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Thursday, March 30, 2017

CASE MANAGEMENT IN GEORGIA WORKER'S COMPENSATION

The monstrous Rule 200.1 of the Rules and Regulations was compared to the US Tax Code in its breadth due to the fact that over the years, every problem, real or imagined dealing with “rehabilitation” was grafted onto 200.1.  The problem is that this section was intended only to deal with Catastrophic injuries. The SBWC has now fixed the problem and seemingly simplified the issue.  Rule 200.1 once again deals with Catastrophic Injuries and with Peer Discipline of misconduct by Rehabilitation providers.  That rule became effective July 1, 2015.    Effective New Year’s Day, 2016, the remainder of the recommendations from the Chairman’s Advisory Committee became effective with the adoption and publication of Rule 200.2, governing Medical Case Management Services. 

Since approximately 1992, Medical Case Management (also known as Nurse Case Management) was severely limited such that MCM/NCM could only be performed by those case managers employed by the Employer or the Insurance Carrier.  Outside contactors needed to have the permission of the injured worker to perform any case management services.  Typically, the first contact that an Employer/Insurer received from an attorney on behalf of the injured worker, notified the Employer/Insurer of representation, demanded documentation and advised the Employer/Insurer that no consent would be given to nurse case management services.  This left many injured workers who’s cases needed the additional assistance without recourse. 

The new Rule 200.2 removes the artificial distinction between a case manager employed by an Employer/Insurer and an outside contactor.  The new Rule focuses on the conduct of the case manager provides: 


“Consent of the employee shall not be required for such qualified medical case manager to contact the treating physician for purposes of assessing, planning, implementing and evaluating the options and services required to effect a cure or provide relief.”

Consent IS required, even under the new rule when the case manager is to work directly with the injured worker or when the case manager is attending a medical appointment. 


Medical Case Managers violating this rule will be subject to the same Peer Disciplinary Procedures as set forth in Rule 200.1. 

So, when you get the “introductory” letter from Opposing Counsel, please remember that your Medical Case Management Services may continue.  We hope that you find this update to be helpful in your practices. 

Skedsvold & White, LLC
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Friday, March 8, 2013

List of Taxes in the Affordable Care Act

From the Americans for Tax Reform Website comes a list (below) of the 47 new taxes in the ACA which the IRS must enforce by audits that they in their discretion get to impose.  Um, you know all that stuff about how the ACA is a bad idea, poorly conceived and executed? Well, um...nevermind.


  1. THE LIST 
  2. Prohibits group health plans from discriminating in favor of highly compensated individuals.
  1. Establishes a temporary reinsurance program to provide reimbursement for a portion of the cost of providing health insurance coverage to early retirees.
  1. Imposes a penalty on health plans identified in an annual Department of Health and Human Services (HHS) penalty fee report, which is to be collected by the Financial Management Service after notice by the Department of the Treasury (Treasury).
  1. Requires state exchanges to send to Treasury a list of the individuals exempt from having minimum essential coverage, those eligible for the premium assistance tax credit, and those who notified the exchange of change in employer or who ceased coverage of a qualified health plan.
  1. Provides tax exemption for nonprofit health insurance companies receiving federal start-up grants or loans to provide insurance to individuals and small groups.
  1. Provides tax exemption for entities providing reinsurance for individual policies during first 3 years of state exchanges.
  1. Provides premium assistance refundable tax credits for applicable taxpayers who purchase insurance through a state exchange, paid directly to the insurance plans monthly or to individuals who pay out-of-pocket at the end of the taxable year.
  1. Provides a cost-sharing subsidy for applicable taxpayers to reduce annual out-of-pocket deductibles.
  1. Outlines the procedures for determining eligibility for exchange participation, premium tax credits and reduced cost-sharing, and individual responsibility exemptions.
  1. Allows advance determinations and payment of premium tax credits and cost-sharing reductions.
  1. Authorizes IRS to disclose certain taxpayer information to HHS for purposes of determining eligibility for premium tax credit, cost-sharing subsidy, or state programs including Medicaid, including (1) taxpayer identity; (2) the filing status of such taxpayer; (3) the modified adjusted gross income of taxpayer, spouse, or dependents; and (4) tax year of information.
  1. Provides nonrefundable tax credits for qualified small employers (no more than 25 full-time equivalents (FTE) with annual wages averaging no more than $50,000) for contributions made on behalf of its employees for premiums for qualified health plans.
  2. Requires all U.S. citizens and legal residents and their dependents to maintain minimum essential insurance coverage unless exempted starting in 2014 and imposes a fine on those failing to maintain such coverage.
  1. Requires every person who provides minimum essential coverage to file an information return with the insured individuals and with IRS.
  1. Imposes a penalty on large employers (50+ FTEs) who (1) do not offer coverage for all of their full-time employees, offer unaffordable minimum essential coverage, or offer plans with high out-of-pocket costs and (2) have at least one full-time employee certified as having purchased health insurance through a state exchange and was eligible for a tax credit or subsidy.
  1.  Requires information reporting of health insurance coverage information by large employers (subject to IRC 4980H) and certain other employers.
  1. Offers tax exclusion for reimbursement of premiums for small-group exchange participating health plans offered by small employers to all full-time employees as part of a cafeteria plan.
  1.  Subjects new group health plans to certain Public Health Service Act requirements and imposes the excise tax on plans that fail to meet those requirements. (Conforming amendment)
  1.  Authorizes IRS to disclose certain taxpayer information to the Social Security Administration (SSA) regarding reduction in the subsidy for Medicare Part D for high-income beneficiaries. (Conforming amendment)
  1.  Requires the independent institute partnering with the National Academy of Sciences (NAS) to implement a key national indicator system to be a nonprofit entity under section 501(c)(3).
  1. . Imposes a fee through 2019 on specified health insurance policies and applicable self-insured health plans to fund the Patient-Centered Outcomes Research Trust Fund to be used for comparative effectiveness research.
  1.  Imposes a 40 percent excise tax on high cost employer-sponsored health insurance coverage on the aggregate value of certain benefits that exceeds the threshold amount.
  1.  Requires employers to disclose the value of the employee’s health insurance coverage sponsored by the employer on the annual Form W-2.
  1.  Repeals the tax exclusion for over-the-counter medicines under a Health Flexible Spending Arrangement (FSA), Health Reimbursement Arrangement (HRA), Health Savings Account (HSA), or Archer Medical Savings Account (MSA), unless the medicine is prescribed by a physician.
  1.  Increases tax on distributions from HSAs and Archer MSAs not used for medical expenses.
  1.  Limits health FSAs under cafeteria plans to a maximum of $2,500 adjusted for inflation.
  1.  Imposes additional reporting requirements for charitable hospitals to qualify as tax-exempt under IRC 501(c)(3) and requires hospitals to conduct a community health needs assessment at least once every 3 years and to adopt a financial assistance policy and policy relating to emergency medical care.
  1.  Imposes a fee on each covered entity engaged in the business of manufacturing or importing branded prescription drugs.
  1.  Imposes an annual fee on any entity that provides health insurance for any U.S. health risk with net premiums written during the calendar year that exceed $25 million.
  1.  Allows the deduction for retiree prescription drug expenses only after the deduction amount is reduced by the amount of the excludable subsidy payments received.
  1. Increases the threshold for the itemized deduction for unreimbursed medical expenses from 7.5 percent of Adjusted Gross Income (AGI) to 10 percent of AGA (unless taxpayer turns 65 during 2013-2016 and then threshold remains at 7.5 percent).
  1.  Denies the business expenses deductions for wage payments made to individuals for services performed for certain health insurance providers if the payment exceeds $500,000.
  1. Imposes an additional Hospital Insurance (Medicare) Tax of 0.9 percent on wages over $200,000 for individuals and over $250,000 for couples filing jointly.
  1.  Limits eligibility for deductions under section 833 (treatment of Blue Cross and Blue Shield) unless the organizations meet a medical loss ratio standard of at least 85 percent for the taxable year.
  1.  Allows an exclusion from gross income for the value of specified Indian tribe health care benefits.
  1.  Allows small businesses to offer simple cafeteria plans—plans that increase employees’ health benefit options without the nondiscrimination requirements of regular cafeteria plans.
  1.  Establishes a 50 percent nonrefundable investment tax credit for qualified therapeutic discovery projects.
  1.  Requires employers to provide free choice vouchers to certain employees who contribute over 8 percent but less than 9.8 percent of their household income to the employer’s insurance plan to be used by employees to purchase health insurance though the exchange.
  1.  Imposes a tax on any indoor tanning service equal to 10 percent of amount paid for service.
  1.  Excludes from gross income amounts received by a taxpayer under any state loan repayment or loan forgiveness program that is intended to provide for the increased availability of health care services in underserved or health professional shortage areas.
  1.  Increases the maximum adoption tax credit and the maximum exclusion for employer-provided adoption assistance for 2010 and 2011 to $13,170 per eligible child.
  1.  Extends the exclusion from gross income for reimbursements for medical expenses under an employer-provided accident or health plan to employees’ children under 27 years.
  1.  Imposes an unearned income Medicare contribution tax of 3.8 percent on individuals, estates, and trusts on the lesser of net investment income or the excess of modified adjusted gross income (AGI + foreign earned income) over a threshold of $200,000 (individual) or $250,000 (joint).
  1.  Imposes a tax of 2.3 percent on the sale price of any taxable medical device on the manufacturer, producer, or importer
  1.  Amends the cellulosic biofuel producer credit (nonrefundable tax credit of about $1.01 for each gallon of qualified fuel production of the producer) to exclude fuels with significant water, sediment, or ash content (such as black liquor).
  1.  Clarifies and enhances the applications of the economic substance doctrine and imposes penalties for underpayments attributable to transactions lacking economic substance.
     
  2. Increases the required payment of corporate estimated tax due in the third quarter of 2014 by 15.75 percent for corporations with more than $1 billion in assets, and reduces the next payment due by the same amount.


"Skedsvold, White & Wesley
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Thursday, March 7, 2013

As Proud As I can be

My son, Miles Skedsvold, is an 18 year old high school senior. He's a newer and much more improved version of the old worn out edition that is me.  Miles has been working on his own blog for longer than I have been working on mine, is rather a bit more erudite that I would ever hope to be.  He  has published a book on Amazon Kindle called Politically Dissident.  It is the thoughts and musings of an 18 year old discussing concepts in politics and natural law from the perspective of an 18 year old. For the next few days, the book is free on Kindle  Please download and support an aspiring young writer. 

Cheers,

Kevin


"Skedsvold, White & Wesley
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Wednesday, March 6, 2013

Oh the Humanity! The looming regulatory state from the Affordable Care Act


With apologies to Martin Niemoller:

First they came for the tanning beds...and I said nothing because I don't use tanning beds (well that and the fact that I don't tan but instead burn and freckle);

Then they came for the medical device manufacturers...and I said nothing because I don't need a hip replacement (yet);

Next they came for Rich people since they are the only ones that pay capital gains taxes...and I said nothing because (heyyyyy,wait a minute);

And then they came for The Pizza.  No really, they are coming after your pizza.  Apparantly one of the lesser noticed provisions of this gem of a statute (yes, savor the irony of being a lesser noticed provision in a law that no one bothered to read) is a menu labeling requirement that stands to increase costs by requiring restaurants to provide nutritional information to its customers.  My first thought here is OH FOR CRYING OUT LOUD IT'S PIZZA, IT'S NOT GOING TO BE HEALTHY!  I KNOW it's not going to be healthy that's why I order BEER with it.  I mean I would appreciate the food being free of assorted rodent parts but I really don't need to know what the precise food dye color in the pepperoni is or how many carbs there are in the delicious crust that holds all of the cholesterol laden mozzarella.  My second thought, however,  has to do with how the Pizza Police propose to enforce this "advice to consumers."  In these days of Internet search engines, online ordering and speedy delivery of this apparently dangerous culinary delight, you might think that online access to this information is exactly how we might want to communicate this critical information to the ultimate consumer.  But noooooooo, the FDA thinks it best to convey the data in the form of a giant poster that will scarcely be noticed next to the Pizza Special Coupons offering a free 2 liter soda (except for New York since you thirsty people are being "protected" by Mayor Bloomberg's apron strings).

Yes, well thanks Doc Obvious for the nutritional information.  Next you're going to tell me that beer is intoxicating, makes you gain weight and impairs your dancing ability.

I am warning you, if you touch my coffee, there's going to be a riot.



"Skedsvold, White & Wesley
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Monday, March 4, 2013

Is the IRS now in the business of running Health Insurance Companies?

Say-do you remember back when the insurance industry thought that the ACA was just a darned peachy idea?  The thought process was apparently that with coverage mandated, that the premium dollars were just going to roll in?    Not being a fan of  this legislative equivalent of three-card-monte, I would have thought that a RESPONSIBLE congressperson would have oh..., maybe..,read the flippin' thing and understood what was coming.  Instead, some preferred to "pass the bill so that we could, uh, see, uh what was in it."  It seems that everyday we find out just what this particular diaper holds (or fails to contain) and everyday we find out just how much a mess that we have to clean up.

Attentive readers may recall at the ACA contains far too many provisions that leave the actual work up to the discretion of an unelected (but oh so compassionate) government functionary.  The discretion, then, is where the rubber meets the road or more accurately, the stuff hits the fan.   In an earlier post, I described how the ACA has limited what a given carrier can charge without regard to the actual risk occasioned, how medical loss ratios must be a certain portion of the premium dollars in order to prevent the presumably greedy and evil carrier from paying executives too much or from denying too many claims or whatever nefarious activity the government has told us is verboten.  The practical effect is that the medical loss ratios create disincentive for carriers to be efficient, to be innovative or do anything since they've been told that if they don't pay out at least 80% of premium dollars, they owe refunds to their policyholders.   For a fuller explanation, see our <a href="http://www.blogger.com/blogger.g?blogID=1133353663305007639#editor/target=post;postID=5441960639964320616">post of 1/14/13 </a>
Not content with the imposition of "no profits for you" now the IRS HAS ginned up another winner, this time in proposed regulations designed to effectuate the ACA.  If it is not clear that Vice President Biden was serious when he predicted that the government would control the insurance companies, these proposed regulations should make patently obvious to even partisan observers that the Federal government considers these carriers little more than public utilities doing its bidding.   First, the HHS intends to charge fees to carriers that decide to participate in the exchanges.  The statute further provides for some pretty hefty fees for the premium earning carriers.  According to a 3/1/13 article in Lifehealthpro,com, Allison Bell notes:
"PPACA will require 'covered entities' that are 'engaged in the business of providing health insurance' to pay a total of $8 billion in "fee amount" in 2014, $11.3 billion in 2015 and 2016, $13.9 billion in 2017, and $14.3 billion in 2018. Starting in 2019, the fee amount will be the total for the previous year increased by the rate of premium growth for the preceding year, officials said."
These fees have to come from somewhere and usually the answer is to pass along the cost to the customer.  The IRS proposes to prevent that from happening by considering any fees recovered from the Insurer's client as regular income and not a deductible expense. Next, Ms. Bell notes "Elsewhere, officials observed that PPACA Section 9010(g)(4) strips the usual tax return confidentiality protection from the health insurer fee filing information."  Is it too late for these private for profit businesses to invoke the "it's none of your damned business clause of the US Constiution?
 Only now is the industry fighting back, and in such tepid fashion that its almost hard to feel sorry for them.  However, if we recall that they too were "rolled" in the machinations of the ACA's passage, maybe it's understandable.
On October 27, 1964 Ronald Reagan delivered a speech, entitled "A Time for Choosing" on behalf of Presidential Candidate Barry Goldwater.  This classic paean  to individual liberty was remarkably prescient and deserving of continued attention.   The most powerful indictment of the ACA was in fact delivered by Reagan in this 1964 address: "the full power of centralized government"--this was the very thing the Founding Fathers sought to minimize. They knew that governments don't control things. A government can't control the economy without controlling people. And they know when a government sets out to do that, it must use force and coercion to achieve its purpose. They also knew, those Founding Fathers, that outside of its legitimate functions, government does nothing as well or as economically as the private sector of the economy."

I think that is time for us, almost 50 years later, to choose.



"Skedsvold, White & Wesley
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Wednesday, February 20, 2013

More on the sinking of the USS Affordable Care Act

We've seen how the States are resisting the ACA by not setting up the State Sponsored Exchanges and by refusals to expand their Medicaid Rolls.  We've read about how business is defending itself against encroaching regulation by cutting full time workers to part time or by keeping their employee numbers under the magic 50 employee threshold. The built in assumption of the ACA, however, was that the insurance industry would be co-opted, caught by the Industry's own greed, into a warm embrace of this Faustian bargain.  That assumption, however, may not be realized.

In a 2/18/2013 Op/Ed on Forbes.com,Sally Pipes  President of the Pacific Research Institute throws a bit more cold water on the assumptions of Congress that the Insurance Industry would pocket the cash and hope for the best.  The full editorial can be found at http://www.forbes.com/sites/sallypipes/2013/02/18/obamacares-health-exchanges-are-customer-free-zones/

Health Insurance giants such as United Health and Aetna don't seem too enthused about the prospect of the premium dollars supposedly awaiting them.  "UnitedHealth Group has stated that it may participate in only 10 to 25 of the 100 or so markets in which it could be active. Aetna has identified 15 exchanges."

According to Ms. Pipes: When Vice President Joe Biden was asked before Obamacare became law whether insurance companies would go along with the president’s heavy-handed intervention in their business, he was blunt. 'You know we’re going to control the insurance companies,' he told ABC News. Maybe not. If insurers opt not to participate in Obamacare’s exchanges, the feds will lose control of their health reform effort — saddling consumers and taxpayers with higher costs."

Comments and Musings:

1) maybe we still have a few off ramps on the road to the single Payor system
2) if the Constitution was designed for protection of liberties (The House is the representative of the people, the Senate the protector of State prerogatives and the President the only nationally elected figure)  isn't working, at least we can count on the people themselves to decide what is best for them.


"Skedsvold, White & Wesley
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