Adam V. Russo | July 28, 2010
By Jerry Geisel of Business Insurance, www.businessinsurance.com
WASHINGTON—New health care reform regulations clarify how health care plans must handle disputed claims, but leave murky a key issue: how a new federal external claims review requirement will work. (more…)
Adam V. Russo | July 26, 2010
By: Philip L. Gordon
The U.S. Department of Health and Human Services (HHS) published on July 14, 2010, a voluminous Notice of Proposed Rulemaking (NPRM), containing dozens of proposed amendments to three sets of Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations: the Privacy Rule; the Security Rule; and the Enforcement Rule. The proposed amendments are directed principally at implementing the Health Information Technology for Economic and Clinical Health Act (HITECH Act), which amended HIPAA and went into effect on February 17, 2010. A careful review of the NPRM for its impact on employers who sponsor HIPAA-covered plans reveals that, if the proposed changes were adopted, employers would be required to revise their business associate agreements, their HIPAA notice of privacy practices, and their policies for responding to access requests. The NPRM also provides employers with a roadmap for avoiding civil monetary penalties. (more…)
Adam V. Russo | July 26, 2010
Spencer’s Benefits Reports: The impact of the Patient Protection and Affordable Care Act on small group and individually purchased health insurance will depend upon many factors, according to a the Urban Institute’s recently issued paper, entitled How Will the PPACA Impact Individual and Small Group Premiums in the Short and Long Term? (more…)
Adam V. Russo | July 26, 2010
www.dwt.com; By Elizabeth J. Deckman
Health Care Reform: New Guidance on Patient Protections in Group Health PlansNew interim final rules address pre-existing condition exclusions, annual and lifetime limits, rescissions, and other patient protections
Recently, federal agencies issued new interim final rules to address several patient-protection provisions of health care reform. The new regulations provide guidance on pre-existing condition exclusions, annual and lifetime dollar limits, rescissions, and other patient protections. Generally, these requirements are effective with respect to insured and self-insured group health plans beginning with the first plan year commencing on or after Sept. 23, 2010 (Jan. 1, 2011, for calendar-year plans). (more…)
Adam V. Russo | July 23, 2010
www.larkinhoffman.com; by Bruce J. Douglas and Kelly M. Burke*
The big question on many people’s minds is where will the money come from to fund the deficit reduction and the Patient Protection and Affordable Care Act (PPACA). The Congressional Budget Office (CBO) estimates that the PPACA will cost $940 billion over the next 10 years. Even with the high cost of the PPACA, the CBO approximates that there will be a $143 billion reduction in the federal deficit over the next 10 years (2010-2019) and a $1.2 trillion reduction in the federal deficit in the 10 years following (2020-2029). (more…)
Adam V. Russo | July 23, 2010
www.hrpolicy.org
This week, the Departments of HHS, Labor and Treasury released interim final rules requiring group health plans and insurers to provide first-dollar coverage for certain recommended preventive items and services. The rules apply to non-grandfathered plans under the Patient Protection and Affordable Care Act (PPACA), providing additional clarity for companies that are in the process of weighing pros and cons of maintaining grandfathered status. The preventive services mandate takes effect for plan years beginning on or after September 23, 2010, or one year after an applicable recommendation or guideline is issued. In general, health plans must provide preventive benefits without cost-sharing for the following: (more…)
Adam V. Russo | July 23, 2010
By Steve Rasnick
I really don’t mean to pick on TPA’s because the same statement could be made for all businesses and business relationships, including insurance agents. In fact, I began to think of this issue as I focused on the fact that on 2/1/10 my TPA celebrated its 13th year of business in Southwest Florida. Thirteen wonderful years serving customers, many of whom who have been with me for all thirteen of those years; but why not all of them? Aren’t long term business relationships supposed to be like fine wines, getting better with age? Why have some of mine, and I would imagine some of yours, turned to vinegar over the years? I think that the answer is intriguing, and it is the pursuit of this answer that caused me to write an article which is only tangentially related to health insurance. (more…)
Adam V. Russo | July 23, 2010
The Self-Insurance Institute of America, Inc. (SIIA) applauded today’s directive by Rep. Dennis Moore (D-KS) to the Government Accountability Office (GAO) that it investigate abuses of federally sanctioned risk retention groups (RRGs) by some state insurance regulators.
Rep. Moore, chairman of the Oversight Committee on Financial Services, directed the GAO to study instances when non-domiciliary states attempt to improperly regulate the operation of RRGs through such tactics as “cease and desist” orders, onerous filing requirements, imposition of fees, waiting periods, information requests or other means. (more…)
Adam V. Russo | July 20, 2010
HCAA, www.hcaa.org
Long-awaited regulations under the grandfather provisions of Section 1251 of the Patient Protection and Affordable Care Act (PPACA) were formally issued by the Departments of Health and Human Services, Treasury and Labor (the “agencies”) on June 14, 2010. The regulations are in the form of an interim final rule, and are effective immediately. They were published in the Federal Register on June 17, 2010. Comments on the regulations are due 60 days after publication in the Federal Register. (more…)
Adam V. Russo | July 20, 2010
By Daran P. Keifer, Kreiner & Peters Co.
2009 was a rough year for subrogation rights in the United States, as we saw many more bills across the various states and even in Congress, which sought to undermine or eliminate subrogation rights. NASP continues to expand its influence as the premier resource for education about “subrogation” and its importance to society. Your Amicus Committee’s efforts in various states prompted other organizations to consult and rely on NASP for education about the vital role subrogation plays. The first quarter of 2010 continued the frenetic pace at which states sought to restrict subrogation rights while strengthening NASP position within the insurance community. (more…)
Adam V. Russo | July 19, 2010
More and more small and midsize companies are looking to get off the insurance grid and cover their own employee health-care claims.
By Alix Stuart, www.CFO.com
Want to save money on health-care insurance? Try this strategy: stop buying it.
While self-insurance is nothing new to large companies — some 90% of those with more than 5,000 employees have been doing it for years — a growing number of smaller companies are self-insuring to cut co sts. According to data collected by PricewaterhouseCoopers, the percentage of employers with fewer than 1,000 people in their health-care programs that self-insure has almost doubled, from 29% in 2008 to 48% in 2010. (more…)
Adam V. Russo | July 19, 2010
CCH® BENEFITS, www.hr.cch.com
On July 1, the Employee Benefit Security Administration provided a temporary safe harbor for outpatient mental health benefit provisions that commonly require a copayment for office visits (for example, physician or psychologist visits) but coinsurance for other outpatient services (for example, outpatient surgery, facility charges for day treatment centers, laboratory charges, or other medical items). (more…)
Adam V. Russo | July 19, 2010
Health Net of Connecticut, Inc. agreed to pay $250,000 to resolve a HIPAA privacy lawsuit by the state of Connecticut that was the first to be filed under HIPAA’s recently added state enforcement powers. Connecticut Attorney General Richard Blumenthal had sued Health Net in January over a major data breach that the insurer suffered in May 2009. (more…)
Adam V. Russo | July 15, 2010
HCAA, www.hcaa.org
Fact Sheet: Keeping the Health Plan You Have: The Affordable Care Act and “Grandfathered” Health Plans
The Affordable Care Act gives American families and businesses more control over their health care by providing greater benefits and protections for family members and employees. It also provides the stability, and also the flexibility, that families and businesses need to make the choices that work best for them. (more…)
Adam V. Russo | July 15, 2010
SIIA, www.siia.org
Departments of Labor, Treasury and Health and Human Services Jointly Release Interim Final Rule on Coverage of Preventative Services
The Departments of Labor, Treasury and Health and Human Services this afternoon jointly released an interim final rule on requirements to cover preventative services. (more…)
