neutrality.” There is no way a company or business can run on this type of language. Also, it will not be long until someone ends up in court to clarify the rhetorical budgeting of this which places no caps or cost ceilings. On specific issues such as illegal aliens or non citizens it is left to the State laws. On other very controversial parts such as abortion; it also demands clarification on the State level. This is total lunacy and insanity put into law and verbal mental poetry. Explicitly it is some form of communism, socialism, or a practical prank to anger the logical acumen and mental capacity of those who read it and tried to understand it. This is a classic example of mind control. This form of mind control is so large; it will fuel huge bureaucrats and yield tremendous political dangers already known and identifiable.
Fiscal budgets merely hints to the “budget neutrality” and finalization of the bill based on spending until each person is equally cared for based on equal amounts of reallocation based on State laws. This is hard to determine as people move or are reallocated by either jobs or opportunity; then retirement based on a lifestyle budgeted decades ago. Had this been a computer program and the code for an operating system it would receive an F or D grade; it could not compile or even be read; no less algorithms or real formulas which inputs and outputs can be transferred and used in a finite and real number. If you send a value to a State; it must be constrained by both limits and ceilings; if not then a definitive number. The bill it absolutely nonsense and makes no sense whatsoever; this is why none of it can be explained; but the debate is “it is something, which is better than nothing.” Someone can read this and declare it witchcraft or some form of black magic where property values and real estate ownership is inflated and used to mesmerize the living dead and the criminal element in a conspiracy. The power of suggestion is you will be taken care of and the government is a new altered state of consciousness where someone will have to explain this in real numbers and real language. The work should be crumpled up and burned as a heating element on a cold night. It might have a stronger and more valuable worth rolled up and used as a blunt instrument to clobber someone with.
‘‘(g) REPORT TO 1 CONGRESS.—Beginning in 2012, and not less than once every other year thereafter, the Secretary shall submit to Congress a report on activities under this section. Each such report shall describe the models tested under subsection (b), including the number of individuals described in subsection (a)(4)(A)(i) and of individuals described in subsection (a)(4)(A)(ii) participating in such models and payments made under applicable titles for services on behalf of such individuals, any models chosen for expansion under subsection (c), and the results from evaluations under subsection (b)(4). In addition, each such report shall provide such recommendations as the Secretary determines are appropriate for legislative action to facilitate the development and expansion of successful payment models.’’.
(b) MEDICAID CONFORMING AMENDMENT.—Section 1902(a) of the Social Security Act (42 U.S.C. 1396a (a)), as amended by sections 5103 and 5105, is amended— (1) in paragraph (77), by striking ‘‘and’’ at the end; (Page 748)
No comments:
Post a Comment