Phia Group Russo & Minchoff

Value-buying Still Possible for Firms Despite Transparency Problems

cmonfils | January 3, 2012

Employer’s Guide to Self-Insuring Health Benefits   December 2011 | Vol. 19, No.3 

The lack of cost transparency stands in the way of health cost control because it makes plan members unable to see prices before services are actually rendered, and harms their ability to budget health spending. Problems include: (1) multiple providers; (2) multiple network-provider contracts; (3) providers that often don’t know how extensive a patient’s treatment needs are until they start treatment; (4) insurers say contractual obligations with providers prohibit the sharing of negotiated rates; and (5) providers afraid of sharing negotiated rates due to their proprietary nature. Leah Binder, CEO of the Leapfrog Group, suggested that most employers can bring more efficient purchasing to their health plan in two ways: (1) change plan documents to reward members for using high-performance providers (for example, by waiving deductibles); and (2) computerize drug ordering and management systems, which would have quality as well as cost and efficiency advantages. (more…)

Florida’s push for specific waiver in health-care law could have big implications

cmonfils | November 27, 2011

A seemingly obscure regulatory battle in Florida could upend efforts to implement health-care reform nationwide.

At issue is a regulation requiring insurance companies to spend at least 80 percent of premiums on medical costs. Florida, a swing state with voters skeptical of the health-reform law, is pushing back. The state wants the Obama administration to waive the spending requirement for Florida insurers, a move that critics say would roll back a crucial consumer protection in the health-reform law.

CareHere Operated Employee Clinic Improves Care and Reduces Health Costs According to Health Data Analyses Provided By Med-Vision’s Health Plan Strategists

cmonfils | September 26, 2011

www.myhealthguide.com
MyHealthGuide Source: Med-Vision, Inc., via Business Wire, 9/22/2011, www.med-vision.com and www.carehere.com 

Editor’s Disclosure:  CareHere’s president is also the publisher and editor of MyHealthGuide Newsletter.

TAMPA, FL — Strategic wellness efforts and a free clinic for the employees and dependents of a major snack food giant’s manufacturing facility has significantly reduced medical costs while decreasing employee health risks.

The manufacturing facility opened its clinic in April 2010 to service 1800 onsite employees. The clinic was installed by and operated by CareHere, LLC, a Tennessee-based firm with more than 100 workplace-based clinics providing primary medical and occupational healthcare nationwide. (more…)

Health Care Reform – Pending Litigation Cases – Florida

cmonfils | June 20, 2011

www.franczek.com

By Andrew Malahowski and Veronica Minin      June 8, 2011

Since the Patient Protection and Affordable Care Act (PPACA) was enacted last year, several state attorneys general and other private plaintiffs have filed lawsuits to repeal it. These lawsuits, among other issues, challenge the constitutionality of the mandate under PPACA that individuals purchase health insurance no later than 2014 or face a penalty. (more…)

Florida Budget Cuts Medicaid Reimbursement Rates By 12%

cmonfils | June 3, 2011

www.modernhealthcare.com          May 30, 2011 

Florida Gov. Rick Scott signed a $69 billion state budget that cuts hospitals’ Medicaid reimbursement rates in the state by 12%, which Moody’s Investors Service said will have a negative effect on the state’s hospitals. The cuts include $407.5 million in inpatient rate cuts and $102.9 million in outpatient cuts. (more…)

Wellness Program Clears ADA Hurdle

cmonfils | May 26, 2011

www.benefitsinbrief.com      Friday, May 13, 2011 | Kenneth A. Mason | 

In a recent decision, a Florida federal trial court waded into an area of the law that has generated substantial concern among employers wishing to implement wellness programs that include both a carrot and a stick. The result was surprisingly good news for those employers.  (more…)

Wellness Program Clears ADA Hurdle

cmonfils | May 22, 2011

www.myhealthguide.com

MyHealthGuide Source: Kenneth A. Mason, Spencer Fane Britt & Browne LLP, 5/13/2011, Benefits In Brief Article

In a recent decision, a Florida federal trial court waded into an area of the law that has generated substantial concern among employers wishing to implement wellness programs that include both a carrot and a stick. The result was surprisingly good news for those employers. (more…)

Incentives OK Under ADA: Court

cmonfils | April 25, 2011

www.businessinsurance.com     April 18, 2011

FORT LAUDERDALE, Fla.—The U.S. District Court for the Southern District of Florida dismissed a lawsuit alleging that financial incentives to participate in a voluntary wellness program as part of a health plan provided to employees by Broward County, Fla., violated the Americans with Disabilities Act. (more…)

Developments for Employers that Sponsor Wellness Programs

cmonfils | April 25, 2011

www.mwe.com 

April 15, 2011

The ruling in Seff V. Broward County has helped to establish guidance as to what is permissible with respect to the design of wellness programs under the Americans With Disabilities Act (ADA). The U.S. District Court for the Southern District of Florida ruled that Broward County’s wellness program fell within the ADA’s safe harbor provision.  (more…)

McGuireWoods Healthcare Reform Guide: Installment No. 17 – Constitutional Challenges to Health Reform Move to Courts of Appeal

cmonfils | February 7, 2011

www. mcguirewoods.com  

2/2/2011

For the reasons stated, I must reluctantly conclude that Congress exceeded the bounds of its authority in passing the Act with the individual mandate. . . . Because the individual mandate is unconstitutional and not severable, the entire Act must be declared void. . . . In accordance with Rule 57 of the Federal Rules of Civil Procedure and Title 28, United States Code, Section 2201(a), a Declaratory Judgment shall be entered separately, declaring ‘The Patient Protection and Affordable Care Act’ unconstitutional. (more…)

Court Won’t Block Case Against Individual Mandate But Blocks State Challenge of Insurance Exchanges (Florida Case proceeds)

Adam V. Russo | October 25, 2010

MyHealthGuide, www.myhealthguide.com

Source: Todd Leeuwenburgh, Thompson Publishing

Mr. Leeuwenburgh’s preface: The case against Individual Mandate proceeds in Florida, but not in Michigan. The Florida court refused to kill the question of whether the individual mandate (to get health coverage or pay a penalty) might have exceeded Congress’ power to regulate trade under the Commerce Clause. But in Michigan, a federal judge ruling on the merits of the case, refused to block health reform’s individual mandate. Both courts heard government arguments that the Commerce Clause allows Congress to prohibit economic “non-activity” — that is, the failure to maintain health insurance, and to penalize those who fail to maintain such insurance. (more…)

Florida Statute Limits Insurer’s Reimbursement from Tort Settlement

Adam V. Russo | August 25, 2010

Coordination of Benefits Handbook

In a case that does not involve a health plan subject to ERISA, a Florida appellate court ruled that a health plan’s reimbursement from the proceeds of a settlement of a medical malpractice case was limited to the amount paid by the plan less its pro-rata share of attorney’s fees incurred by the plaintiff. The case is Ingenix v. Ham, 2010 WL 1780012 (Fla. App., May 5, 2010). (more…)

Florida: PPACA

Adam V. Russo | June 28, 2010

Florida. The state legislature is ready to cut Medicaid funding for nursing homes and is considering cuts to numerous other health programs to balance the budget. The proposed 7% cut to Medicaid payments rates for nursing homes totals approximately $200 million. Nursing homes likely would be able to offset at least part of the $200 million in cuts during the 2010-11 fiscal year, which starts July 1. Among other things, nursing homes expect to receive additional money because of an increase in a nursing-home tax that draws down more federal matching money. For more information, visit http://www.dcf.state.fl.us/programs/access/medicaid.shtml.

States Rejected Federal Funds to Administer a High-Risk Insurance Pool

Adam V. Russo | June 28, 2010

Twenty states so far have rejected federal funds to administer a high-risk insurance pool, as designed by the Patient Protection and Affordable Care Act. The high-risk pool would extend coverage to state residents unable to purchase insurance because of preexisting medical conditions. In these states, the federal government will be responsible for creating and running a high-risk pool on behalf of the state, as mandated by the Affordable Care Act. The 20 states are: Alabama, Arizona, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Louisiana, Minnesota, Mississippi, Nebraska, Nevada, North Dakota, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Wyoming. Two states, Oregon and Utah, have not indicated whether they will be running their own high-risk pool or if they will let the HHS run it for them. The remaining 28 states have decided they will run their own temporary high-risk pool. For more information, visit http://www.hhs.gov/ociio/initiative/hi_risk_pool_facts.html. (more…)

Florida Bar Association Eyes Creating Additional Right to Attorneys Fees for Fighting Subrogation Liens and Recoveries

Adam V. Russo | June 28, 2010

NASP, www.subrogation.org

Florida attorneys and recovery specialists should be aware that the Florida Bar Association Board of Governors is looking to adopt a rule change to the fee limits that are placed on contingency fees that will allow attorneys who fight against subrogation liens to charge a fee separate from or in excess of the contingency fee caps found in the Rules of Professional Conduct. (more…)