cmonfils | January 31, 2012
Coordination Of Benefits January 2012 Vol. 20 No. 1
In a surprising decision, the 3rd U.S. Circuit Court of Appeals used the concept of “appropriate equitable relief” to restrict an employer sponsored health plan’s recovery from a third-party settlement to less than what the plan paid out in health benefits. In US Airways, Inc. v. McCutchen, the appeals court held that full reimbursement of expenses to the employer-sponsored health plan would be “inappropriate and inequitable relief.” Full recovery would constitute unjust enrichment for the plan because: (1) the plan participant’s recovery ended being less than what the plan paid after attorney’s fees were deducted; and (2) the plan never intervened in the third-party recovery. The appeals court held these facts overruled the fact that the plan had subrogation reimbursement provisions asserting recovery rights over any monies collected from a third party, and it overturned a lower court’s decision requiring the participant to pay the plan the whole amount. (more…)
Category: 3rd, ERISA, Self-Funding, Supreme Court |
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cmonfils | January 31, 2012
Whether Leeson is a participant for purposes of ERISA is a substantive element of his claim, not a prerequisite for subject matter jurisdiction. As the Supreme Court has instructed, “when Congress does not rank a statutory limitation on coverage as jurisdictional, courts should treat the restriction as nonjurisdictional in character.” Arbaugh v. Y & H Corp., 546 U.S. 500, 516, 126 S. Ct. 1235, 163 L. Ed. 2d 1097 (2006).
http://www.healthplanlaw.com/?p=2220
Category: ERISA |
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cmonfils | January 30, 2012
Although more than half of the states are suing to get out of a massive Medicaid expansion under the federal healthcare overhaul, most also are working to overcome a key obstacle to growing their programs.
The Patient Protection and Affordable Care Act relies heavily on broadening eligibility in the joint federal and state program beginning in 2014 in order to extend health coverage to most Americans. The required Medicaid expansion also faces a constitutional challenge by 26 states on which the Supreme Court will decide by the end of its session in June. Those states maintain that the law creates an unconstitutional cost burden on their states beyond the federal government’s initial coverage of the cost of the new Medicaid enrollees.
http://www.modernhealthcare.com/article/20120121/MAGAZINE/301219954/
Category: Health Care Legislation, Medicaid, PPACA |
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cmonfils | January 30, 2012
Many in healthcare, including leaders at the CMS Innovation Center, are betting on experiments with more coordinated services and value-based payments to show it’s possible to spend less for better outcomes. For two decades, the Medicare program has tried some of these ideas—and now a new federal report has some bad news about the results
http://www.modernhealthcare.com/article/20120121/MAGAZINE/301219973/
Category: CMS, Health Care Legislation, Medicare |
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cmonfils | January 30, 2012
The department has proposed a rule implementing Senate Bill 80, enacted by the 81st Legislature, Regular Session, allowing carries to offer a small employer health benefit plan with 100 percent employer contribution. A copy of this proposed rule may be accessed at:
http://www.tdi.texas.gov/rules/2012/documents/26.8.pdf
Category: Health Insurance, Texas |
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cmonfils | January 27, 2012
WASHINGTON (AP) — One of the most popular provisions of President Barack Obama’s health care overhaul — consumer-friendly summaries of what your insurance plan covers — suddenly seems to be at risk.
Consumer groups say it’s not Republican opposition they’re worried about, but a White House that doesn’t want to be seen, in an election year, of churning out costly new regulations.
http://www.benefitspro.com/2012/01/26/user-friendly-health-plan-summaries-at-risk?utm_source=BenefitsProDaily&utm_medium=eNL&utm_campaign=BenefitsPro_eNLs
Category: Health Care Legislation, Health Insurance |
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cmonfils | January 27, 2012
BOSTON—Massachusetts residents who do not have health insurance will face a higher financial penalty in 2012 under newly finalized rules.
Category: Health Insurance, Massachusetts |
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cmonfils | January 27, 2012
Among other things, 2012 will be the year of the Department of Health and Human Services (“HHS”) Office of Civil Rights (“OCR”) pilot audit program to assess compliance with the Health Insurance Portability and Accountability Act (“HIPAA”) Privacy and Security Rules and Breach Notification standards. The American Recovery and Reinvestment Act of 2009, in Section 13411 of the HITECH Act, required that HHS conduct periodic audits to monitor and ensure compliance with HIPAA. OCR will implement this requirement through a pilot program of 150 audits from November 2011 through December 2012, including an initial wave of 20 audits that will inform how the remaining audits will be conducted. OCR has established a HIPAA Audit Program website.
Category: HHS, HIPAA |
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cmonfils | January 27, 2012
Fri Jan 13, 2012 5:00am EST (Reuters) What could pediatrician appointments possibly have to do with Joe Merrick’s business as an online precious metals dealer? When it comes to health insurance, the answer is everything. The 13 full-time employees of Merrick’s Dallas-based Provident Metals have 30 children, all under the age of 15, with four babies born in 2011 alone. That means potentially high medical bills for everything from childbirth to vaccinations, which Merrick had to factor into his health-insurance decisions.
Category: Health Insurance |
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cmonfils | January 25, 2012
The Department of Health and Human Services (HHS) issued interim final regulations addressing standards for electronic funds transfers (EFTs) applicable to health care claims payments transmitted by health plans to health care providers.
Category: HHS, HIPAA |
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cmonfils | January 25, 2012
January 17, 2011 (PLANSPONSOR.com) – California Attorney General Kamala D. Harris has filed a friend-of-the-court brief in the U.S. Supreme Court supporting the constitutionality of federal health care reform and urging the high court to uphold the law.
Harris, joined by 12 other attorneys general, argued in the brief that the Constitution gives Congress broad powers to regulate interstate commerce, including individual conduct that substantially affects interstate commerce.
Category: Health Care Legislation, PPACA, Supreme Court |
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cmonfils | January 25, 2012
People without health insurance are more likely to smoke and generally have less healthy habits than people with coverage, Gallup reports show.
People with health insurance are less likely to smoke and more likely to exercise regularly and eat a healthy diet than those without insurance, according to Gallup Poll data released in December 2011.
Category: Health Insurance |
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cmonfils | January 25, 2012
DOVER — “If you do something to encourage a healthy lifestyle, it will make folks happier, they’ll have more energy and be more productive,” says Pat Sliva at the Tuscarawas County Board of Developmental Disabilities.
Sliva is human resources coordinator at the Board and credits these positive outcomes to the organization’s five-year involvement with Union Hospital’s Workplace Wellness program.
Category: Ohio, Wellness |
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cmonfils | January 25, 2012
The 2011 Society for Human Resource Management (SHRM) Health Care Benchmarking Survey examined health care costs for U.S. employees and found that costs vary widely, depending on the industry. One way to try to streamline health care costs is to opt for a self-funded health plan.
Some of the industries that the survey found “spent the most on health care per covered employee during plan year 2010″ were: Utilities; Insurance; Real Estate; Government; and Manufacturing. The industries that spent the least were: Telecommunications; Publishing; Broadcasting and other Media; Accommodation and Food Services; Arts, Entertainment and Recreation; and Business Support Services.
Category: Health Insurance, Self-Funding |
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cmonfils | January 25, 2012
The Eleventh Circuit Court of Appeals recently held in a case of first impression in this circuit that the Family and Medical Leave Act (FMLA) “protects a pre-eligibility request for post-eligibility leave.” That is, the FMLA protects an employee who gives notice, before she is eligible for leave, of intent to take FMLA leave for a qualifying reason once she becomes eligible. Pereda v. Brookdale Senior Living Communities, Inc., D.C. Docket No. 0:10-cv-60773-FAM, Eleventh Circuit Court of Appeals (January 10, 2012).
Category: 11th, FMLA |
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