CMS wants Input on Selling Health Insurance Across State Lines
The Trump administration says offering health insurance across state lines will enhance competition and lower premiums, but states may raise objections if their regulatory authority is challenged.nnKey Takeawaysn
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- CMS has issued a request for information about selling health insurance across state lines.
- The RFI follows up on a 2017 Trump administration executive order that CMS “facilitate the purchase of health insurance across state lines.”
- State insurance regulators have traditionally looked askance at any federal initiatives that weaken their oversight.
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nThe Centers for Medicare & Medicaid Services wants suggestions on how to “eliminate regulatory, operational and financial barriers” that hinder the sale of health insurance plans across state lines.nn”Americans are in desperate need of more affordable health insurance options,” CMS Administrator Seema Verma said Wednesday in a media release announcing the request for information.nn”Eliminating the barriers to selling health insurance coverage across state lines could help provide access to a more competitive and affordable health insurance market,” she said.n
Trump’s 2017 executive order also directs the Secretary of Labor “to consider expanding access to Association Health Plans, which could potentially allow American employers to form groups across State lines.” That would allow health insurance providers to bypass state coverage requirements.nnHealth insurance oversight is left largely to the purview of states, which has created a regulatory patchwork that varies widely from state to state.nnState and federal lawmakers, mostly Republican, have for the past decade pushed to sell health insurance across state lines, but the issue has proved to be nettlesome. The National Association of State Legislatures reports that at least 23 state legislatures have considered the idea over the past 10 years.nnThe National Association of Insurance Commissioners hasn’t taken a firm stand on the idea, because it represents independent state insurance commissioners, many of whom may have varying levels of support for the idea.nnIn the past, however, state insurance commissioners have been reluctant to support any federal initiatives on the issue that weaken states’ regulatory oversight.nnA NAIC spokesman on Wednesday declined to comment, but said the association would respond to the RFI.nnThe RFI will be open for public comment for 60 days.nnOriginal article published on healthleadersmedia.com.nn nn
HISTORY OF PRESENT ILLNESS: A 36-year-old female who underwent a revision microdiskectomy for disk reherniation at which point there was an incidental durotomy. The patient developed evidence of CSF leakage including positional headaches. She was treated with 2 blood patches and the patient seemed to improve. Subsequently, she developed a collection under her skin. This was tapped, demonstrating clear fluid consistent with CSF. Given this and the failure of blood patch for treatment of CSF leak, the patient was brought to the OR for direct repair of the CSF leak. The patient understood the risks of surgery including bleeding, infection, continued CSF leak, need for future operation, and agreed to undergo the operation.nnPROCEDURE IN DETAIL: The patient was brought to the OR, placed under general endotracheal anesthesia. She was flipped into the prone position on a Jackson table, prepped and draped in the usual fashion. The previous small incision on the left side of the back over the lumbar spine was opened with a 10 blade until clear fluid was reached. The fluid was drained, and there was a large cavity consistent with a pseudomeningocele left. The tubular retractor system was then placed down over the previous laminotomy at the site of probable CSF leak. The microscope was brought in. The durotomy and leaking CSF was easily identified, and scar tissue was carefully separated from the dura. Further laminotomy was also performed to provide room for suturing the leak. Once this was complete, a 5-0 Prolene suture was used to suture the dura back together. Valsalva after the initial closure demonstrated l area of leakage. A fat graft was then obtained from the patient’s subcutaneous fat layers, and this was sewn into the leakage area. Subsequent Valsalva maneuver did not demonstrate any leakage of CSF. Given this, it was felt that the repair was adequate to stop the CSF leak. A piece of DuraGen was then placed over the exposed dura, and DuraSeal was placed over the DuraGen. Steroids were also placed over the dura. Prior to placement of the DuraGen, the wound was thoroughly irrigated, and hemostasis was achieved with bipolar cautery and Gelfoam powder. Next, the tubular retractor system was removed. The pseudomeningocele tissue was cut away from the normal tissue using monopolar cautery and removed from the patient. Hemostasis was then achieved with bipolar cautery. Attention was then turned to closure. A watertight closure was performed in the fascial layer using 0 Vicryl sutures. Next attempts were made to close down any potential space between the fascia and fat layer using 0 Vicryl sutures. The fat layer was also reapproximated with 0 Vicryl sutures. Finally, the deep dermal layer was closed with 0 Vicryl sutures and the skin was closed with a running subcuticular Monocryl. Dermabond was placed over the wound. The patient was then flipped into the supine position, extubated, and transferred to the PACU.
UnitedHealthcare is revising the Consultation Services Policy and will no longer reimburse CPT® codes 99241-99255. This change aligns UnitedHealthcare with the Centers for Medicare and Medicaid Services (CMS). We would like to partner with care providers on older fee schedules (2009 and prior) to move to more current fee schedules.nnUnitedHealthcare will take a phased approach to implement this change as follows:nn1. Effective with dates of service of June 1, 2019, UnitedHealthcare will no longer reimburse CPT codes 99241-99255 when billed by any health care professional or medical practice with a participation agreement that includes contract rates determined on a stated year 2010 or later CMS RVU basis.nn2. Effective with dates of service of October 1, 2019, UnitedHealthcare will no longer reimburse CPT codes 99241-99255 when billed by any health care professional or medical practice.nn3. Health care professionals and medical practices should instead bill consultation services in accordance with current evaluation and management guidelines published by CMS.nn4. With respect to telehealth and telemedicine services, the Telehealth & Telemedicine Policy will continue to apply and HCPC codes G0406 – G0408, G0425 – G0427, G0508 and G0509 will be payable pursuant to that policy, the participation agreement and the member’s benefit plan.nn5. Consultation services may still be reimbursed when billed in accordance with the Preventive Care Services Coverage Determination Guideline for services such as lactation counseling.nn6. At this time, we will not be altering the Global Days Policy to apply a reduction to evaluation and management codes submitted with modifiers 25 or 57 as once announced with this Consultation Services policy change.nnCMS ceased reimbursement of consultation services CPT codes in January 2010 and increased the Relative Value Units (RVUs) for E/M codes at that time to offset this shift in its reimbursement methodology.nnFor this reason, UnitedHealthcare encourages providers who are on an older fee schedule to modernize their fee schedules to bring them into alignment with CMS’s current Relative Value Unit methodology, since the older fee schedule reimbursement does not appropriately align with current RVU structure for E/M services and many other procedure codes.nnUnitedHealthcare appreciates this change may have an impact on participating health care professionals and medical practices. So, if you have concerns or questions, or to update your fee schedule to a more current fee schedule, please reach out to your UnitedHealth Network representative.nClick 
2019 has begun a long process to eliminate redundant paperwork for providers and giving greater importance to patient interaction. One of the first changes to this multi-year program is the elimination of some home visit documentation requirements.nnE/M visits in the patient’s private residences (CPT codes 99341-99350) had, in previous years, to justify the home visit by documenting medical necessity. Effective January 1, 2019 CMS, as part of the “Final Rule”, has finalized the policy change and removed the requirement to the medical record documentation for these visits.
nnIn addition, please call your local DEA office and provide them with the details of the call.n