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EasyToInsureME Individual Health Insurance Reform Weekly

Week of November 9, 2023

Given that the Senate is expected to require much more time than the House to vote on a health care bill (see below), it is likely there is not enough legislative time left in 2009 to wrap up a bill for Christmas delivery to the White House. Senate Majority Leader Harry Reid fueled concerns about the schedule last week when he refused to commit publicly to passing an overhaul bill this year. This makes a “conference” between the House and Senate MORE likely in January 2010 THAN IN 2009, and that could require some time since the current House and Senate versions are vastly different on several key provisions. If the Conference pathway proves too contentious, House Speaker Nancy Pelosi and Reid could play legislative “ping-pong,” whereby each Chamber makes a modest change and ships if off to the other, back and forth, until they both approve the same language.

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Federal

Late Saturday night the House of Representatives approved its version of health care reform by the slim margin of 220 to 215 (218 was the minimum needed). The core of the approved House bill remained unchanged from the version the Speaker introduced a few weeks ago and includes: an employer mandate to provide and pay for coverage; a fairly strong individual coverage requirement; a public plan option set up by government that would pay “negotiated” rates to providers; and insurance reforms, including guaranteed issue and modified community rating. It does not include the “Cadillac” plan tax or the insurer tax provisions currently in the Senate bill. The House bill would be paid for in part with cuts to Medicare Advantage and a surcharge on the “wealthy.”

On the Senate side, Majority Leader Reid is waiting for the revenue score from CBO on several different Senate Bill scenarios, given that several Senators have publicly stated opposition to going forward without a hard and fast number on both cost and impact on bending the spending curve. He also needs this time to win over the 60 votes needed to even proceed with consideration of the bill, let alone the 60 needed to cut off debate once the debate begins; he may not have either right now. The earliest the Senate could start debate would be the week of November 16, but a date in December seems more likely. Approval of the House bill will surely put increased pressure on the Senate to move forward but to do so cautiously, given the slim voting margin in the House, as the issue moves closer to the finish line.

Bills to extend and expand COBRA have been introduced in both the House and Senate and could well be part of the final push on health care reform. Both versions extend the Special COBRA subsidy program from end of 2009 to June 30, 2024 and maintain the government’s 65 percent subsidy. The Senate version increases this subsidy to 75 percent, and the House extends basic COBRA eligibility from 18 to 24 months. Given the unemployment numbers, it seems likely that, whether as part of health reform or on its own, a COBRA extension (including the subsidy) will be enacted in 2009.

States

ARIZONA: Governor Jan Brewer and legislative leaders have reached a tentative agreement to reconvene to address the projected 2010 budget shortfall, which ballooned from billion in early September to billion by the end of October. Although the governor favors a temporary tax increase to boost revenue, she is unlikely to float that idea this time around to help limit the length of the session. Governor Brewer is expected to announce her candidacy for re-election. Although the former lieutenant governor is now the incumbent and has never lost an election, she is viewed as vulnerable by some Republicans because of budget concerns and her continued focus on obtaining additional revenue through taxation.

CALIFORNIA: California’s state budget deficit could reach billion for the current fiscal year in part because of recent court decisions blocking state funding cuts. For example, a federal judge recently blocked the state’s plans to cut million from its budget for In-Home Supportive Services, and Insurance Commissioner Steve Poizner has filed a suit to block the sale of part of the State Compensation Insurance Fund, which was projected to generate billion. Some analysts project that the state’s budget deficit will range from billion to billion in the upcoming fiscal year. In other developments, Lt. Governor John Garamendi won a special election to fill the Congressional seat vacated by U.S. Representative Ellen Tauscher (D). Garamendi was elected lieutenant governor in 2006 after 16 years in the legislature and two terms as insurance commissioner.

COLORADO: Senator Betty Boyd, President Pro Tem and Chair of the Health and Human Services Committee, met with insurer representatives to highlight the issues likely to get attention in the upcoming session. A proposal to prohibit the use of gender in rating individual policies has a high likelihood of passing, she said. Senator Boyd also advised that efforts will be made to ensure that the Cover Colorado program remains solvent, as it has potential to be used as the state’s public plan option. Speculation has it that Colorado could become one of the first states to act on federal health care reform if it is enacted. Finally, she expressed a strong interest in authorizing the DOI to establish standardized policy forms.

DELAWARE: Department of Health and Social Services Secretary Rita M. Landgraf has issued an update to existing statutes adding virtual colonoscopy as an approved colorectal screening modality. Delaware law requires coverage for colorectal screening modalities and empowers the Secretary to add modalities as recommended by the Delaware Cancer Consortium. Accordingly, all contracts for health insurance issued, delivered or renewed after December 1, 2023 must include coverage for virtual colonoscopy for colorectal cancer screening.

DISTRICT OF COLUMBIA: Newly passed legislation requires individual and group health plans to provide coverage for orally administered chemotherapy medication in a manner no more restrictive than intravenously administered treatment or injected cancer medications. In other business, the Council of the District of Columbia confirmed Acting Commissioner Gennet Purcell as Commissioner for the District of Columbia Department of Insurance, Securities and Banking (DISB). Commissioner Purcell, who served as DISB’s Deputy Commissioner since 2008, is an attorney and member of both the State of Maryland Bar and the Commonwealth of Virginia Bar. As deputy, her primary responsibilities included oversight of the agency’s core functional areas, including the divisions of Insurance, Securities, Banking, Fraud Enforcement and Investigation, and Risk Finance.

GEORGIA: A meeting was held last week between health insurance representatives and the Chairman of the Senate Insurance Committee to discuss legislation for 2010 that would restrict rental networks. The Medical Association of Georgia also was represented. Aetna has committed to work with all interested parties on the legislation.

ILLINOIS: A fall veto session concluded at the end of October, and three health insurance bills of import passed both chambers. The first bill creates external review requirements for all commercial insurance products, rather than just HMOs, effective July 1, 2010. The bill also establishes committees to create a uniform small-employer group health status questionnaire and an individual health statement for use on January 1, 2011. The legislation also requires insurers to semi-annually prepare and provide the Department of Insurance a statement on aggregate administrative expenses and other information. It is a good compromise versus what was originally proposed. In addition, both chambers passed an orthotics and prosthetics mandate on health carriers and HMOs for policies amended, delivered, issued, or renewed six months after the effective date of the amendatory act. The third bill changed the requirements to obtain a producer license. The Illinois General Assembly is not expected to reconvene until January 2010.

MISSOURI: The Secretary of the State recently approved a ballot initiative proposal for the November 2010 ballot that would essentially eliminate network-based health care delivery in Missouri. The move follows unsuccessful efforts to enact an any-willing-provider bill in past legislative sessions.The petition effort behind the ballot initiative appears to have been spearheaded by a local surgical practice that has been excluded from the medical staffs of local hospitals. Any willing provider is only one portion of the proposal. It would apply to health carriers and health benefit plans, including Medicare and Medicaid, and facilities. It would, for example, prohibit carriers from: Imposing on a beneficiary any co-payment, fee, or condition that is not equally imposed on all other beneficiaries in the same benefit category, co-payment level, or class; prohibiting or limiting a provider from the opportunity to participate in the network if that provider is willing to accept the carrier’s operating terms and conditions, fee schedule, covered expenses, utilization and quality standards. The State Auditor is preparing an assessment of the fiscal impact of the proposed measure as well as a brief summary of the fiscal impact for the petition. Legal challenges to the ballot initiative are permitted. A group of stakeholders, including Aetna, are discussing strategy.

NEW JERSEY: Health insurance issues were front and center in a bitter battle for the governor’s office, which ended last week when Republican candidate Chris Christie defeated Democratic Governor Jon Corzine. The governor-elect has publicly supported greater flexibility for carriers to make health coverage more affordable via mandate-free plan designs and interstate sales of health policies. The Democrats remain in firm control of the legislature, which will make the governor-elect’s agenda an uphill battle. Also, the Department of Banking and Insurance (DOBI) adopted a regulation standardizing the information and format on health identification cards. Additionally, DOBI initiated a meeting with the state’s major health plans seeking guidance as to how the state might proceed in limiting plans,’ and members,’ exposure to exorbitant out-of-network provider charges. This is one in a series of meetings aimed at developing consensus on an appropriate fee schedule or other mechanism for non-par provider charges. Lastly, the NJ Department of Health & Senior Services (DHSS) has launched a six-month Hospital Newborn Pilot Program. Nine hospitals throughout the state are participating in a pilot to ensure no newborn leaves the hospital without health insurance. The participating hospitals are expected to submit data to the DHSS.

NEW YORK: Governor David Paterson is calling for a special session to address the current state budget deficit. The Governor’s two-year, .2 billion Deficit Reduction Package would have a current-year impact of .2 billion in 2009-10 and a recurring impact of billion in 2010-11. The components include across-the-board spending reductions and a tax penalty forgiveness program. The Governor indicated that his agenda will include a bill that would completely prohibit all subrogation (collateral source) recoveries on any insured or self-insured plans. The existing collateral source rule eliminates the potential windfall of double recoveries to plaintiffs who receive benefits and make recoveries from both their insurance coverage and defendant payments, while still ensuring that uncompensated losses are fully compensated. This subrogation legislation passed the Senate earlier this year, but it has not passed the Assembly. In other business, State Sen. Eric Schneiderman, chairman of the Codes Committee, and Sen. Neil Breslin, chairman of the Insurance Committee, introduced a bill known as “Ian’s Law,” which is named after a patient with muscular dystrophy. The proposed legislation would prohibit non-renewal of group policies and would require heath plans to get state Department of Insurance approval before discontinuing a class of insurance. The bill also would require plans to continue covering a totally disabled policyholder for 18 months, even if the plan gets state permission to cancel an entire class of policies.

Employer based Health Insurance

When looking for health insurance, the first question you should ask is, “Does my employer offer a health insurance plan?” Most companies provide health insurance as a benefit, and larger firms are required to provide health insurance. If your employer has a health insurance plan you should take the time to look into the costs and benefits. Very often employer-based health insurance is less expensive than comparable individual coverage.

Employer-based health insurance is cheaper for a number of reasons. Number one is your employer bears some of the cost for your health insurance. Another key reason employer-based health insurance can be less expensive than individual health insurance is rates and qualification requirements are typically lower. You can also save additional money with employer-based health insurance. One way is to have your employer pay the premium on a pre-tax basis to lower your overall taxable gross pay. Another way to reduce your taxable income is to participate in your employer’s flexible spending plan to save money for out-of-pocket health insurance expenses such as co-pays, some medications and certain medical devices.

COBRA benefits

A concern you might have about employer-based health insurance is what happens to your health insurance when you change jobs, are released by your employer or otherwise become unemployed? A government program called the Consolidated Omnibus Budget Reconciliation Act (COBRA) gives you the right to carry your employer-based group health insurance coverage with you for up to 18 months. While COBRA will allow you to remain insured, you will have to pay the entire premium for your group health insurance. Previously both you and your employer contributed to the cost of your health insurance. If you find yourself requiring COBRA benefits make sure to fill out the appropriate forms available from your previous employer’s benefits department within 60 days of leaving the job. Otherwise you could be denied COBRA health insurance coverage.

No employer-based health insurance? No problem!

What if your employer doesn’t offer health insurance? Not a problem, you can always buy an individual health insurance policy. And it’s possible, if you are member of an organization or group that offers group health insurance, to retain the benefit of employer-based health insurance in terms of lower rates and qualification requirements.

Whether your employer offers health insurance or you are just looking for an individual health insurance policy, be sure to take your time and compare health insurance quotes to find a policy that best fits your family’s health insurance needs and saves you money. It pays to shop around for your health insurance policy.

Security Solutions - Identifying issues in the organization

In the modern computing, businesses have started working within business networks where they interact with external partners such as customers, vendors. In such a chaotic environment, it is critical that security takes the highest precedence.

Security within perimeters mindset needs to go away, and replaced by a more robust and end to end approach. Developing comprehensive security architecture requires methodical and deliberate analysis. In order to devise optimized security solution, one must evaluate existing security issues within the organization.

How do you identify security issues in your organization?

Security Access Provisioning Process: One of the most common issues in any organization is about security access provisioning. Most if the time, this is done in ad hoc manner. Somebody wants access to a system (e.g. CRM application) and sends a request to the administrator. Administrator provisions the access. Later when that somebody has moved to other department or left the company, that access is still there. Developing a comprehensive access provisioning to all IT systems is very important for any organization.

Data in Transit Issues: Data in transit (when data moves from one system to another system) is another critical aspect of data security. How do you make sure that data flowing on network bus is not being compromised? Passwords, employees’ sensitive HR information flow on network without sufficient protection can lead to severe results. It is important to realize that most of the security issues come from within the firewalls. Employees getting unauthorized access to systems and data can result into significant legal issues.

Data exchanged with External Partners: Data exchanged with external business partners poses another challenge. How do you make sure that the data is viewed only by its intended recipient? How do you make sure that the data integrity was not compromised on the way? On the other hand, how do you make sure that the data coming from external partner was sent by the expected sender? You should realize that enabling a secure operating environment with your partners is a big boost to the business itself.

Intrusion Prevention: When so many systems are put in place to communicate with external partners, how do you make sure that no unwanted intruder is trying to get access to your valuable information? How do you make sure that the incoming data is secure enough so that it can be processed by your systems (e.g. emails, documents, messages)?

Security Analysis and Audit: Do you enforce regular security audits? Do you capture required level of system and access logs in a consistent manner so that a detailed security analysis can be done as and when required? One can identify patterns in log data about upcoming security threats.

Why Healthcare Facilities Need Vendor Credential Systems

Healthcare vendor credentialing is becoming more critical with the increased responsibility that hospitals and other healthcare centers carry. These facilities must know at any given time who provides specific services and who currently is in the facility. With the rise of pandemic regulations and the desire to be sure patients receive the best care, vendor management and credentialing must be a focus for every hospital administration. The sheer volume of the vending sources required to effectively run a hospital quickly overwhelms anyone considering implementation of such as system.

Developing a software system through the hospital IT department often leads to complex questions, long delays, and frustration between IT and administration. There are options already on the market that will quickly bring any hospital or healthcare center into compliance. This can happen with no charge to the hospital. Hospital vendor management and credentialing has never been easier.

Before considering specific companies, a definition of such a service needs to be provided. A hospital vendor credential management system provides the necessary tools to assess vendor credentials and track vendor entrance and exit to the healthcare facility. It provides a base through which all vendors receive credentialing and necessary identification. Centralization of this information removes pressure from hospital administration to credential individual vendors and provides the necessary tools for access.

Individual practices create confusion and an abundance of needless paperwork. However, signing up with a hospital vendor management company gives the hospital a central place to send their vendors for credentialing. The credentialing agency also handles all the documentation necessary for maintaining current and accurate records. Securing a management company gives the administration peace of mind knowing that all vendors carry current credentials, accurate identification, and all entrance and exits are electronically logged.

Anytime questions arise regarding as to who is in the healthcare facility or who was in the facility at a particular time, that critical information can be easily obtained through the web-based technology. This system effectively plugs many security holes, ensuring that only those qualified to be in the facility at certain times and performing certain duties are present. Tracking this information is especially critical when dealing with vendors delivering various drugs and other important resources to the hospital or healthcare center. One large heathcare vendor credentialing system allows both providers and suppliers the ability to carry on with their main responsibilities and keep from being overwhelmed with excessive paper work and compliance issues.

Web-based hospital vendor management can be set up within a few minutes, once the proper framework is established. Special computers and software are not necessary. A few computers off the shelf at a local appliance store, some scanners, and a label printing machine constitute the only equipment needed by the hospital. Badges are printed for all the vendors and scanned upon entry and exit.

The actual software set up can be done in less that five minutes. Vendors that sign up with a central hospital vendor credentialing system receive access to all hospitals for one flat fee. If vendor supplies only one hospital, a base membership at no charge is available. The centrality of such a system allows cost to the vendor to remain low, thus keeping vendors from passing rising costs to hospitals.