A central Pennsylvania health system says it won’t hire smokers
cmonfils | January 24, 2012
The vaunted Geisinger Health System in central Pennsylvania ushered in the new year by becoming the latest employer to resolve not to hire smokers.
I Hope Trustmark Tells HHS to Go Pound Sand
cmonfils | January 22, 2012
Today, the Department of Health and Human Services announced that, “Trustmark Life Insurance Company has proposed unreasonable health insurance premium increases in five states—Alabama, Arizona, Pennsylvania, Virginia, and Wyoming. The excessive rate hikes would affect nearly 10,000 residents across these five states.”
Affordable Care Act holding insurers accountable for premium hikes
cmonfils | January 22, 2012
Health insurance premium increases in five states have been deemed “unreasonable” by the U.S. Department of Health and Human Services, HHS Secretary Kathleen Sebelius announced today.
After independent expert review, HHS determined that Trustmark Life Insurance Company has proposed unreasonable health insurance premium increases in five states—Alabama, Arizona, Pennsylvania, Virginia, and Wyoming. The excessive rate hikes would affect nearly 10,000 residents across these five states.
Juggling the lineup
cmonfils | January 20, 2012
Excela Health entered the Great Recession as the largest mental health provider for the Pennsylvania county that’s home to its three hospitals.
A year and a half later, as the recession drew to a close, Excela began to refer and transfer outpatient mental health patients to primary-care doctors and community clinics to stem losses.
Appeals Court: Unjust Enrichment Limits Equitable Plan Recovery
cmonfils | January 18, 2012
Employer’s Guide to Self-Insuring Health Benefits January 2012 | Vol. 19, No. 4
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. Full reimbursement of what the plan paid out would have been “inappropriate and inequitable,” even though the plan had asserted recovery rights over any monies collected from a third party. Full recovery would have been unfair because: (1) the plan participant’s recovery ended up 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 outcome diverges from many recent cases, which upheld plans’ claims on total proceeds, regardless of whether the plan participant was “made whole” or had money to pay attorney’s fees. (more…)
Cloudy Outlook – Supercommittee failure leaves healthcare providers questioning future cuts, impact on hospitals
cmonfils | December 2, 2011
Now that the deficit-reduction supercommittee has failed to reach agreement, healthcare providers are dealing with the reality that things could get worse before they get worse.
A series of congressional hearings, intense lobbying efforts and countless closed-door meetings were not enough to help the 12-member Joint Select Committee on Deficit Reduction complete its task last week of delivering a proposal to Congress that identified ways to reduce the federal deficit by at least $1.2 trillion over the next 10 years. This summer’s Budget Control Act required that unless Congress could identify such savings, “sequestration” would kick in starting in January 2013, when $1.2 trillion in automatic, across-the-board cuts over 10 years will be split between defense and nondefense programs. The law limits the amount of healthcare savings by capping reductions to Medicare payments at 2%.
http://www.modernhealthcare.com/article/20111128/MAGAZINE/311289960/cloudy-outlook
Judge Rules in Favor of Pennsylvania Couple’s Challenge of Federal Health Care Reform Law
Another U.S. Judge Rejects Health Care Insurance Mandate
cmonfils | September 19, 2011
MyHealthGuide Source: Business Insurance, 9/14/2011, www.businessinsurance.com
Case: Goudy-Bachman et al. vs. Sebelius et al., U.S. District Court, Middle District of Pennsylvania, No. 10-00763
HARRISBURG, Pa. — A federal judge in Pennsylvania said the insurance-buying mandate in the 2010 health care reform law is unconstitutional, the latest ruling over an issue likely to be taken up by the U.S. Supreme Court. (more…)
States Move To Implement Health Reform Provisions
cmonfils | September 19, 2011
CCH® BENEFITS — 09/01/11
from Spencer’s Benefits Reports: According to the Kaiser Family Foundation’s State Health Facts, 23 states have established American Health Benefit Exchanges under the Patient Protection and Affordable Care Act (ACA), have enacted legislation with the intent to establish an Exchange, or have Exchange legislation pending.
Massachusetts and Vermont have established Exchanges, while California, Colorado, Connecticut, Hawaii, Maryland, Nevada, Oregon, Vermont, Washington, and West Virginia have enacted legislation to establish an Exchange. Hawaii’s Exchange will be a nonprofit, Vermont Exchange will be operated by the state. The rest of the Exchanges will be quasi-governmental.
The Exchange will be a clearinghouse and contract with all qualified health plans in Colorado and Hawaii. In California, Connecticut, Oregon, and Vermont, the Exchange will be an active purchaser contracting with selected health plans and/or negotiating premium prices with health plans. The other states have not yet decided the type of Exchange they will operate.
In Illinois, Indiana (by executive order of the governor), North Dakota, and Virginia, legislation has established the intent to set up an Exchange, while Alabama (by executive order of the governor), Georgia (by executive order of the governor), Mississippi, and Wyoming will study the feasilibility of an Exchange.
The District of Columbia, New Jersey, North Carolina, and Pennsylvania have Exchange legislation pending.
For more information, visit http://statehealthfacts.kff.org/comparemaptable.jsp?ind=962&cat=17.
Rate Review Programs
The federal government will either conduct or assist health insurance rate reviews in nine states, according to the most recent fact sheet from the Center for Consumer Information and Insurance Oversight (CCIIO), which discusses the rate review requirements included in the ACA.
According to the CCIIO, as of Aug. 15, 2011, state rate review procedures were as follows:
43 states, the District of Columbia, and one U.S. territory have effective rate review in at least one insurance market;
41 states, the District of Columbia, and the U.S. Virgin Islands have effective review for all insurance markets and issuers.
In two states (Virginia, Pennsylvania), the federal government will partner with the state to conduct reviews; and
The federal government will conduct reviews in seven states (Wyoming, Montana, Missouri, Louisiana, Idaho, Arizona, and Alabama) and four U.S. territories (American Samoa, Guam, Northern Marianas Islands, and Puerto Rico) until those areas are able to strengthen their review processes and authorities.
Starting Sept. 1, 2011, insurers seeking rate increases of 10% or more for non-grandfathered plans in the individual and small group markets are required to publicly disclose the proposed increases and the justification for them.
For more information, visit http://cciio.cms.gov/resources/factsheets/rate_review_fact_sheet.html.
Federal Judge Strikes Individual Mandate
cmonfils | September 16, 2011
September 13, 2011 By Jenny Ivy
A federal judge in Pennsylvania ruled Tuesday the requirement imposed by federal health reform that individuals must buy health insurance or pay a penalty is unconstitutional.
U.S. District Judge Christopher C. Conner in Harrisburg declared the minimum coverage provision of the Patient Protection and Affordable Care Act exceeds Congress’s authority under the U.S. Constitution. (more…)
Claim Against Plan Administrator May Proceed Where Rule Was Left Out of Plan Language
cmonfils | August 30, 2011
MyHealthGuide Source: Rebecca Moore, PlanSponsor, 8/25/2011, PlanSponsor Article
Case: Baker v. Pennsylvania Economy League Inc. Retirement Income Plan, E.D. Pa., No. 2:10-cv-06738-AB, 8/23/11
Editor’s Note: While the subject of case is a pension plan, the court’s ruling against plan administrator and fiduciary breach has application for self-funded ERISA plans. Court rules that plaintiff./ claimant could continue with her claim against plan administrators’ actions constituted a fiduciary breach. (more…)
Amicus Update 2011
cmonfils | July 11, 2011
The Subrogator Spring/Summer 2011
By Kammy Poff, Allstate Insurance Company, Roanoake, VA and Daran Kiefer, Kreiner and Peters Co., LPA, Cleveland, OH
Bills/Legislation
In February of this year, the National Association of Subrogation Professionals (NASP) embarked on a trip to Pierre, South Dakota. House Bill 1184 had just passed in the South Dakota House of Representatives and was on its way to the Senate. NASP was slated to testify before the Senate Judiciary Committee. House Bill 1184 needed to be stopped in the Senate. (more…)
Pennsylvania: PPACA
Adam V. Russo | June 28, 2010
Pennsylvania. Governor Edward Rendell has announced that the state’s insurance department is investigating Pennsylvania’s nine largest health insurance companies to determine the reasons behind controversial rate increases. Mr. Rendell is especially concerned with the extent to which the premium increases are driven by the use of “questionable health profiling tools.” These include the use of individualized medical questionnaires and drug profiling in the small group market, according to the state’s insurance commissioner. For more information, visit http://www.governor.state.pa.us.
PA State Health Care Reform Update
Adam V. Russo | February 23, 2010
Pennsylvania. Premiums for the state’s adultBasic health insurance plan will double in March from $330 per month to $600 per month. In addition, more than 40,000 participants will face new higher out-of-pocket costs, with higher copayments for doctor and emergency room visits and more expensive coinsurance requirements for services including chemotherapy, dialysis, and outpatient surgery. The Pennsylvania Insurance Department cited higher medical service use and escalating health care costs, combined with limited state funding, as the reason for the coverage changes. For more information, visit http://www.portal.state.pa.us/portal/server.pt/community/health_insurance/9189/adultbasic_benefit_chanages/646477.
State Laws for Balance Billing
Adam V. Russo | February 4, 2009
Forty-seven states ban in-network providers from billing insured patients more than their required copayment or deductible and federal law prohibits providers from billing Medicare beneficiaries for unpaid balances. Some states also ban additional charges for insured patients who seek care from out-of-network providers and emergency departments. While national statistics on the practice are unavailable, economists and patient advocates estimate that consumers pay at least $1 billion annually for medical bills that they are not legally responsible to pay. (more…)
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