cmonfils | February 6, 2012
January witnessed the filing of the first briefs in the Patient Protection and Affordable Care Act (PPACA) cases now before the Supreme Court. Initial briefs on the four issues — the Anti-Injunction Act, minimum coverage requirement, severability and Medicaid — have all been submitted. Numerous amicus curiae — or “friend of the court” — briefs were also filed in support.
http://benefitslink.com/articles/guests/washbull120123a.html
Category: Health Care Legislation, PPACA |
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cmonfils | February 3, 2012
Last week’s State of the Union speech was notable because the President hardly mentioned the new health care reform law.
Avoiding what is supposed to be the centerpiece domestic accomplishment of President Obama’s first term stuck out like a sore thumb.
Category: Health Care Legislation, PPACA |
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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 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 24, 2012
Under the Patient Protection and Affordable Care Act (ACA) passed by Congress, most Americans will be required to be covered by health insurance or pay a penalty—the so-called individual mandate. The legality of this feature is being debated in the courts.
These Urban Institute authors estimate the effects of the ACA and the individual mandate, as well as various levels of exchange participation, using a model that simulates decisions of individuals and businesses in response to policy changes. Exchange enrollment is viewed as necessary to reduce adverse selection, or the likelihood of only the sickest choosing to be insured.
Category: Health Care Legislation, Health Insurance, PPACA |
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cmonfils | January 24, 2012
The Patient Protection and Affordable Care Act of 2010 (ACA) is arguably the most significant health legislation enacted in generations. As remarkable a political and policy achievement as it was, what the reform will actually accomplish is largely yet to be determined. Whether it slows the growth of costs, increases access to care, or improves the quality of care will depend on how it is implemented. Although major components of the law do not go into effect until 2014, the fate of the ACA depends on the outcome of four key events in 2012.
Category: Health Care Legislation, PPACA |
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cmonfils | January 24, 2012
from Spencer’s Benefits Reports: Uniform rate setting for medical provider payments offers the greatest health care cost growth containment potential, a recent study from the Urban Institute’s Health Policy Center found. The report noted that from 2000 to 2010, national health expenditures (NHE) have risen at an average annual rate of 6.6 percent, while gross domestic product (GDP) has grown only 4.1 percent annually. The Patient Protection and Affordable Care Act (ACA) contains a number of cost growth containment provisions, which the Urban Institute reviews in the report, Containing the Growth of Spending in the U.S. Health System, along with several other options, and estimates potential savings the options may provide.
Category: Health Insurance, PPACA |
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cmonfils | January 18, 2012
Employer’s Guide to Self-Insuring Health Benefits January 2012 | Vol. 19, No. 4
As illustrated here, ERISA did not preempt the Washington Mental Health Parity Act.
Even though it correctly applied an insured ERISA plan’s coverage restrictions on neurodevelopmental therapy for children over six years old, the administrator’s refusal to pay a 10-year-old dependent’s mental health treatment violated a state law that bound insurers and HMOs. (more…)
Category: ERISA, Health Care Legislation, Mental Health Parity, PPACA, Preemption, Supreme Court, Washington |
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cmonfils | January 18, 2012
Employer’s Guide to Self-Insuring Health Benefits January 2012 | Vol. 19, No. 4
The U.S. Department of Labor (DOL) on Dec. 5 proposed new enforcement and oversight rules targeting Multiple Employer Welfare Arrangements (MEWAs). Officers who ran sham MEWAs were using plan funds improperly, absconding with funds and disappearing to set up fraudulent entities in other states, DOL Assistant Secretary Phyllis Borzi said. Under the proposed rules: (1) MEWAs would register with DOL before starting business in a state; (2) they would file the Form M-1 with DOL, regardless of their size; (3) DOL could issue cease-anddesist orders against MEWAs without prior notice or hearings, if they commit fraud and abuse; and (4) DOL would gain fast-track power to seize assets from a MEWA when there is probable cause that the plan is financially unstable. This would enable DOL to preserve plan assets before they’re totally dissipated, she said. (more…)
Category: DOL, Health Care Legislation, PPACA |
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cmonfils | January 18, 2012
Employer’s Guide to Self-Insuring Health Benefits January 2012 | Vol. 19, No. 4
Sponsors and administrators of employer-sponsored health plans will spend lots of 2012 in implementing the health reform law, because there’s still a lot of uncertainty that will decide the fate of self-funded health plans in particular. Plans will have to raise annual limits on essential benefits (as defined by reform rules) to $2 million starting next Sept. 23. Plans won’t have to pay new fees to fund comparative effectiveness research in 2012. But 2012 will be the year plans learn the payment frequency of and the method used to calculate the fees they will start paying in 2013. Similarly, plans won’t have to start issuing summaries of benefits and coverage (SBCs) to all participants, but they will be waiting and watching for rules about the SBC to develop, so they know how to satisfy that requirement. (more…)
Category: Accountable Care Organizations, DOL, Health Care Legislation, HHS, Medicare, Plan Sponsor, PPACA, PPOs, Third Party Administrators |
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cmonfils | January 17, 2012
Breast-feeding avengers may be coming to a workplace near you.
Women want to be able to breast feed their babies when and where they want to. Witness the “nurse-ins” at Target stores on the West Coast last week that were prompted by a shopper who was mocked for breast feeding by employees at one Target. Moms, however, also want to be able to breast feed when they’re on the clock.
Category: Health Care Legislation, PPACA |
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cmonfils | January 17, 2012
With little fanfare and little attention from the media, the Obama Administration recently issued proposed rules to crackdown on health insurance scams that use ERISA to avoid state law enforcement and regulatory actions.
Since the 1974 enactment of ERISA — the federal law governing employee pension and health benefit plans — crooks have used it to promote health insurance scams. There have been bipartisan Congressional attempts to address this problem, e.g., the passage of the 1982 amendments to clarify state authority and the 1996 HIPAA amendments to increase penalties for health fraud. But until the passage of the Patient Protection and Affordable Care Act (ACA), the federal government has had limited administrative authority to fight health insurance scams.
Category: DOL, ERISA, Health Care Legislation, Health Insurance, PPACA |
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cmonfils | January 13, 2012
A mandatory uniform standard for health plans to pay claims electronically was adopted in rules issued Jan. 5 by the U.S. Department of Health and Human Services (HHS). The rules are designed to help health care providers match payments received with the “remittance advice” transactions that plans are already sending them under an existing HHS standard.
Category: HHS, HIPAA, PPACA |
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cmonfils | January 12, 2012
Published by the Self-Insurance Educational Foundation, Inc. in cooperation with the Self-Insurance Institute of America, Inc.
Manage your Health Plan as you would manage your business. An introduction to self-funding.
“Become part of the Health Care solution!”
If there were a proven method to managing your health plan costs that over 57% of employees in the U.S. were utilizing today, would you be interested? Well there is a proven method, and it is called self-funding. (more…)
Category: ERISA, Plan Sponsor, PPACA, Self-Funding |
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cmonfils | January 10, 2012
The Patient Protection and Affordable Care Act (the Act) enacted a series of insurance market reforms that impose new rules on health insurance issuers and group health plans. Commencing in 2014, the Act requires that polices of health insurance offered in the individual and small group markets as well as Medicaid benchmark plans offer a comprehensive package of items and services known as “essential health benefits” (EHB). Essential health benefits must include items and services within at least the following 10 categories: (1) ambulatory patient services, (2) emergency services (3) hospitalization, (4) maternity and newborn care, (5) mental health and substance use disorder services, including behavioral health treatment, (6) prescription drugs, (7) rehabilitative and habilitative services and devices, (8) laboratory services, (9) preventive and wellness services and chronic disease management, and (10) pediatric services, including oral and vision care. Self-insured group health plans, health insurance coverage offered in the large group market, and grandfathered health plans are not required to provide essential health benefits.
Category: Health Care Legislation, Health Insurance, HHS, PPACA |
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