Anti-markup rule delayed by CMS

The Centers for Medicare and Medicaid Services has decided to delay for one year the application of an “anti-markup” provision that primarily affects groups that purchase interpreting services, such as the reading of X-rays and MRIs.CMS delayed the application of the rule until Jan. 1, 2009, due to confusion over the application of the rule and to give providers more time to comply, said Meghan Cosgrove, a health law attorney who practices with Donoghue, Barrett & Singal in Boston.

The rule prevents relevant entities from marking up the cost of reading X-rays and MRIs and profiting from the difference between the purchase price and the Medicare reimbursement rate.

However, the provision would not apply to services provided on-site in an office where the physician provides a full range of services, and the payment is basically reassigned.

Wellness programs can’t discriminate based on health

The U.S. Department of Labor has decided that programs that reward employees for exercising or not smoking could violate the Health Insurance Portability and Accountability Act if employers do not offer alternatives for workers unable to participate because of health factors.

HIPAA requires health plans to charge the same price for insurance regardless of preexisting conditions or other health factors. It exempts supplemental benefits such as wellness programs. The extra benefits must be provided under a separate policy and fill gaps in primary coverage.

According to AMNews, the department discovered that some insurance companies were issuing supplemental policies with lower deductibles for individuals who had healthy lifestyles, such as non-smokers or people with normal blood pressure, said Sharon Cohen, an attorney and health care benefits expert in Arlington, Va.

The department issued a Field Assistance Bulletin late last year that set new requirements for supplemental policies.

To comply with the bulletin, employers and insurers must offer reasonable alternatives for individuals who cannot qualify for a wellness incentive because of a health condition, Cohen told AMNews.

She added that violators face monetary penalties, and a harmed individual could take a separate action under federal pension law.