Posted By bhoffman on August 5, 2010
Bryan Cave LLP, www.bryancave.com
The Departments of Treasury, Labor and Health & Human Services (the “Departments”) recently issued two more batches of interim final regulations under the Patient Protection and Affordable Care Act, as amended (the “Act”). This new guidance addresses (i) the preventive services coverage mandate, and (ii) the new internal claims and appeals and external review processes. Both sets of interim final regulations are effective for plan years beginning on or after September 23, 2010. Neither requirement applies to grandfathered group health plans. (more…)
Category: Claims Procedures, Claims Review, PPACA, Welfare Benefit Plans |
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Posted By bhoffman on August 5, 2010
Tuesday, August 3rd, I had the pleasure of speaking at the 2010 TriZetto Benefits Administration Client Conference held at the Sheraton Chicago Hotel & Towers in Chicago, IL.
Click here to see my entire PowerPoint presentation on “Innovative Plan Document Strategies”.
Category: Summary Plan Description |
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Posted By bhoffman on August 3, 2010
SIIA, www.siia.org
SIIA Submits Official Comments to Federal Agencies Regarding the Proposed Rule on Grandfathered Health Plans
SIIA was one of a select group of industry organizations who submitted official comments to the Federal agencies responsible for drafting and ultimately implementing regulations dealing with grandfathered health plans. The issued interim rule dealt with allowable modifications plans may make that will not jeopardize its status as a grandfathered health plan. (more…)
Category: Health Care Legislation, PPACA |
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Posted By bhoffman on August 3, 2010
SIIA, www.siia.org
SIIA has protested to the Nevada attorney general against the state’s recent prohibition of insurance coverage issued by Alliance for Non-Profits for Insurance, Risk Retention Group (ANI), a SIIA member.
SIIA Chief Operating Officer Mike Ferguson wrote to Attorney General Catherine Cortez Mastro stating that the DOI ruling prohibiting ANI from issuing automobile liability coverage in the state discriminates against RRGs in a manner that is prohibited by federal law. (more…)
Category: Nevada |
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Posted By bhoffman on August 3, 2010
By Patricia C. Shea of K & L Gates, www.klng.com
On July 7, 2010, the United States Department of Health and Human Services (HHS) conducted a press conference to announce long-awaited proposed modifications to the Health Insurance Portability and Accountability Act of 1996 rules on privacy, security and enforcement (the “Privacy Rule,” “Security Rule,” and “Enforcement Rule,” respectively). These modifications were mandated by the Health Information Technology for Economic and Clinical Health Act (the “HITECH Act”). HHS billed the proposed regulations as “significant,” and they are touching numerous aspects of the existing regulations with the aim of tightening perceived loopholes and granting individuals greater rights and protections over their health information. If adopted as proposed, these modifications to the rules will impact how covered entities and business associates conduct business. (more…)
Category: HIPAA |
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Posted By bhoffman on August 3, 2010
Troutman Sanders, www.troutmansanders.com
This is the seventh in a series of advisories on Health Care Reform and other recent developments in health care. This advisory summarizes the most recent interim final regulations jointly released by the Treasury Department, the Department of Labor and Health and Human Services relating to coverage of preventive care and new claims and appeals procedures under the Patient Protection and Affordable Care Act (the “Act”). (more…)
Category: Health Care Legislation, PPACA |
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Posted By bhoffman on August 2, 2010
By Kathryn R. Paradise & Hugh W. Davis II of Pyner Spruill, www.poynerspruill.com
The Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively the “Act”), includes a series of significant changes that are relevant to employer-provided group health plans. Some of these changes take effect for plan years beginning on and after September 23, 2010. As a result, plan sponsors will need to update enrollment materials and participant communications for the upcoming plan year. Several of the Act’s more notable provisions affecting employer-sponsored health plans are highlighted below. (more…)
Category: Health Care Legislation |
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Posted By bhoffman on July 28, 2010
By Jerry Geisel of Business Insurance, www.businessinsurance.com
WASHINGTON—New health care reform regulations clarify how health care plans must handle disputed claims, but leave murky a key issue: how a new federal external claims review requirement will work. (more…)
Category: Health Care Legislation |
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Posted By Adam V. Russo on July 26, 2010
By: Philip L. Gordon
The U.S. Department of Health and Human Services (HHS) published on July 14, 2010, a voluminous Notice of Proposed Rulemaking (NPRM), containing dozens of proposed amendments to three sets of Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations: the Privacy Rule; the Security Rule; and the Enforcement Rule. The proposed amendments are directed principally at implementing the Health Information Technology for Economic and Clinical Health Act (HITECH Act), which amended HIPAA and went into effect on February 17, 2010. A careful review of the NPRM for its impact on employers who sponsor HIPAA-covered plans reveals that, if the proposed changes were adopted, employers would be required to revise their business associate agreements, their HIPAA notice of privacy practices, and their policies for responding to access requests. The NPRM also provides employers with a roadmap for avoiding civil monetary penalties. (more…)
Category: HIPAA, Health Care Legislation |
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Posted By Adam V. Russo on July 26, 2010
Spencer’s Benefits Reports: The impact of the Patient Protection and Affordable Care Act on small group and individually purchased health insurance will depend upon many factors, according to a the Urban Institute’s recently issued paper, entitled How Will the PPACA Impact Individual and Small Group Premiums in the Short and Long Term? (more…)
Category: Health Care Legislation, PPACA |
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Posted By Adam V. Russo on July 26, 2010
www.dwt.com; By Elizabeth J. Deckman
Health Care Reform: New Guidance on Patient Protections in Group Health PlansNew interim final rules address pre-existing condition exclusions, annual and lifetime limits, rescissions, and other patient protections
Recently, federal agencies issued new interim final rules to address several patient-protection provisions of health care reform. The new regulations provide guidance on pre-existing condition exclusions, annual and lifetime dollar limits, rescissions, and other patient protections. Generally, these requirements are effective with respect to insured and self-insured group health plans beginning with the first plan year commencing on or after Sept. 23, 2010 (Jan. 1, 2011, for calendar-year plans). (more…)
Category: HIPAA, Health Care Legislation, PPACA |
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Posted By Adam V. Russo on July 23, 2010
www.larkinhoffman.com; by Bruce J. Douglas and Kelly M. Burke*
The big question on many people’s minds is where will the money come from to fund the deficit reduction and the Patient Protection and Affordable Care Act (PPACA). The Congressional Budget Office (CBO) estimates that the PPACA will cost $940 billion over the next 10 years. Even with the high cost of the PPACA, the CBO approximates that there will be a $143 billion reduction in the federal deficit over the next 10 years (2010-2019) and a $1.2 trillion reduction in the federal deficit in the 10 years following (2020-2029). (more…)
Category: Health Care Legislation, PPACA |
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Posted By Adam V. Russo on July 23, 2010
www.hrpolicy.org
This week, the Departments of HHS, Labor and Treasury released interim final rules requiring group health plans and insurers to provide first-dollar coverage for certain recommended preventive items and services. The rules apply to non-grandfathered plans under the Patient Protection and Affordable Care Act (PPACA), providing additional clarity for companies that are in the process of weighing pros and cons of maintaining grandfathered status. The preventive services mandate takes effect for plan years beginning on or after September 23, 2010, or one year after an applicable recommendation or guideline is issued. In general, health plans must provide preventive benefits without cost-sharing for the following: (more…)
Category: Health Care Legislation, PPACA |
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Posted By Adam V. Russo on July 23, 2010
By Steve Rasnick
I really don’t mean to pick on TPA’s because the same statement could be made for all businesses and business relationships, including insurance agents. In fact, I began to think of this issue as I focused on the fact that on 2/1/10 my TPA celebrated its 13th year of business in Southwest Florida. Thirteen wonderful years serving customers, many of whom who have been with me for all thirteen of those years; but why not all of them? Aren’t long term business relationships supposed to be like fine wines, getting better with age? Why have some of mine, and I would imagine some of yours, turned to vinegar over the years? I think that the answer is intriguing, and it is the pursuit of this answer that caused me to write an article which is only tangentially related to health insurance. (more…)
Category: Health Care Legislation, Third Party Administrators |
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Posted By Adam V. Russo on July 23, 2010
The Self-Insurance Institute of America, Inc. (SIIA) applauded today’s directive by Rep. Dennis Moore (D-KS) to the Government Accountability Office (GAO) that it investigate abuses of federally sanctioned risk retention groups (RRGs) by some state insurance regulators.
Rep. Moore, chairman of the Oversight Committee on Financial Services, directed the GAO to study instances when non-domiciliary states attempt to improperly regulate the operation of RRGs through such tactics as “cease and desist” orders, onerous filing requirements, imposition of fees, waiting periods, information requests or other means. (more…)
Category: Health Care Legislation |
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