New York Healthcare Law Blog

 We have previously identified four critical areas of concern for New York physicians, in which the healthcare reform law will affect your practices. Here are some specific provisions that are of key importance.

 With respect to expanding coverage:

 * Over 3 million uninsured New Yorkers will have coverage (with 2/3 of this number covered through private insurance).

 * 1 million of the uninsured New Yorkers will be enrolled in Medicaid. Physicians will receive payment for treating the uninsured.

 * State-based Health Insurance Exchange providing a broad choice of physicians and health plans.

 * Catastrophic-only coverage option for those under 30 years old. Takes effect immediately.

 * Option to extend parent’s coverage to children under age 26. Takes effect immediately.

 * Immediate temporary high-risk pool with subsidized premiums for low-income uninsured with pre-existing conditions who have been denied healthcare coverage. In existence until the rest of the bill takes effect.

 * 50% Medicaid rate increase for primary care physicians (internists, family practice and pediatricians) to Medicare levels for E&M services and immunizations.

 * Medicaid expansion is 90-100% federally financed. Rate increases are 100% federally financed.

 With respect to Medicare, the following bonuses will be provided on top of current Medicare rates:

 * 50% bonus for Medicare primary care physicians 2011–2015 (10%/year). It is NOT financed with a cut to other physicians.

 * 50% bonus for Medicare general surgeons in rural areas 2011–2015 (10%/year).

 * An additional 5% bonus payment for physicians practicing in shortage areas.

 * Medicare Physician Quality Reporting (PQRI) program bonuses.

 * Bonus payments for physician medical homes and physicians who coordinate care through new Accountable Care Organizations.

 * New investments in physician training programs and workforce support.

 With Respect to Stopping Insurance Industry Abuses:

 * Requires health plans to dedicate 85% of revenues to direct patient care rather than overhead and profit.

 * Health Plans must have adequate provider networks.

* No insurance denials for pre-existing conditions.

 * Prohibits insurance companies from rescinding coverage when a patient gets sick.

 * No life-time or annual limits on benefits.

 * Requires administrative simplification by all payers to reduce physician billing hassles.

 Further, the healthcare reform includes employer coverage expansions, administrative simplifications, preventive and screening benefit expansions, as well as changes affective Medicare prescription drug coverage.