Adam V. Russo | August 25, 2010
Coordination of Benefits Handbook
Alabama’s collateral source rule statute has been through a turbulent history since it was enacted in 1987. In 1996, the Alabama Supreme Court ruled that the statute violated the due process and equal protection guarantees of the Alabama Constitution. However, in 2000, the Alabama Supreme Court reversed its earlier decision holding that statute to be unconstitutional. A recent decision by a U.S. District Court in Alabama dealt with the complexities resulting from this turbulent history. The case is Shelley v. White, 2010 WL 1904043 (M.D. Ala., May 10, 2010). (more…)
Category: Alabama, Subrogation |
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Adam V. Russo | August 25, 2010
SIIA, www.siia.org
Oklahoma Tax on Paid Claims Ruled Unconstitutional
This afternoon, a recently enacted tax that would have applied to all claims paid in Oklahoma by health plans, was struck down by the Oklahoma Supreme Court.
Earlier this summer, the Oklahoma State Legislature passed a measure, subsequently signed into law by the Governor, which would have assessed a 1% tax on all health claims paid within the State. TPAs of self-insured health plans as well as stop-loss providers were to be taxable entities. (more…)
Category: Claims Procedures, Oklahoma |
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Adam V. Russo | August 25, 2010
SIIA, www.siia.org
Departments of Labor, Treasury and Health and Human Services Issue Enforcement Safe Harbor for Compliance of Mandated External Review Process
Federal agencies released a Technical Notice detailing safe harbor options for non-grandfathered self-insured plans to avoid non-compliance of the PPACA’s external review process requirement. (more…)
Category: PPACA |
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Adam V. Russo | August 16, 2010
By Norbert F. Kugele of Warner Norcross & Judd LLP, www.wnj.com
Back in February of 2009, many of us were somewhat taken aback to find HIPAA amendments in the economic stimulus bill. After months of delay, proposed regulations implementing these amendments – commonly known as the HITECH amendments – have finally arrived, and they contain a few surprises! Here’s a quick summary of some key provisions that will impact employer-sponsored health plans. (more…)
Category: HIPAA |
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Adam V. Russo | August 16, 2010
By Deborah J. Williamson of Warner Norcross & Judd LLP, www.wnj.com
A frequent question of physicians, medical practices and other providers I represent is whether the HIPAA Privacy Rule prohibits them from providing third-party payors with access to medical records for the purposes of an audit. In other words, does HIPAA prevent third-party payors from conducting post-payment audits? (more…)
Category: Claims Review, HIPAA, Third Party Administrators |
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Adam V. Russo | August 12, 2010
CCH® BENEFITS, www.hr.cch.com
California
The California Public Employee’s Retirement System (CalPERS) has approved an average increase of more than 9% in health premiums next year for state and local government workers. CalPERS blamed the rate increase on rising costs for hospital care, doctor visits, and prescriptions. The increase will mean higher premiums for public agencies and their 1.3 million employees, dependents, and retirees. For more information, visit http://www.calpers.ca.gov/. (more…)
Category: California, Connecticut, Health Care Legislation, Kansas, Louisiana, Maine, Massachusetts, New York, Ohio, Utah, Washington D.C., Wisconsin |
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Adam V. Russo | August 12, 2010
By Norbert F. Kugele of Warner Norcross & Judd LLP, www.wnj.com
If a patient asks you not to report treatment to his or her health plan, are you prepared to carry out that request?
HIPAA privacy regulations have always given individuals the right to request restrictions on how health care providers use or disclose their information, but until recently, health care providers have always had the discretion to say “no” to these requests. (more…)
Category: HIPAA |
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Adam V. Russo | August 11, 2010
Leaders of Cigna, Humana, UnitedHealth, WellPoint and Aetna received nearly $200 million in compensation in 2009, according to a report, while the companies sought rate increases as high as 39%.
By Noam N. Levey of the Los Angeles Times, www.latimes.com
The top executives at the nation’s five largest for-profit health insurance companies pulled in nearly $200 million in compensation last year — while their businesses prepared to hit ratepayers with double-digit premium increases, according to a new analysis conducted by healthcare activists. (more…)
Category: News |
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Adam V. Russo | August 10, 2010
CCH® BENEFITS, www.hr.cch.com
An interim final rule under the Health Information Technology for Economic and Clinical Health (HITECH) Act was published in the Federal Register on Aug. 24, 2009, and became effective on Sept. 23, 2009. (more…)
Category: HIPAA |
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Adam V. Russo | August 9, 2010
CCH® BENEFITS, www.hr.cch.com
Congress is relying on circular reasoning in its attempt to require all Americans to obtain health insurance, and the constitutionality of the Patient Protection and Affordable Care Act (PPACA) is questionable, according based in to attorney Jonathan W. Emord, principal of Emord & Associates, based in Clifton, VA. The following is an excerpt from a two-part interview conducted by CCH with Mr. Emord. The interview will appear in the two August editions of CCH’s Employee Benefits Management Directions newsletter. (more…)
Category: Health Care Legislation, PPACA |
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Adam V. Russo | August 6, 2010
By Richard Wolf, USA Today
WASHINGTON — Savings projected under the landmark health care law signed by President Obama this year have improved Medicare’s financial projections, but Republican critics and even the program’s chief actuary say the new prognosis is too rosy. (more…)
Category: Medicare |
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Adam V. Russo | August 5, 2010
Bryan Cave LLP, www.bryancave.com
The Departments of Treasury, Labor and Health & Human Services (the “Departments”) recently issued two more batches of interim final regulations under the Patient Protection and Affordable Care Act, as amended (the “Act”). This new guidance addresses (i) the preventive services coverage mandate, and (ii) the new internal claims and appeals and external review processes. Both sets of interim final regulations are effective for plan years beginning on or after September 23, 2010. Neither requirement applies to grandfathered group health plans. (more…)
Category: Claims Procedures, Claims Review, PPACA, Welfare Benefit Plans |
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Adam V. Russo | August 5, 2010
Tuesday, August 3rd, I had the pleasure of speaking at the 2010 TriZetto Benefits Administration Client Conference held at the Sheraton Chicago Hotel & Towers in Chicago, IL.
Click here to see my entire PowerPoint presentation on “Innovative Plan Document Strategies”.
Category: Summary Plan Description |
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Adam V. Russo | August 3, 2010
SIIA, www.siia.org
SIIA Submits Official Comments to Federal Agencies Regarding the Proposed Rule on Grandfathered Health Plans
SIIA was one of a select group of industry organizations who submitted official comments to the Federal agencies responsible for drafting and ultimately implementing regulations dealing with grandfathered health plans. The issued interim rule dealt with allowable modifications plans may make that will not jeopardize its status as a grandfathered health plan. (more…)
Category: Health Care Legislation, PPACA |
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Adam V. Russo | August 3, 2010
SIIA, www.siia.org
SIIA has protested to the Nevada attorney general against the state’s recent prohibition of insurance coverage issued by Alliance for Non-Profits for Insurance, Risk Retention Group (ANI), a SIIA member.
SIIA Chief Operating Officer Mike Ferguson wrote to Attorney General Catherine Cortez Mastro stating that the DOI ruling prohibiting ANI from issuing automobile liability coverage in the state discriminates against RRGs in a manner that is prohibited by federal law. (more…)
Category: Nevada |
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