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Archives for June 2012

U.S. Supreme Court’s Reasoning in Upholding Required Health Insurance Is Questionable

Yesterday the U.S. Supreme Court upheld the Patient Protection and Affordable Care Act.  While some of the media’s “talking heads” may say they were not surprised by the decision few, if any, can say that they were not surprised by the Court’s reasoning in upholding the Act’s most controversial element requiring most Americans to have “minimum essential” health insurance.

The High Court accepted the government’s secondary argument that what the Act calls a “penalty” against Americans that do not obtain the required insurance is valid on a tax since the penalty is to be paid to the IRS and varies based on income.  At first blush is seems like taxes are levied against Americans that make a choice to take an action like purchase a good, own land or live in a particular state, as opposed to choosing not to do something like the purchasing of insurance contemplated in the Act.

Writing for the majority, Chief Justice Roberts framed the tax analysis under the premise that a number of people would opt to pay the penalty rather than pay for health insurance.  The Court repeatedly refers to the penalty as a “payment” rather than a “fine” or “penalty” (as it is referred to in the legislation) to emphasize its point that the penalty is not punitive.  Roberts wrote that “The payment is not so high that there is really no choice but to buy health insurance; the payment is not limited to willful violations, as penalties for unlawful acts often are; and the payment is collected solely by the IRS through the normal means of taxation.”

Chief Justice Roberts went on to explain that “[N]either the Affordable Care Act nor any other law attaches negative legal consequences to not buying health insurance, beyond requiring a payment to the IRS.” He particularly stressed that “Congress’s choice of language…does not require reading §5000A as punishing unlawful conduct. It may also be read as imposing a tax on those who go without insurance.”

We have concerns whether the Court’s characterization of the penalty as a tax will  act as an instruction manual for greater government control over citizens’ inaction simply by characterizing penalties as taxes in any legislation.

 

 

Tips on How to Request Medicaid Hearings in Georgia (Part II of III)

This post is the second in a three part series about how to request Medicaid Hearings in Georgia.Georgia Medicaid Hearing

Planning and preparing is always important, but the one of most important steps is making sure your Request for Hearing is submitted to the Department on time.

Once a hearing has been requested, it becomes even more important to make sure you have a plan in place.

• Providers can represent members at hearings (federal law)

• Get written authorization to represent

• Ask “Why” 10x. . . And then ask 10x more! (Then “how” and “what”)

• Rates can be provider or member appeals

• Meet all deadlines for filing

• Ask for all documents to be used by the other side at the hearting (subpoena)

• Make the state prove each piece of its reduction/denial

Here are some tools that you can leverage during this process:

Subpoenas

  • Can subpoena documents or people
  • Must be reasonable to the case
  • Can get form from OSAH
  • Must be served by certified or registered mail 5 days before hearing
  • See OSAH Rule 19

 

Request a Pre-hearing conference with ALJ

  • Request a Pre-hearing Order
  • Exhibit exchange
  • Witness lists

 

One of the best ways to help you navigate through this process is to engage a lawyer that specializes in healthcare, specifically Medicaid Hearings to help ensure the best possible outcome.

Next week, we’ll post the final tips segment on how to request Medicaid Hearings. www.jeylaw.com 

Tips on How to Request Medicaid Hearings in Georgia (Part I of III)

Jeyaram & AssociatesGeorgia’s Medicaid system has been the subject of numerous television reports and newspaper articles recently.  However, one Medicaid topic that usually does not receive enough attention is the appeals process.  We are devoting the next several blog posts to information about the Medicaid appeals process as it relates to members and providers.  The first in our three part series is how to request an appeals hearing if you’re a healthcare provider in Georgia.

Following are steps on how to request an appeals hearing:

The Department of Community Health (DCH) must receive the request within 30 days from when the administrative decision was received by the member.

Request must be in writing and include the following:

– That you want a hearing

– A copy of the administrative decision issued by the Department

– Evidence as to why the Department’s decision is incorrect

– Declaration of what the Department’s decision should be

If you do not raise an issue in your administrative review, it is considered waived

Filing a request for hearing will not delay the Department from enforcing its decision.