Changing names keeps this topic off the front page but it’s still lurking out there and EVERYONE will be impacted.
Originally, Obamacare(PPACA) called it the Federal Commission Coordinating Comparative Effectiveness Research (FCCCER). ObamaCare opposition leaders called it the Death Panels. Now it has been officially renamed the Patient-Centered Outcomes Research Institute (PCORI). The new name certainly sounds better and the acronym is certainly better when trying to say it on national television. Almost sounds like a private market think tank. I’m getting warm and cozy feelings just saying it now.
The purpose of the “Institute” (cozy again) is to determine where medical dollars are best spent as the inevitable tightening of the belt looms on the horizon. There research is supposed to provide insurers with information, not mandate levels of care. However, there is a time coming when we just won’t do expensive life saving surgeries on 90 years olds or otherwise terminal patients. Morbidly obese people aren’t going to get those knee replacements when they aren’t going to take care of them. Does everyone need an nice electric wheel chair? Maybe not. They will get what Canadians get now, univeral and cheap walkers. The Institute will be the panel determining your options in the future.
The purpose of today’s blog is to let you know who is paying for the “Institute”. The insane will tell you that those nasty thieves at the insurance companies are going to pay fees! The sane know that people pay all taxes, one way or the other. In this case, the Institute will be funded by a trust fund that is financed in part by fees from health plan insurers and self funded plan sponsors. Fees will be collected for plan years ending after September 30, 2012 and before October 1, 2019. (Anyone want to start betting on the date they raid the trust fund and extend this temporary “fee”?)
The fees look like this:
From 10-1-2012 to 9-30-2013 – The fee is equal to $1 per average number of lives insured.
From 10-1-2013 to 9-30-2014 – The fee is equal to $2 per average number of lives insured.
From 10-1-2014 to 9-30-2019 – The fee is equal to $2 per (adjusted for medical inflation) average number of lives insured.
I know it is just a couple of bucks, but they are YOUR bucks and my bucks. Large employers who fully self fund their own benefits even have to pay the fee. And by the way, it is a fee. Taxes are paid to government entities. This Institute was intentionally called a Nonprofit, NonGovernmental organization supported by a trust fund. The fact that it is created and mandated by federal law and supported by forced contributions from the general public doesn’t mean it’s Governmental! (Note: Medicare, Medicaid, SCHIP, VA and Indian Health are exempt)
You aren’t hearing about this anymore because they changed the name. It’s all about what you call it. FCCCER, Government Death Panels, Taxes have been replaced with cheery, non-instrusive, Patient-Centered, Non Profit, Fee based Institutes! Oh joy!
Paula L. Wilson, RHU, REBC is an insurance agent and benefits consultant in Southern California.
Leave a comment | tags: Death Panels, employer, insurance, insurance agent california, obamacare, PCORI, PPACA | posted in Health Care, Health Care Reform, PPACA, Uncategorized
It’s hard to find a family that has not been touched by the diagnosis of Autism. It’s epidemic spread not only causes devastating concern for families but the financial implications are extreme. Federal and State educational programs are only spread so thin before resources run dry for many. Even with Federal and State Mental Health Parity Laws, the insured public continues to fight on a daily basis for therapies to help their children.
As insurance agents engaged in this daily fight, we welcome this clarity of coverage. Our agency has always worked as an advocate for our clients to get the most out of their policies and to provide as much covered care as possible. Help is arriving in California on July 1, 2012 in the form of SB946. SB946 (aka. Mental Illness: Pervasive Developmental Disorder) will add coverage for Behavioral Health Treatment (BHT).
The technical definition of BHT is “professional sevices and treatment programs, including applied behavior analysis and evidence-based intervention programs that develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive development disorder or autism.” Coverage must be prescribed by a licensed physician and pre-authorized by the health plan. It will cover treatment in non-institutional and home settings as well as in-office services.
In addition to mandating coverage for autism treatment, the bill requires the creation of the Autism Advisory Task force. Advocates for Autism issues will be well represented on this board. “Autism Speaks” Vice President, Lorri Unumb was named as a member of this important task force. “I am honored to serve on this task force and to contribute to making California’s autism insurance reform law one of the most effective in the nation,” said Unumb. “Autism Speaks welcomes this opportunity to work with the DMHC.”
California insurers will begin mailing notices to all policyholders over the next month to provide information on this important July 1, 2012 amendment. The bill also mandates that insurers provide adequate access to providers that will be able to provide these services. This will help to assure policyholders that covered services will also be made more available.
When an employee is dealing with this family issue they are very often pulled away from work. They may spend hours on the phone fighting for coverage approvals and provider access. Employers are paying the price for this lack of “presenteeism” in these employees. We look forward to educating employers and employees on the benefits of this new law and how proper Wellness and Employee Assistance Programs can work together to provide the best outcome when dealing with the issues affected by this new law.
Paula L. Wilson, RHU, REBC is principal of Paula L. Wilson, Inc., an Employee Benefits Firm. Employers are encouraged to contact Paula at 888-447-2852.
Leave a comment | tags: 2012, autism, Autism July 1, Autism mandate, Autism Speaks, Autism Task Force, California Autism Insurance, EAP, Employee Assistance Programs, Employee Benefits, insurance agent Temecula, presenteeism, SB946, Wellness | posted in Health Care, Health Care Reform
Employers with health insurance costs weighing heavily on their backs should enjoy a small sigh of relief as Buck Consultants released their recent survey results of 129 insurers and administrators. The results? For the first time since 2001 they estimate the cost increase for health plans to be less than 10%……..only 9.9% for 2012.
The survey goes on to explain the reduction in the rate of increase is primarily due to a correction in margins insurers had previously built in for health reform as well as a reduction in elective procedures by the insured public. During a time of such prolonged economic slowdown, people are just putting off what they consider to be elective.
Last year the trend was 11.2%.
Even at 10%, the result is a huge new nut to crack on top of already enormous numbers. It isn’t quite what employers were looking for in upcoming benefit budgeting. They still long for that time when rates remained relatively flat.
It is my opinion that employers and benefit professionals should continue to push everyone to take advantage of the preventive services now available on all non-grandfathered plans. Getting the right preventive care and continuing the expansion of Wellness Programs is vital in order to avoid the explosion of costs to follow if new disease is left undiagnosed or untreated due to cost concerns. Employers and their Benefit Advisors cannot to overlook the proactive role they must continue promote.
If you are interested in learning more about Health Care Reform, Wellness Programs or preparing for the upcoming mandates, please contact Paula Wilson at 951-694-1009.
Leave a comment | tags: benefit advisor, buck consultants, cost, employers, health care, Insurance Agent, PPACA, reform | posted in Health Care, Health Care Reform, PPACA
Employers getting overwhelmed with timelines and deadlines shortly after PPACA was passed are now confused with the slowdown on the action. Why? Because timelines change as the administration realizes they keep putting the cart before the horse and extend and amend deadlines. And so it is with the ominous Summary of Benefit and Coverages requirement. You know, the one that says people can’t possibly comprehend the benefits as outlined in the current Summary Plan Description, yet need twice the information carved into a 4 page cornucopia of information they still won’t read. Originally slated for March 2012, employers who were paying attention to these threats of non-compliance are worried about fines and fees…..are they behind the curve?
Well, we are currently receiving phone calls and inquiries regarding these PPACA regulations that were to go into effect on 3-23-2012. Specifically employers are asking us for directions on the required Summary Benefits of Coverage that, if not distributed, can result in $1,000 penalties per failure. Please note the following:
ON SUMMARY BENEFITS OF COVERAGE
- Refresher: PPACA (Obama Care) requires that ALL employers distribute a very specific 4-Page Summary of Benefits (not to be confused with the current Summary Plan Description).
- The original deadline for implementation of this requirement has been delayed, in general, to the first renewal after September 23, 2012. AKA: All effective or renewal dates beginning 10-1-12.
- The Insurer is responsible for creating this Summary for each plan offered. It applies to your health benefits only. (HSA and HRA information may be included.)
- It is the responsibility of the employer to make sure this is distributed to all of the employees and their dependents. It can be in paper or electronic form. (Caution: Electronic form must abide by current ERISA rules. In short, if your employees don’t log on to a computer daily to receive employer communications, that system will not pass. )
- These rules apply to COBRA beneficiaries as well. This is where you COBRA administrator will become very important. We are confident that every COBRA administrator we have installed will provide excellent support in this area.
- A penalty of $1,000 per failure applies to the Employer.
- This applies to our Self-Funded clients as well. We will negotiate with the reinsurance carriers for that SBC.
- There are very specific rules regarding continued distribution of this 4-page SBC as new employees are hired, benefits are change mid-year and upon request of any beneficiary.
ON PREMIUM REBATES
As you know, insurers must rebate excess premiums when they exceed the new MLR (minimum loss ratio) rules. We have just received details on how employers distribute rebates to employees. We are reviewing these regulations now regarding the taxability of these to the employees as well as other details. Since the first rebates are not expected until August 2012, we will be sure to present you with guidance long before they occur. We believe the taxability will depend on the method of deduction in the first place. (After tax vs. Pre-Tax via Section 125 Cafeteria POP Plan)
NOTE: California employers currently receiving rebates from Blue Shield should not confuse these current voluntary rebates with the upcoming MLR rebates.
Ongoing Support during PPACA Implementation
Please be assured that we continue to be very current on all of the implementation details of PPACA and will continue to monitor and assist our employer clients as if PPACA will survive the pending SCOTUS decision. Our library of details is very complete and we will get information to you on a timely basis.
We appreciate all referrals to your employer group friends and associates that may benefit from our services. Frankly, I rarely run into insurance “agencies” that know or care much about this challenge. We continue to be very hands on in order to assure that OUR clients receive the most timely and proper advice as the full implementation of this law approaches. Planning over the next year is critical. We are just 19 months away from the full implementation. HHS is rolling out more and more detail every week. The sooner we can build relationships with new clients, the better we will be able to guide them through the upcoming tsunami of regulations coming at them. Please feel free to forward this to your associates.
Paula L. Wilson, RHU, REBC PAULA@PAULAWILSON.COM 951-694-1009
Leave a comment | tags: california, coverage, employer, health care, health insurance, Insurance Agent, PPACA, premium, rebates, summary of benefits, updates | posted in Health Care, Health Care Reform, PPACA