cmonfils | November 29, 2011
Wisconsin Senate Bill 217: A bill which will affect the amount of time a driver’s license suspended for negligent operation of a motor vehicle has passed both the Wisconsin House and Senate and is currently on the Governor’s desk. SB 217 would limit the aforementioned suspension period to five years from the date of entry of a judgment against the negligent driver. This is a significant departure from current law, which allows the suspension to remain in place until the judgment is satisfied or discharged.
Thanks to Ken Wilber of Wilber & Associates in Bloomington, Illinois for bringing this bill to NASP’s attention.
Category: Wisconsin |
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cmonfils | November 29, 2011
Kansas Senate Bill 136: Kansas recently enacted a bill that would prohibit a driver from recovering noneconomic losses if they fail to maintain the mandatory personal injury protection coverage required in the state. The bill applies to personal injury lawsuits and wrongful death causes of action and bars recovery of noneconomic losses when someone is driving an automobile without the mandatory PIP benefits required by Kansas automobile injury reparations act, article 31 of chapter 40 of the Kansas Statutes Annotated. Two exceptions are noted: (more…)
Category: Kansas |
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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.
Category: Florida, Health Care Legislation, Health Insurance |
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cmonfils | November 20, 2011
Employer’s Guide to Self-Insuring Health Benefits
Thompson Publishing November 2011 Vol. 19, No. 2
A plan participant cannot pick definitions from various state or federal statutes and impose them on the plan where the plan left terms undefined, if the plan applies a common and ordinary meaning to those terms when asked to justify a claims denial.
Applying this rule, a Michigan appeals court affirmed a lower state court’s ruling upholding a plan’s benefits denial for a surrogate mother’s delivery of triplets. (Spectrum Health v. Lehr, No. 298688, (Mich. App., Sept. 8, 2011).) (more…)
Category: Claims Procedures, ERISA, Health Insurance, Michigan |
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cmonfils | November 20, 2011
Employer’s Guide to Self-Insuring Health Benefits
Thompson Publishing November 2011 Vol. 19, No. 2
A plan’s decision to circumvent its own written appeals procedures led to ERISA claims. In a dispute involving an experimental service denial, plan administrator Viacom and claims administrator United Healthcare told a plan participant to skip the plan’s normal appeals route and appeal to Viacom, because it might overrule the plan’s exclusion or revise the plan to allow payment for the service. When the plan sponsor fumbled its decision, gave conflicting explanations and took months to ultimately deny the claim, the participant sued alleging unpaid benefits, breach of fiduciary duty and other charges. United managed to get all breach of fiduciary duty charges waived but the Viacom defendants still have to face all charges. Wrongful denial of benefits charges still stand against both defendants. (more…)
Category: Claims Review, ERISA, PPACA, Tennessee |
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cmonfils | November 20, 2011
Employer’s Guide to Self-Insuring Health Benefits
Thompson Publishing November 2011 Vol. 19, No. 2
The 9th U.S. Circuit Court of Appeals ordered Blue Shield of California, the plan administrator of an insured ERISA plan, to cover a residential stay for psychological treatment despite plan terms excluding residential stays of any kind. The court even found that Blue Shield gave its plan document a sound reading. California’s Mental Health Parity Act provides coverage for “medically necessary” diagnosis and treatment of “severe mental illnesses,” whether or not it involves a residential stay. The court rejected Blue Shield’s attempt to circumscribe the Parity Act to services listed in that Act and matching the Knox-Keene Act. Then the court held Blue Shield forfeited its right to argue against medical necessity in court because it had not done so in the administrative stage. (more…)
Category: 9th, California, ERISA, Health Insurance, Mental Health Parity |
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cmonfils | November 18, 2011
Massachusetts has recently finalized regulations requiring third party administrators to register with the Commonwealth as well as file annual reports. This will likely affect many TPAs in Massachusetts because the definition of TPA is broad:
Third-party Administrator: A person domiciled inside or outside of the Commonwealth who, on behalf of a Health Insurer or purchaser of health benefits, receives or collects charges, contributions or premiums for, or adjusts or settles claims on or for residents of the Commonwealth. Third-party Administrator shall also include pharmacy benefit managers and any other entity with claims data, eligibility data, provider files and other information relating to health care provided to residents of the Commonwealth and health care provided by health care providers in the Commonwealth, except that Third-party Administrator shall not include an entity that administers only claims data, eligibility data, provider files and other information for its own employees and dependents. (Emphasis added.) 211 C.M.R. 148
These new regulations amend the proposed regulations issued in February which originally excluded from the definition of third-party administrator an “entity with claims data, eligibility data, provider files and other information relating to health care provided to residents of the Commonwealth and health care provided by health care providers in the Commonwealth.”
The hearing for the regulations was March 16, 2011 and the regulations became effective May 27, 2011. The Division of Insurance posted the updated regulations as well as the application and annual report information on its website in June. This is the link to the application and the annual report: http://www.mass.gov/ocabr/licensee/license-types/insurance/third-party-administrators/.
Category: Massachusetts, Third Party Administrators |
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cmonfils | November 18, 2011
ALBANY, N.Y.—Eleven health insurers have been ordered to refund $114.5 million to policyholders in New York under minimum medical spending requirements similar to those being enacted nationwide under health care reform beginning this year.
Category: Health Insurance, New York |
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cmonfils | November 18, 2011
It won’t be the body blow to President Barack Obama’s health-care law that some might have hoped, but Ohio voters yesterday overwhelmingly approved a state constitutional amendment voicing their displeasure with a federal law requiring most Americans to buy health insurance by 2014 or face fines.
Category: Health Care Legislation, Health Insurance, Ohio |
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cmonfils | November 18, 2011
ALBANY, N.Y. — New York soon will require insurers to cover screening, diagnosis and treatment for autism spectrum disorders, which will increase premiums for all individuals and businesses.
Supporters say the new law will include routine toddler screenings, behavioral health treatments, speech therapy, occupational therapy and physical therapy. That should bolster early and effective treatment and save families as much as $50,000 a year in out-of-pocket cost for 30,000 autistic New York children.
Category: Health Insurance, New York |
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cmonfils | November 16, 2011
New York insurance companies that were not covering the screening, diagnosis and treatment for autism spectrum disorders will now be mandated to do so effective Nov. 1, 2012.
New York is the 29th state to pass some version of Ryan’s Law, a bill that started in South Carolina in 2005 after Lorri Unumb, who was at the time a law professor at the Charleston School of Law and a mother of a two-year-old autistic son, decided to write a bill that would mandate insurance companies provide up to $50,000 in behavioral therapy annually for children up to age 16. The New York bill puts an annual cap of $45,000 on coverage.
Category: Health Insurance, New York |
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cmonfils | November 16, 2011
SAN FRANCISCO—San Francisco Mayor Edwin Lee and the city’s legislators are nearing an agreement on a compromise plan to impose new restrictions on health reimbursement arrangements, potentially setting the stage for a new legal battle involving the city’s controversial health care spending law.
Category: California, Reimbursement |
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cmonfils | November 11, 2011
Last week, San Francisco’s Mayor exercised his veto power for the first time to stop legislation designed to close an alleged “loophole” in the San Francisco Health Care Security Ordinance. This week, employers wait to see whether the San Francisco Board of Supervisors will go back to the drawing board or pass competing legislation targeting the same perceived abuse. Meanwhile, the vetoed amendment is embedded in the competing legislation so that it would become law if alternate provisions are legally challenged. The vetoed and competing legislation fail to take into account federal health care and tax laws, undermining San Francisco employers’ ability to implement long-term solutions to their employees’ health needs.
Category: California, Health Care Legislation |
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cmonfils | November 8, 2011
TRENTON, N.J.—Advocates of self-funding health benefits are fighting an attempt by New Jersey regulators to crack down on the practice among small businesses, saying it is part of a broader attack on self-insurance at the state and national levels.
Category: New Jersey, Self-Funding |
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cmonfils | November 8, 2011
Although health care reform legislation excluded the value of employer-provided health benefits provided to any employee’s child under the age of 27 at the end of the taxable year (not just tax dependents) effective March 30, 2010, several states did not incorporate that change into state law. As a result, there has been some confusion as to whether the value of employer-provided health benefits provided to non-tax dependent children would be subject to state taxes in those states. However, earlier this year, several states, including California and Minnesota, enacted legislation to conform state tax treatment of such coverage with federal tax treatment.
Category: Health Care Legislation, Health Insurance, Wisconsin |
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