cmonfils | January 27, 2011

National Health Policy Forum www.nhpf.org

Kathryn Linehan, Principal Policy Analyst

OVERVIEW — The Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care Education Reconciliation Act of 2010 makes landmark changes to health insurance markets. Individual and small-group insurance plans and markets will see the biggest changes, but PPACA also affects large employer and self-insured plans by imposing rules for benefit design and health plan practices. Over half of workers—most often those in very large firms—are covered by self-insured health plans in which employers (or employee groups) bear all or some of the risk of providing insurance coverage to a defined population of workers and their dependents. As PPACA provisions become effective, some have argued that smaller firms that offer insurance may opt to self-insure their health benefits because of new small-group market rules. Such a shift could affect risk pooling in the small-group market. This paper examines the definition and prevalence of self-insured health plans, the application of PPACA provisions to these plans, and the possible effects on the broader health insurance market, should many more employers decide to self-insure. (more…)

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cmonfils | January 27, 2011

I have just received this information from a TPA client. Please check out the bolded language on how PPO’s are trying to dictate plan terms and claims process.

Eligibility Verification. Client shall maintain during normal business hours a procedure for prompt verification of a Covered Person’s enrollment in a Benefit Plan. Client will use best efforts to provide current eligibility/compensability information to Contract Providers. Notwithstanding, the parties agree that: (a) verification of eligibility is not a guarantee of benefits and (b) benefits for Covered Services shall be paid in accordance with the provisions of the applicable Benefit Plan. Client agrees that after confirmation by Contract Provider of a Covered Person’s eligibility, Client may not deny payment for Covered Services performed under the terms of this Agreement which are medically necessary.

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cmonfils | January 27, 2011

January 26, 2011 – SIIA lobbyists this week met with senior staff members of the House Oversight Committee to discuss anticipated hearings focused on the Patient Protection & Affordable Care Act (PPACA), and more specifically how SIIA can be involved in this process. (more…)

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cmonfils | January 27, 2011

www.siia.org

January 27, 2011 – SIIA today announced that it has confirmed lead sponsors for federal legislation intended to modernize the Liability Risk Retention Act (LRRA). Senator Jon Tester (D-MT) will introduce the bill in the U.S. Senate while Rep. John Campbell (R-CA) has committed to take the lead in the House of Representatives.

This will be a reintroduction of SIIA-backed LRRA legislation that was considered in the House last year but failed to attract a sponsor in the Senate. (more…)

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cmonfils | January 25, 2011

Union of Tufts, Harvard Pilgrim would pose a stronger Mass. competitor to Blue Cross

http://www.boston.com/business/healthcare/articles/2011/01/25/tufts_harvard_pilgrim_explore_merger/?p1=News_links

By Robert Weisman and Kay Lazar

Globe Staff / January 25, 2011

The state’s second- and third-largest health plans, Harvard Pilgrim Health Care and Tufts Health Plan, are set to tell their employees today that they are exploring a merger that would reshape the region’s health insurance landscape.

Harvard Pilgrim and Tufts are close to signing a memorandum of understanding that would combine their operations in four New England states and make them a stronger competitor to the market leader, Blue Cross Blue Shield of Massachusetts, in their home state, according to several people who have been briefed on the transaction. They asked not to be identified because they were not authorized to discuss the deal. (more…)

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cmonfils | January 25, 2011

http://www.rapidcityjournal.com/article_9921b66e-2767-11e0-8296-001cc4c03286.html

State legislators have begun the work of complying with the Patient Protection and Affordable Care Act.

In at least two Senate bills being considered in the 2011 Legislative session, technical changes to current state regulations are being considered.

Senate bills 43 and 38, both introduced by the Committee on Commerce, would change state statutes that regulate insurance companies, said Randy Moses of the South Dakota Division of Insurance. (more…)

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cmonfils | January 25, 2011

http://www.leagle.com/xmlResult.aspx?xmldoc=In%20FCO%2020110118108.xml&docbase=CSLWAR3-2007-CURR

JOHNSON CONTROLS, INC. v. FLAHERTY

JOHNSON CONTROLS, INC., in its capacity as fiduciary for the Johnson Controls, Inc. Welfare Plan, Plaintiff-Appellee,v.DANIEL J. FLAHERTY, METNICK, LEVY & LONG, P.A., Defendants-Appellants. (more…)

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cmonfils | January 25, 2011

MyHealthGuide Source:

• Definitions, Rules, More from Equal Employment Opportunity Commission, 1/20/2011

• Regulations Under the Genetic Information Nondiscrimination Act of 2008

• Q & A – EEOC Final Rule on Title II of GINA

On January 10, 2011, the final regulations under Title II of the Genetic Information Nondiscrimination Act (GINA II), which were issued by the Equal Employment Opportunity Commission, went into effect. The new regs apply to employers and prohibits the use of genetic information in employment, restricts employers from requesting, requiring, or purchasing genetic information, and strictly limits the disclosure of genetic information. (more…)

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cmonfils | January 25, 2011

MyHealthGuide Source: Bloomberg, 11/18/2011, Business Insurance Article

Case: Commonwealth of Virginia vs. Sebelius, 10-cv-00188, U.S. District Court, Eastern District of Virginia (Richmond).

WASHINGTON –The United States asked a federal appeals court to overturn a Virginia judge’s ruling that the Obama administration’s health care overhaul is unconstitutional because it requires some Americans to buy health insurance.

The government filed a notice of appeal Tuesday with U.S. District Judge Henry Hudson, who struck down the linchpin of President Barack Obama’s health care legislation, finding its insurance mandate beyond Congress’s power to regulate interstate commerce. (more…)

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cmonfils | January 25, 2011

MyHealthGuide Source:

Timothy K. Lake, Kate A. Stewart, Paul B. Ginsburg, January 2011, NIHCR Research Brief No. 2

Referred by Erica Massey, Self-Insured Institute of America (SIIA)

Editor’s Note: ACOs are currently targeted at Medicare patients. However, the concept is reminiscent of the original HMO mission and ACOs could provide a medical management system consideration for self-funded employers.

Accountable Care Organizations (ACOs) are organized groups of physicians, hospitals or other providers jointly accountable for caring for a defined patient population. The goals are: (more…)

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cmonfils | January 25, 2011

MyHealthGuide Source: Stacy Johnson, MoneyTalkNews, 9/12/2010, MTN Article

Referred by Drew Ben-Aharon, MD Live Care, 1/19/2011

Checkups over a computer are becoming more popular especially if you’re sick of wasting time and money in a waiting room.

• In Maryland, an 87-year-old woman wakes up each morning and takes her blood pressure in her apartment by slipping her arm through a collar hooked up to a computer — which sends the results straight to her doctor.

• In Utah, a family therapist meets online with a mother who’s children are acting out and offers counseling.

• In Hawaii, a 59-year-old nurse with an infected cut on her arm sits at her computer to chat with a doctor and get a prescription for antibiotics.

Survey findings (more…)

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cmonfils | January 25, 2011

www.nasp.com

Oregon—Senate Bill 372

The Oregon Senate has just introduced a bill that attempts to codify the “made whole” doctrine for personal injury protections (“PIP”) benefits. As we have witnessed in many other states, the language in the bill is unclear, vague and confusing.

Oregon’s current law, ORS 742.544, allows for a property and casualty carrier to be reimbursed for personal injury protection benefits only if the recovery exceeds “economic” damages. The proposed amendment would remove the word “economic” from the current law as follows: (more…)

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cmonfils | January 20, 2011

www.boston.com

By Matt Viser and Mark Arsenault    Globe Staff / January 19, 2011

WASHINGTON — A health care repeal vote expected today will send a highly symbolic political message — the icing on the midterm elections that gave Republicans control of the House — but the GOP’s effort to undermine the rollout of the contentious measure and put its own imprint on health care will probably hinge on smaller attempts to change the law.

The complete legislative repeal that House Republicans are promising to pass today is all but doomed, because the Democrats who still control the Senate have said they will not approve it. Even if a repeal did emerge from Congress, President Obama would veto it. (more…)

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cmonfils | January 20, 2011

www.siia.org

SIIA Legislative Update – Healthcare Reform     January 19, 2010

Information Disclaimer Note: Congressional developments regarding health care reform are fluid and SIIA lobbyists are continually meeting with Members of Congress, key staff members and other industry stakeholders, which generate ongoing intelligence. In order to keep our members informed in “real time”, we will report relevant information as we become aware of it. Given that the political process is inherently unpredictable, information communicated in previous reports may be superseded in subsequent reports. Should you have any questions in between reports, please contact SIIA’s Washington, DC office directly at 202/463-8161.

Moments ago, the House passed a repeal of the PPACA -fulfilling a campaign promise made by the new Republican majority. While the repeal bill had a significant amount of House support, it is unlikely to move any further as there is not enough support in the Democrat controlled Senate as well as in the White House. (more…)

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cmonfils | January 20, 2011

www.nytimes.com

By DAVID M. HERSZENHORN        Published: January 19, 2011

WASHINGTON – The House on Wednesday voted to repeal the Democrats’ landmark health care overhaul, in a largely symbolic step that the new Republican majority said marked the beginning of an all-out effort to dismantle President Obama’s signature domestic policy achievement.

Leaders of the Democratic-controlled Senate have said that they will not act on the repeal measure, effectively scuttling it. (more…)

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