HR3200/Section 132

I would like to post part of my reply to Elizabeth of yesterday. She has been very helpful in supplying information regarding the Congress's Health Care Bill. I have read all the articles and in some instances agree in kind. Some authors are known to be or professed "far left". They have their right to express their opinion also. That is what makes this the greatest country on Earth.

My partial response:

.....it was a good article from a used to be insider. I firmly believe no one wants anybody to do with out health care. For me that would be against my beliefs and morals. What I don't want is to pay for some schmuck that won't get a job or keep a job to help himself and help pay for his/her own insurance.

What I don't want is another Medicare/Medicaid entitlement!

On with:

SEC. 132. REQUIRING FAIR GRIEVANCE AND APPEALS MECHANISMS.

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(a) In General- A QHBP offering entity shall provide for timely grievance and appeals mechanisms that the Commissioner shall establish.CommentsClose CommentsPermalink


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(b) Internal Claims and Appeals Process- Under a qualified health benefits plan the QHBP offering entity shall provide an internal claims and appeals process that initially incorporates the claims and appeals procedures (including urgent claims) set forth at section 2560.503-1 of title 29, Code of Federal Regulations, as published on November 21, 2000 (65 Fed. Reg. 70246) and shall update such process in accordance with any standards that the Commissioner may establish.CommentsClose CommentsPermalink



(c) External Review Process-CommentsClose CommentsPermalink



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(1) IN GENERAL- The Commissioner shall establish an external review process (including procedures for expedited reviews of urgent claims) that provides for an impartial, independent, and de novo* review of denied claims under this division.CommentsClose CommentsPermalink



(2) REQUIRING FAIR GRIEVANCE AND APPEALS MECHANISMS- A determination made, with respect to a qualified health benefits plan offered by a QHBP offering entity, under the external review process established under this subsection shall be binding on the plan and the entity.CommentsClose CommentsPermalink




(d) Construction- Nothing in this section shall be construed as affecting the availability of judicial review under State law for adverse decisions under subsection (b) or (c), subject to section 151.




On its face this sounds like a very, very good section of the bill. Unfortunately as with anything written by an attorney/legislator one must look deeply into the wording. Being a retired union member but, not very pro union, I like anything that has a grievance and appeals policy.

1(a) In General- A QHBP offering entity shall provide for timely grievance and appeals mechanisms that the Commissioner shall establish.

Who is establishing the "timely grievance and appeals mechanisms"? The QHBP or the Commissioner? This sentence says both. Could/would someone in Congress please explain this to me?

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(b) Internal Claims and Appeals Process- Under a qualified health benefits plan the QHBP offering entity shall provide an internal claims and appeals process that initially incorporates the claims and appeals procedures (including urgent claims)

Great! An appeals process is established (by someone) that will address even "urgent claims". Would someone in Congress please explain what "urgent is". As many of you know my wife passed away a short 5 months ago. Due to the rapid spreading of the Cancer she applied for Disability under some section of Social Security. An appointment was set and she was granted benefits within 3 weeks. We felt the situation was urgent and apparently so did the lady who helped with the paperwork. We felt a little less than disappointed when the lady said my wife would have to wait for 6 months to receive her first disability check. Being a Christian two income family we were still very thankful she would be receiving some funds in 6 months. She passed away March 30,2009.

Her first check was due on or about April 10,2009. Needless to say that check never hit the bank. The Federal government stopped payment on it within approximately 48 hours of her death certificate being issued. Is that the way "urgent claims" are going to be processed? Could/would someone in Congress please explain this to me?

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Nothing in this section shall be construed as affecting the availability of judicial review under State law for adverse decisions under subsection (b) or (c), subject to section 151.

When was the last time you heard of some poor schmuck suing and winning against the Federal Government. In my life time NEVER!!!

What troubles me most about Congress's bill is two fold. A. No where in the bill does it say "everyone without health insurance will get health insurance". Isn't that what this was suspose to be about, health care for ALL Americans. B. The cost. This bill will take $500 million from Medicare to help pay for it. What happens to the Medicare recipients? My dad called that, "robbin' Peter to pay Paul" Say what you will but I call it rationing health care to Medicare recipients.

Finally, "the Commissioner shall" this phrase is used so many times in this bill I quit counting. Just who is this "commissioner", what are his qualifications, how does he get this job, will he be cabinet level or another CZAR? There are just too many loopholes in this bill to pass any form of it.

Let's all just take a deep breath, relax, and start over with "we the people" in mind, not we the Congress.

*Law Encyclopedia: De Novo Top

Home > Library > Law & Legal Issues > Law Encyclopedia

This entry contains information applicable to United States law only.

[Latin, Anew.] A second time; afresh. A trial or a hearing that is ordered by an appellate court that has reviewed the record of a hearing in a lower court and sent the matter back to the original court for a new trial, as if it had not been previously heard nor decided.

Let's all take a deep breath and relax.

Debate has been hot and heavy regarding the Congresses proposed health care reform. Let's all take a deep breath and relax with a little funny I am sure both sides can enjoy. We shall take up heated discussion next week.

Have a great weekend!

Pops

Subject: The Proposed US Healthcare Plan

The American Medical Association has weighed in on the new healthcare plan.

The Allergists voted to scratch it, but the Dermatologists advised not to
make any rash moves. The Gastroenterologists had sort of a gut feeling
about it, but the Neurologists thought the Administration had a lot of
nerve.

The Obstetricians felt they were all laboring under a misconception.
Ophthalmologists considered the idea shortsighted. Pathologists yelled,
"Over my dead body!" while the Pediatricians said, 'Oh, Grow up!'

The Psychiatrists thought the whole idea was madness, while the
Radiologists could see right through it. Surgeons decided to wash their
hands of the whole thing. The Internists thought it was a bitter pill to
swallow, and the Plastic Surgeons said, "This puts a whole new face on the
matter."

The Podiatrists thought it was a step forward, but the Urologists were
pissed off at the whole idea. The Anesthesiologists thought the whole idea
was a gas, and the Cardiologists didn't have the heart to say no.

In the end, the Proctologists won out, leaving the entire decision up to
the assholes in Washington.

THIS IS OUTRAGE...OUS ! ! !

OUTRAGE....OUS #1

Although my liberal friends/associates may disagree and, that is their right, the OUTRAGEOUS behavior from the Democrats on "the hill" is not only outrageous but unconscionable. I am referring to the letters house Democrats sent out to high paid, profitable, insurance executives. These letters requested financial records on approximately 20 insurance companies and their highest paid executives. Isn't it strange that the very insurance companies being ask for their financial records are the very insurance companies that oppose the current health care reform package.

OUTRAGE.....OUS # 2

To me this is about as low as you can go in politics and some things that have happened in the past have been pretty low. Today, the President of the United States crossed over the line for me. He openly (I'll give him credit for that) pleaded to church leaders, Pastors, Rabbis and Ministers to take "HIS" health care plans to the pulpit! He doesn't HAVE a health care plan. He has let Nancy Pelosi do his dirty work.

I say it now and say it loud any clergy who pushes ANY, I mean ANY politics from the pulpit is NOT a Man of the Cloth. The pulpit is for preaching the word of G-d and Jesus Christ O N LY ! ! !

Mr President have you no soul or is there no level you will stoop to to fulfill your OUTRAGE...OUS EGO? This line isn't even worth hi-liting!

GOD HELP AMERICA

Canada's Health Care "IMPLODING"

Monday, August 17, 2009

Dr. Anne Doig, the incoming president of the Canadian Medical Association, said her country’s health care system is “sick” and “imploding,” the Canadian Press reported.

'Nuff said!

HR3200/Section 208

While all the TV pundits are hyping their favorite sections of this moronic government bill I am more concerned with sections such as this one. IMHO, this is quietly stealing the power from the states and giving it to the Federal government. Thereby diluting the power and sovrenty of the states as The Constitution, so well thought our, attempts to preserve.

The problem with this is in the first and last lines of the section.

SEC. 208. OPTIONAL OPERATION OF STATE-BASED HEALTH INSURANCE EXCHANGES.

(a) In General- If--CommentsClose CommentsPermalink





(1) a State (or group of States, subject to the approval of the Commissioner) applies to the Commissioner for approval of a State-based Health Insurance Exchange to operate in the State (or group of States); andCommentsClose CommentsPermalink



(2) the Commissioner approves such State-based Health Insurance Exchange,CommentsClose CommentsPermalink




then, subject to subsections (c) and (d), the State-based Health Insurance Exchange shall operate, instead of the Health Insurance Exchange, with respect to such State (or group of States). The Commissioner shall approve a State-based Health Insurance Exchange if it meets the requirements for approval under subsection (b).CommentsClose CommentsPermalink




(b) Requirements for Approval- The Commissioner may not approve a State-based Health Insurance Exchange under this section unless the following requirements are met:CommentsClose CommentsPermalink




(1) The State-based Health Insurance Exchange must demonstrate the capacity to and provide assurances satisfactory to the Commissioner that the State-based Health Insurance Exchange will carry out the functions specified for the Health Insurance Exchange in the State (or States) involved, including--CommentsClose CommentsPermalink




(A) negotiating and contracting with QHBP offering entities for the offering of Exchange-participating health benefits plan, which satisfy the standards and requirements of this title and title I;CommentsClose CommentsPermalink




(B) enrolling Exchange-eligible individuals and employers in such State in such plans;CommentsClose CommentsPermalink




(C) the establishment of sufficient local offices to meet the needs of Exchange-eligible individuals and employers;CommentsClose CommentsPermalink




(D) administering affordability credits under subtitle B using the same methodologies (and at least the same income verification methods) as would otherwise apply under such subtitle and at a cost to the Federal Government which does exceed the cost to the Federal Government if this section did not apply; andCommentsClose CommentsPermalink




(E) enforcement activities consistent with federal requirements.CommentsClose CommentsPermalink




(2) There is no more than one Health Insurance Exchange operating with respect to any one State.CommentsClose CommentsPermalink




(3) The State provides assurances satisfactory to the Commissioner that approval of such an Exchange will not result in any net increase in expenditures to the Federal Government.CommentsClose CommentsPermalink




(4) The State provides for reporting of such information as the Commissioner determines and assurances satisfactory to the Commissioner that it will vigorously enforce violations of applicable requirements.CommentsClose CommentsPermalink




(5) Such other requirements as the Commissioner may specify.

(a) In General- If--CommentsClose CommentsPermalink



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(1) a State (or group of States, subject to the approval of the Commissioner) applies to the Commissioner for approval of a State-based Health Insurance Exchange to operate in the State (or group of States); andCommentsClose CommentsPermalink



(2) the Commissioner approves such State-based Health Insurance Exchange,CommentsClose CommentsPermalink




then, subject to subsections (c) and (d), the State-based Health Insurance Exchange shall operate, instead of the Health Insurance Exchange, with respect to such State (or group of States). The Commissioner shall approve a State-based Health Insurance Exchange if it meets the requirements for approval under subsection (b).CommentsClose CommentsPermalink




(b) Requirements for Approval- The Commissioner may not approve a State-based Health Insurance Exchange under this section unless the following requirements are met:CommentsClose CommentsPermalink




(1) The State-based Health Insurance Exchange must demonstrate the capacity to and provide assurances satisfactory to the Commissioner that the State-based Health Insurance Exchange will carry out the functions specified for the Health Insurance Exchange in the State (or States) involved, including--CommentsClose CommentsPermalink




(A) negotiating and contracting with QHBP offering entities for the offering of Exchange-participating health benefits plan, which satisfy the standards and requirements of this title and title I;CommentsClose CommentsPermalink




(B) enrolling Exchange-eligible individuals and employers in such State in such plans;CommentsClose CommentsPermalink




(C) the establishment of sufficient local offices to meet the needs of Exchange-eligible individuals and employers;CommentsClose CommentsPermalink




(D) administering affordability credits under subtitle B using the same methodologies (and at least the same income verification methods) as would otherwise apply under such subtitle and at a cost to the Federal Government which does exceed the cost to the Federal Government if this section did not apply; andCommentsClose CommentsPermalink




(E) enforcement activities consistent with federal requirements.CommentsClose CommentsPermalink




(2) There is no more than one Health Insurance Exchange operating with respect to any one State.CommentsClose CommentsPermalink




(3) The State provides assurances satisfactory to the Commissioner that approval of such an Exchange will not result in any net increase in expenditures to the Federal Government.CommentsClose CommentsPermalink




(4) The State provides for reporting of such information as the Commissioner determines and assurances satisfactory to the Commissioner that it will vigorously enforce violations of applicable requirements.CommentsClose CommentsPermalink




(5) Such other requirements as the Commissioner may specify.




The Commissioner is appointed by the Presidential Czar who is at the beck and call of the President. This circumventing of the Constitution again, IMHO.

HR3200/Section 207

I invite you to read Section 207 of the Health Care Bill.

Please note this Administration is attempting to change the moniker to Health Insurance Bill. It is said Americans identify the insurance industry as "big bad guys". This is so very childish it is almost unbelievable. It reminds me of the administration trying to change the word of Terrorist to something like non-natural-disaster. Please give me a break. The American Public is NOT that stupid.

My concerns regarding this section are listed below Section 207

Installment 2

SEC. 207. HEALTH INSURANCE EXCHANGE TRUST FUND.

(a) Establishment of Health Insurance Exchange Trust Fund- There is created within the Treasury of the United States a trust fund to be known as the ‘Health Insurance Exchange Trust Fund’ (in this section referred to as the ‘Trust Fund’), consisting of such amounts as may be appropriated or credited to the Trust Fund under this section or any other provision of law.CommentsClose CommentsPermalink

(b) Payments From Trust Fund- The Commissioner shall pay from time to time from the Trust Fund such amounts as the Commissioner determines are necessary to make payments to operate the Health Insurance Exchange, including payments under subtitle C (relating to affordability credits).CommentsClose CommentsPermalink

(c) Transfers to Trust Fund-CommentsClose CommentsPermalink

(1) DEDICATED PAYMENTS- There is hereby appropriated to the Trust Fund amounts equivalent to the following:CommentsClose CommentsPermalink

(A) TAXES ON INDIVIDUALS NOT OBTAINING ACCEPTABLE COVERAGE- The amounts received in the Treasury under section 59B of the Internal Revenue Code of 1986 (relating to requirement of health insurance coverage for individuals).CommentsClose CommentsPermalink


(B) EMPLOYMENT TAXES ON EMPLOYERS NOT PROVIDING ACCEPTABLE COVERAGE- The amounts received in the Treasury under section 3111(c) of the Internal Revenue Code of 1986 (relating to employers electing to not provide health benefits).CommentsClose CommentsPermalink



(C) EXCISE TAX ON FAILURES TO MEET CERTAIN HEALTH COVERAGE REQUIREMENTS- The amounts received in the Treasury under section 4980H(b) (relating to excise tax with respect to failure to meet health coverage participation requirements).CommentsClose CommentsPermalink

(2) APPROPRIATIONS TO COVER GOVERNMENT CONTRIBUTIONS- There are hereby appropriated, out of any moneys in the Treasury not otherwise appropriated, to the Trust Fund, an amount equivalent to the amount of payments made from the Trust Fund under subsection (b) plus such amounts as are necessary reduced by the amounts deposited under paragraph (1).

NOTE:
A couple things

It calls for a tax,
It calls for a tax,
It calls for a tax,
I calls for money "not otherwise appropriated" to to cover "GOVERNMENT CONTRIBUTIONS". This country is all ready over 2 T, That's T for Trillion dollars in debt. In my mind there is no such thing as unappropriated money!

Call you Congressman/Congresswoman today! Tell them to just say NO to this and all Health Care Reform until we have a balanced budget.

Link: http://www.opencongress.org/bill/111-h3200/text?version=ih&nid=t0:ih:184


CommentsClose Comments

HR 3200 Section 1233

As readers of my blog you have known for quite a while I am a believer in smaller more efficient government. For the next several weeks I will be posting specific sections of House Bill 3200. The sections will be my objections to the passage of this bill and any bill that attempts to add another Government Entitlement to an all ready bankrupt budget. This current Congress is totally and completely irresponsible regarding what Americans want.

I give you House Bill 3200

Advance Care Planning Consultation

`(hhh)(1) Subject to paragraphs (3) and (4), the term `advance care planning consultation' means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:

`(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

`(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

`(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.

`(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

`(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

`(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include--

`(I) the reasons why the development of such an order is beneficial to the individual and the individual's family and the reasons why such an order should be updated periodically as the health of the individual changes;

`(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and

`(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).

`(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State--

`(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and

`(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).

`(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--

`(I) ensures such orders are standardized and uniquely identifiable throughout the State;

`(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional's authority under State law) may sign orders for life sustaining treatment;

`(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and

`(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.

Is Barack REALLY a U.S. Citizen

A story that continues to haunt this administration is the one about whether President Obama is really a natural born American. It reminds me of John Kerry's military record. If you have it why don't you show it and put this story to rest. Well I am not a conspiracy fan however, I would feel more comfortable knowing somehow President Obama is legally the President of our country.

For the full story clik on World Net Daily, now!

Have a nice day.

Health Care Bill Update

Short, sweet and to the point!!!

The Patriot Depot has listed two sites for the NON HEALTH CARE BILL. It has 2 health care sections listed on it. The first is an overview, the second is the entire health bill being proposed. I suggest you read the first. Find your concerns and then go to the second. Copy your concerns. Next go down on the page to the elected officials, find your and paste your concerns in their Contact Me Section. Then send it to him/her. It's very easy. It's just like Life Cereal. Try it, you'll like it.Clik HERE to review a synopsis of this NON-HEALTH CARE BILL. Clik here to read the sections you have concerns with.

This bill needs stopped. PERIOD.

I would have you do one other task. Send these web sites (or my blog address)to your friends and ASK, PLEAD, go down on bended knee and BEG them to contact their Elected Officials regarding the audacity of them to even consider such a mess! Folks we are talking about 1/6 of the GNP of this country. This Administration and/or Congress can't even manage the Medicare System, or a paltry $1Billion "Cash for Clunkers" give away.

Thank you.