It its recent decision on the Affordable Care Act (ACA), the Supreme Court ruled the requirement that individuals must have health care coverage or face a penalty was an allowable tax (rather than a penalty). But the Court decided the federal government couldn’t require states to expand existing Medicaid programs by planning to disqualify noncompliant states from Medicaid funding.
Here are a few ACA areas to watch for hematology and oncology:
Preventive services: If patients “have a new health insurance plan or insurance policy beginning on or after September 23, 2010,” certain preventive services must be covered when delivered by a network provider. For these services, the patient is not responsible for a copayment, co-insurance, or meeting the deductible. Early detection could mean an increase in oncology and hematology patients.
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According to the preventive services fact sheet at www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html, some of the covered services that may affect your oncology/hematology practice include:
- Colorectal cancer screening for adults over 50
- BRCA counseling about genetic testing for women at higher risk
- Mammography screenings every 1 to 2 years for women over 40
- Breast cancer chemoprevention counseling for women at higher risk
- Cervical cancer screening for sexually active women
- Hemoglobinopathies or sickle cell screening for newborns
- Iron supplements for children ages 6 to 12 months at risk for anemia.
Clinical trials: “This is the first federal law mandating group health plans (including new self-funded arrangements) and state-licensed health insurance issuers to cover the standard of care costs associated with participation in clinical trials,” according...
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