News & Events
Missouri voters on Tuesday overwhelmingly rejected a key provision of health care reform law. About 71 percent of Missouri voters backed a ballot measure, Proposition C, that would prohibit the government from requiring people to have health insurance or from penalizing them for not having it. Missouri is the first state to challenge aspects of the federal law in a referendum.
This is just another clear sign that people are not happy about the health care Law. Anytime there are 71% of people opposing that is a big number. The Missouri Hospital Association spent $400,000 trying to warn Missouri residents that Proposition C could raise prices at the hospitals. Even with $400,000 being spent to oppose proposition C it still passed by 71%. The could start a chain reaction of other states opposing the health care reform by referendum.
With the Affordable Care Act comes medicare Reforms. Historically, Medicare has often led the entire health care system in the adoption of quality and payment innovation. The reforms that go into place will not only affect Medicare but could change the way the health care system is paid.
Meidcare reform means Reform our health care delivery system, appropriately price services and modernize financing systems, and fight waste, fraud and abuse.
Unnecessary hospital readmissions
The Affordable Care Act creates a “hospital readmissions reduction program,” which will help hospitals smooth transitions for patients and reward hospitals that are successful in reducing avoidable readmissions.
Hospital acquired conditions
The Affordable Care Act imposes payment penalties on the 25 percent of hospitals whose rates of hospital acquired conditions like bedsores, complications from extended use of catheters, and injuries caused by falls, are the highest.
Rewarding Better Care
CMS will expand payments for value—in 2013—by rewarding better care for five of the most prevalent conditions. Physician payments will also become more closely linked to value with the launch of a physician value-based payment system and the implementation of a “value-modifier” that rewards physicians who deliver better care.
Accountable Care Organizations
The Affordable Care Act promotes team-based health care through Accountable Care Organizations (ACOs) under the Medicare shared savings program
Center for Medicare and Medicaid Innovation
To support the ongoing development of new models of payment and delivery, the Affordable Care Act establishes the Center for Medicare and Medicaid Innovation
Independent Payment Advisory Board
The Affordable Care Act also establishes the Independent Payment Advisory Board, or IPAB, to monitor the fiscal health of the Medicare program and to recommend payment policy revisions to contain Medicare cost growth.
Improvements to productivity and market basket adjustments in certain provider settings
The Affordable Care Act ensures that Medicare more accurately accounts for productivity when determining provider payments and revises annual payment updates in certain health care settingsTo support the ongoing development of new models of payment and delivery, the Affordable Care Act establishes the Center for Medicare and Medicaid Innovation
Ending Overpayments to Medicare Advantage Plans
A major inefficiency that the Affordable Care Act addresses is overpayments to private insurance plans that serve Medicare beneficiaries, known as Medicare Advantage plans
Modified equipment utilization factor for advanced imaging
Provisions in the Affordable Care Act address widely recognized areas of overutilization, such as advanced imaging services, which not only wastes resources but may also pose a danger to beneficiaries from needless exposure to radiation
Bidding for Durable Medical Equipment
CMS also continues to implement competitive bidding for durable medical equipment (DME), which the Affordable Care Act accelerated
Targeted and efficient anti-fraud activities
The new law gives CMS the authority to target anti-fraud activities to geographic areas, provider types, or services based on the type or level of risk posed to the program.
Ensures transparency of ownership and ensures provider compliance with Medicare’s requirements
The Affordable Care Act includes new protections that require all providers to have compliance plans. This will ensure that providers are abreast of Medicare requirements and in compliance with them and can focus their attention on patient-care.
The new health care reform forces everyone to buy health insurance or pay a tax penalty. This has become a major debate with many who oppose the health care reform. This requirement is the corner stone of the white house health plan. The argument was that if everyone is on a health plan that will help to offset costs for both the insurer and providers. There is a long legal battle a head but if this aspect was determined to be unconstitutional it would have a huge impact on the over all health care reform.
U.S. District Judge Henry Hudson refused to dismiss the state’s lawsuit, which argued the requirement that its residents have health insurance was unconstitutional.
The Judge who noted that his ruling was an initial step, decided the law was ripe for review. He said the issue the state raised — whether forcing residents to buy something, namely health care, is constitutional — had not been fully tested in court.
On Thursday, the US Department of Health and Human Services announced that there would be federal grants of $1 million to help for each state to set up the health insurance exchange. Each state is then going to be able to set up the exchange how they see fit. The idea is that the Gov sets up the market place and then the private market competes.
New Mexico’s wants to develop “a strong Exchange that promotes competition between plans based on quality and price in a way that is transparent to consumers.” This is an interesting approach because this could include restricting plans from the Exchange that would exceed specified premium levels or by requiring cost initiatives of plans participating. So it looks like New Mexico will decide what carriers get to participate in the exchange.
As states start to develope the exchanges the orginal view that the exchange would act as a market place for carreirs to compete with guarnteed issue plans. Now the big question is what will a plan in the exchange cost?
Sept. 1st we will see many stats launch their high risk pool plans. Ohio has released details of their high risk pool plan and it was reported that they would only be able to insure 5000 of the 17,000 people that are eligible for the health plan. They are keeping premiums low $98 to $493 a month for nonsmokers and $98 to $642 a month for smokers. The state of Ohio received $152 million in federal money to pay for the new program and time will tell if that is enough. The first red flag that this program is under funded is that Ohio can not offer to the full 17,000 that need it.
Section 9006 of the health care bill — just a few lines buried in the 2,409-page document — mandates that beginning in 2012 all companies will have to issue 1099 tax forms not just to contract workers but to any individual or corporation from which they buy more than $600 in goods or services in a tax year.
It has now come to light what a burden this aspect of the health care reform is going to have on small business.
Democrats and Republicans want to repeal it, but getting them to work together on the issue is proving difficult in an election year.
Republicans want to repeal the filing requirement and pay for it by changing other parts of the new health-care law, a strategy that Democratic leaders won’t support. Democrats want to repeal the filing requirement and pay for it by raising taxes on international corporations and limiting taxpayers’ ability to use special trusts to avoid gifts taxes. Republicans won’t support that.
The House rejected the Democratic bill Friday after Democratic leaders brought it up under a procedure that requires a two-thirds majority for approval. The vote was 241-154, with nearly all Democrats voting in favor of the bill and nearly all Republicans opposed.
Its important to note that both political parties recognize how this law is going to impact small business. Both sides are willing to repeal it but have different ideas on how to make up the funding. This is very important because there will be many more debates on aspect of the health care reform that will need to be appealed or changed.
Under the health care reform all children under 19 can not be declined or pre x on a health plan. Everyone in the industry had major concerns over this issue. One of the big concerns was parents would wait until the child had a health care crisis and then enroll them on the plan. It was just released that carriers are now going to be able to have open enrollments for these types of plans. That means the child can get the plan without underwriting but only once a year.
We are now starting to see the reality of what can and cannot be done under the health care reform. In the last few months almost every Individual carrier pull out of the stand alone child market. Not only did we see regional carriers pull out but we also saw national carriers. When national carriers pull out of a market that is the a huge red flag because they have large reserves. It will be interesting to see if the carriers that pulled out get back in.
Another aspect that might be interesting is the premium for those stand alone policies during the open enrollment period. Will that policy cost more?
Effective first of the plan year or after September 23, 2010 , health plans will have in effect internal claims appeal procedures. Each plan must allow the insured to review his or her plan to present evidence and testimony as part of the appeal process.
So what this means is if carrier declines a claim the insured now has the right to appeal the claim from an independent source. If the independent source declines the claim the insured can this go to the Department of Insurance and appeal the claim in person. So some could give their testimony in person to appeal the claim.
This would have a huge impact on experimental treatment. Almost all plans exclude experimental treatment but now the insured has a right to appeal the denied claim. For example if a family had a child that need a experimental heart transplant and received the treatment and the claim was denied. Now that family has multiple sources to appeal the claim. There is a very good possibility that if a family appeals that claim in person the chance of it being declined is a lot less. Who would decline a claims that saved a child’s life?
Now this does create some situations for groups that are self funded that use reinsurance. It is vital going forward that the contract states the re insurance will pay for that claim if its appealed and won. Other wise you could have a group that is self funded that is now responsible for paying for a very large claim. So any group that has re insurance contracts in place should be looking at the at this aspect very closely.
If a group is grandfathered in then they do not have to comply with this requirment of the health care reform.
As we move forward with health insurance reform small group plans with under 50 employees may be dropping health plans all together in 2014. There is still going to be a need and desire for employee benefits. These future employee benefit packages are going to come in the form on non-medical benefits. This would Long Term Disability, Short term disability, Dental, Vision, Life and supplemental policies. Metlife came out with a study on how to keep your employee happy/loyal should you drop the group health plan. The purpose of these type of benefit packages is show the employee that the company is still investing in them.
According to MetLife’s 8th Annual Study of Employee Benefits Trends, 43% of all employees agree that benefits are a very important reason why they remain with their employers. This number drops to 31% for employees at smaller companies.
While healthcare legislation has grabbed the attention of small business owners and brokers, it is important to recognize that health coverage may become less of a differentiator when it comes to hiring, retaining and motivating workers. Non-medical benefits – like dental, disability, life insurance – and voluntary offerings will likely play an increasingly significant role in driving employee loyalty, retention and engagement.
Building a Better Benefits Program Without Breaking the Budget: Five Practical Steps Every Small Business Should Consider outlines steps that small business owners can take to strengthen their non-medical benefits program and optimize benefits value:
1. Manage costs for dental, disability and life insurance while increasing employee loyalty. Many small business owners underestimate the value that their employees place on non-medical benefits like dental, disability and life insurance. While 59% of small business employees say these benefits contribute to their feelings of employer loyalty, only 34% of employers recognize this. The resource outlines ways that employers can control their budgets while still offering benefits that drive loyalty.
2. Deliver budget-conscious wellness programs to aid productivity and help control medical costs. While 61% of larger employers offer wellness programs, just 22% of small companies offer the programs. However, 67% of small businesses believe wellness programs are effective at reducing medical costs. Low-cost options can be implemented by small businesses to help create a culture of health and control long-term costs. Options can include leveraging local health organizations and associations that can help to educate employees on healthy behaviors, or providing convenient access and time off to participate in wellness programs like weight loss, exercise and smoking cessation.
3. Help employees become financially secure and support productivity goals at the same time. About one in five small business employees admits that in the last 12 months, he/she has taken unexpected time off to deal with a financial problem or taken more time than should be spent at work to deal with personal financial issues. In fact, 64% of small businesses strongly believe that employees’ productivity is impacted when they are worried about personal financial matters. Small businesses can consider tapping into local financial institutions and services to provide retirement and/or financial planning options during work hours, or provide access to web-based financial resources for their employees.
4. Simplify benefits communications for greater benefits effectiveness. Only one in five small business employees believes that his/her employers’ benefits communications effectively educate the employee about their benefits programs. The resource gives best practices for benefits communication including using multiple channels, removing jargon, and making messages relevant to key life events or life stages. Employers can also beta test communications to listen and learn from their employees prior to launching a full communication campaign.
5. Leverage small business workplace advantages for increased worker loyalty. The MetLife Study found a loyalty gap in that nearly two-thirds of small businesses say they feel very loyal toward their employees but only about one-third of employees feel their employers have that strong sense of loyalty. Small business employers can take advantage of their company culture to foster an environment where work-life balance, which garners employee loyalty.
The major health carriers have developed a kind of efficiency rating for doctors and hospitals. These rating systems are directly communicating with the consumer. The rating systems show price of a procedure and quality of care. So if an insured wants to look up how many times a doctor has performed a certain procedure they can. They can also view the complication rate from that doctor or facility on that particular procedure.
The American Medical Association is stating that the Rating Measures are wrong up to 25% of the time. This is a very high % if they are correct. The Wall Street Journal confirmed that one of the studies that reported this high % was funded by the AMA.
What we are seeing from the top health insurance carriers is they are developing health plans that want you to use the top rated doctors and facilities. These plans will have less cost to the insured if they use the preferred doctors.
So now it seems that the health care providers are not happy that the insured can now look up the cost of the procedure and the quality of care that doctor provides. All of these types of plans were developed pre health care reform so it will be interesting to see if this type of health care information will continue to be available to the consumer. Recently the HHS launched a site that also gives a quality of care. So at this point there is not just the carriers programs available but now a free service to shop health care.
With the health care reform we are now going to see plans required to cover preventive care. It should be very interesting to see what kind of impact these coverages have on premium. There is no doubt that these additional coverage will increase premium. The problem right now is no one knows what kind of premium increase these coverages are going to have. From a long term standpoint if everyone takes advantage of these first dollar benefits will it reduce costs? If someone can catch a health problem early then the treatment can be much more effective which could reduce larger treatments down the road. In the short period we all pay more in premium.
“If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a copayment or coinsurance or meet your deductible, when these services are delivered by a network provider.”
Covered Preventive Services for Adults
Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
Alcohol Misuse screening and counseling
Aspirin use for men and women of certain ages
Blood Pressure screening for all adults
Cholesterol screening for adults of certain ages or at higher risk
Colorectal Cancer screening for adults over 50
Depression screening for adults
Type 2 Diabetes screening for adults with high blood pressure
Diet counseling for adults at higher risk for chronic disease
HIV screening for all adults at higher risk
Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:
Hepatitis A
Hepatitis B
Herpes Zoster
Human Papillomavirus
Influenza
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Tetanus, Diphtheria, Pertussis
Varicella
Obesity screening and counseling for all adults
Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
Tobacco Use screening for all adults and cessation interventions for tobacco users
Syphilis screening for all adults at higher risk
Covered Preventive Services for Women, Including Pregnant Women
Anemia screening on a routine basis for pregnant women
Bacteriuria urinary tract or other infection screening for pregnant women
BRCA counseling about genetic testing for women at higher risk
Breast Cancer Mammography screenings every 1 to 2 years for women over 40
Breast Cancer Chemoprevention counseling for women at higher risk
Breast Feeding interventions to support and promote breast feeding
Cervical Cancer screening for sexually active women
Chlamydia Infection screening for younger women and other women at higher risk
Folic Acid supplements for women who may become pregnant
Gonorrhea screening for all women at higher risk
Hepatitis B screening for pregnant women at their first prenatal visit
Osteoporosis screening for women over age 60 depending on risk factors
Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
Syphilis screening for all pregnant women or other women at increased risk
Covered Preventive Services for Children
Alcohol and Drug Use assessments for adolescents
Autism screening for children at 18 and 24 months
Behavioral assessments for children of all ages
Cervical Dysplasia screening for sexually active females
Congenital Hypothyroidism screening for newborns
Developmental screening for children under age 3, and surveillance throughout childhood
Dyslipidemia screening for children at higher risk of lipid disorders
Fluoride Chemoprevention supplements for children without fluoride in their water source
Gonorrhea preventive medication for the eyes of all newborns
Hearing screening for all newborns
Height, Weight and Body Mass Index measurements for children
Hematocrit or Hemoglobin screening for children
Hemoglobinopathies or sickle cell screening for newborns
HIV screening for adolescents at higher risk
Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
Diphtheria, Tetanus, Pertussis
Haemophilus influenzae type b
Hepatitis A
Hepatitis B
Human Papillomavirus
Inactivated Poliovirus
Influenza
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Rotavirus
Varicella
Iron supplements for children ages 6 to 12 months at risk for anemia
Lead screening for children at risk of exposure
Medical History for all children throughout development
Obesity screening and counseling
Oral Health risk assessment for young children
Phenylketonuria (PKU) screening for this genetic disorder in newborns
Sexually Transmitted Infection (STI) prevention counseling for adolescents at higher risk
Tuberculin testing for children at higher risk of tuberculosis
Vision screening for all children
http://www.healthcare.gov/law/about/provisions/services/lists.html
