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:
cmonfils | January 17, 2012
H-E-B is sharing with the public what it’s learned about its own employees’ wellness and on Friday will launch “Healthy at H-E-B” at the store at 2950 Southmost Blvd.
The company describes the effort as a “comprehensive commitment to improve the health of Texans.” As part of the initiative, H-E-B will showcase chef-inspired recipes at in-store cooking demonstrations designed to show customers how to make healthy, inexpensive meals
cmonfils | January 8, 2012
As a general rule, state insurance laws apply to employer-sponsored insured group health plans but not self-insured group health plans. The Employee Retirement Income Security Act of 1974, as amended (ERISA) generally exempts group health plans sponsored by private sector employers from state insurance laws. However, because insurers must comply with state insurance laws, a group health plan that purchases insurance to provide benefits will be indirectly subject to the state laws applicable to the insurer. Thus, if your company sponsors a group health plan that includes any kind of insurance contract or policy, you should make sure that you keep up-to-date on state law changes and their impact on your plan, and that you properly notify your participants (and, in certain cases, eligible individuals) of any changes to their plan benefits.
cmonfils | January 5, 2012
MyHealthGuide Source: The Self-Insurance Institute of America, Inc. (SIIA), 12/15/2011, www.SIIA.org (Article provided again from last week’s MyHealthGuide Newsletter as background reference to above article.)
Case: Holdings, Inc. v. Baylor Health Care Systems (more…)
cmonfils | January 5, 2012
MyHealthGuide Source: The Phia Group, 12/31/2011
Editor’s Note: Last week (and again below), this Newsletter reported that The Self-Insurance Institute of American (SIIA) filed an Amicus Brief on behalf of GPA Holding, Inc. in the case, GPA Holding, Inc. v. Baylor Health Care System. The Texas Supreme Court has now responded.
The Texas Supreme Court has requested an answer from Baylor in response to the Amicus Brief filed by SIIA. This indicates a greatly improved likelihood that the Court will hear the appeal. Evidently, the issues raised in SIIA’s brief, as well as briefs filed by the petitioner and other organizations, worried the Court enough to examine the lower court’s decision.
“This is a positive development in that Court has taken our briefs very seriously and is now forcing Baylor to respond before making a decision whether or not to take the case,” says Mike Ferguson, SIIA’s Chief Operating Officer.
At issue is whether third party administrators (TPAs) can be held financially liable for health care services incurred by self-insured group health plan participants. The lower courts (trial and appeal) declared that such financial liability is lawful, relying solely upon a one-sided interpretation of the applicable PPO agreement’s terms.
SIIA’s brief, drafted by attorneys Adam Russo and Ron Peck of The Phia Group, LLC, argues that such legal interpretation requires that TPAs be deemed plan fiduciaries (as only fiduciaries may be responsible for usage of plan assets), which clearly conflicts with the Employee Retirement Income Security Act (ERISA).
More broadly, SIIA contends that the Appeals Court decision threatens the existence of TPAs in Texas and elsewhere, and in turn, would greatly compromise the viability of self-insured group health plans for most employers eliminating one of the most cost efficient, and effective methods for providing robust health benefits to Americans.
cmonfils | December 26, 2011
Scott Golding, executive director of the Presbyterian Medical Care Mission, knows the clinic’s policy of paying female employees six weeks of maternity leave is “pretty rare” these days.
“But it’s just important for us to let them have that time,” Golding said. “We take the philosophy this is an important job, but it is a job — and family comes first. And if we can help people keep their family happy and together as much as possible, then they make much better employees.”
cmonfils | December 22, 2011
December 12, 2011 (PLANSPONSOR.com) – The Texas Employees Retirement System expects to save about $20 million next year by shifting most of its retirees to a Medicare Advantage health-insurance plan.
cmonfils | December 15, 2011
On July 1, 2011 the Texas Supreme Court finally settled the long-standing issue of whether an injured plaintiff may recover the amount of medical expenses charged by doctors or the amount actually paid or incurred. Trial lawyers have long argued that plaintiffs should be entitled to recover the amount charged to them by doctors and hospitals, which is usually significantly more than the discounted amounts paid by subrogated insurers or compensation carriers. Defendants have, of course, argued just the opposite. This new standard for proving medical expenses is having the effect of bringing plaintiffs’ counsel and subrogated carriers together, because we have something the trial lawyers want and need. (more…)
cmonfils | September 1, 2011
www.mwl-law.com August 2011
During the tort reform flurry of 2003 in Texas, CPRC § 41.0105 was amended to limit a plaintiff’s recovery of medical expenses to those that are paid or incurred, rather than the full medical bill charged to the patient. One of the lingering questions was whether the full, non-discounted bills could be presented to a jury. The Texas Supreme Court addressed this issue on July 1, 2011, holding only paid or incurred medical expenses can be presented to a jury. (more…)
cmonfils | August 15, 2011
www.modernhealthcare.com By Rich Daly August 8, 2011
The newly enacted debt-ceiling deal may have saved the nation from a financial crisis, but it also managed to paint a target on the backs of healthcare providers. And the potential size and scope of the cuts they could face has providers scrambling for a response. (more…)
cmonfils | August 15, 2011
www.haynesboone.com Michael Silhol 08/04/2011
Citing concerns that federal law does not adequately protect patient privacy, Texas recently enacted stringent new health privacy legislation that extends patient protections beyond those contained in the Health Insurance Portability and Accountability Act (HIPAA) or the Health Information Technology for Economic and Clinical Health (HITECH) Act. (more…)
cmonfils | July 28, 2011
www.nixonpeobody.com 7/21/2011
Texas health care entities must comply with a new health care privacy law that requires an update to policies and procedures, Notice of Privacy Practices, and employee training by September 2012.
Texas House Bill 300 (HB 300), recently signed into law by Governor Rick Perry, mandates new patient privacy protections and harsher penalties for privacy violations related to electronic health records (EHR). The requirements of the Texas law are more stringent than those of its federal counterpart, the Health Insurance Portability and Accountability Act (“HIPAA”). (more…)
cmonfils | July 15, 2011
“Not good for subrogation. Most plaintiff’s attorneys will seek, as damages, the “charged” amount, but reimburse the plan only the “paid” amount… with the difference going to the plaintiff and their attorney. Now, if 100% of medical damages the plaintiff claims are included on our lien, they are going to fight more now than ever to pay a percentage of the lien instead of 100%.” – Ron E. Peck, Esq.
www.lexology.com Karin B. Torgerson, Locke Lord Bissell & Lidell LLP July 6, 2011
In a significant win for defendants in cases involving insured medical expenses, the Texas Supreme Court has decided that medical expenses not required to be paid by or on behalf of the claimant are neither recoverable nor admissible at trial. Haygood v. Escobedo, ____ S.W.3d _____, Cause No. 09-0377 (Tex. June 30, 2011). (more…)
cmonfils | July 11, 2011
www.businessinsurance.com Mark A. Hofmann July 4 & 11, 2011
Supporters cite legislative success in Texas, other states
WASHINGTON—Promoting tort reform as a means to foster economic growth may be a winning strategy to win passage of such measures, tort reform advocates say.
They point to Texas, where Gov. Rick Perry—a possible Republican presidential contender—signed a comprehensive tort reform measure aimed at reducing “frivolous” lawsuits. Among other things, the law includes a modified “loser pays” provision in cases where certain settlement offers are rejected (see box). (more…)
cmonfils | April 20, 2011
Robyn Jacobson of Entrust, Inc.
Late last night, Rep. Eiland made progress persuading Rep. Taylor (our advocate) that his bill needed to be passed without any amendment exempting TPAs/Employers. Apparently, this is the “only bill that TMA is really pushing this session” and “passage would be an unfair competitive advantage for TPA’s”. (more…)
