Tuesday, November 25, 2014

Cost of Diabetes Care Keeps Climbing, Report Shows

The cost of diabetes care in the United States has increased 48 percent in recent years, climbing to more than $322 billion annually, a new report shows.

Even greater increases in cost were seen with prediabetes care, which have risen 74 percent, and undiagnosed diabetes, which have jumped 82 percent, the researchers added.

In 2012, excess medical costs and lost productivity associated with diabetes totaled more than $1,000 for every American. That total includes $244 billion in medical costs -- including doctor's office and hospital visits, prescription drugs and other health conditions such as high blood pressureand kidney complications -- and $78 billion in lost work productivity.

Read the full story via HealthDay.

CMS Announces PPACA Transitional Reinsurance Fee Amount for 2016; Formalizes In-Patient Hospitalization Requirement for Minimum Value Plans

NBCH thanks the American Benefits Council for the information provided in this post.

On November 21, 2014, the U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) released proposed regulations in the form of the 2016 Notice of Benefit and Payment Parameters. The proposed regulations address a number of issues, including the transitional reinsurance program (TRP) fee and minimum value requirements that were the subject of some recent attention and controversy.

Transitional Reinsurance Program Fee
Under Section 1341 of the Patient Protection and Affordable Care Act (PPACA), during the first three years that state health insurance exchanges are operational (2014 through 2016), health insurance issuers and plan administrators (on behalf of self-insured group health plans) will be assessed a per-enrollee fee to finance a three-year transitional reinsurance program. The contribution rate for 2015 is $44 per covered life; it was $63 per covered life for 2014.

The proposed regulations set the TRP fee at $27 per enrollee for the 2016 benefit year. The regulations also include additional information on the exception for certain self-administered, self-insured group health plans, clarifications regarding certain counting methods, and guidance regarding the deadline for satisfying reporting requirements where the reporting date does not fall on a business day. Specifically: 
  • Self-administered, self-insured plan exception: For the 2015 and 2016 benefit years, a "covered entity" does not include qualifying self-administered, self-insured group health plans. In the preamble to the 2015 Notice of Benefit and Payment Parameters, HHS indicated that it considered a third party administrator to be an entity that is not under common ownership or control with the self-insured group health plan or its plan sponsor. The preamble to the proposed regulations states that principles similar to the controlled group rules of Code sections 414(b) and (c) would apply for purposes of determining whether a third-party administrator is under common ownership or control with a plan or its plan sponsor.
  • Clarification to Snapshot Count and Snapshot Factor Counting Methods: The proposed regulations clarify the application of the snapshot count and snapshot factor counting methods to a health insurance plan or coverage that is established or terminated, or that changes funding mechanisms, in the middle of a quarter. The proposed regulations provide that, if the plan or coverage in question had enrollees on any day during a quarter and if the contributing entity uses either the snapshot count or snapshot factor method, it must choose a set of counting dates for the counting period such that the plan or coverage has enrollees on each of the dates, if possible. However, the enrollment count for a date during a quarter in which the plan or coverage was in existence for only part of the quarter can be reduced by a factor reflecting the amount of time during the quarter for which the plan or coverage was not in existence.
  • Clarification to Reporting Deadlines: The proposed regulations would require a contributing entity to submit its annual enrollment count for the applicable benefit year to HHS no later than November 15 of benefit year 2014, 2015, or 2016, or, if such date is not a business day, the next business day. 

In-Patient Hospitalization Requirement for Minimum Value Plans
The proposed regulations formalize guidance provided in IRS Notice 2014-69 (released on November 4) addressing the glitch in the HHS minimum value (MV) calculator that generated a fair amount of media attention earlier this year. The calculator is intended to be used to determine whether an employer-sponsored plan provides 60 percent minimum value. According to HHS and Treasury, the online MV calculator was improperly qualifying certain group health plan benefit designs that do not provide coverage for in-patient hospitalization services.

The proposed regulations formalize the guidance provided in Notice 2014-69. The proposed regulations would require that, in order to satisfy minimum value, an employer-sponsored plan must provide substantial coverage of both in-patient hospital services and physician services. The proposed regulations would apply to employer-sponsored plans, including plans that are in the middle of a plan year, immediately on the effective date of the final regulations. However, the proposed regulations provide that the final regulations will not apply before the end of the plan year for plans that, before November 4, 2014, entered into a binding written commitment to adopt, or began enrolling employees into, the plan, so long as that plan year begins no later than March 1, 2015.

Friday, November 21, 2014

NBCH Recognizes Plans for Engaging Members in their Health

Anthem Blue Cross and Blue Shield, BlueCross BlueShield of Tennessee, and Health Net receive 2014 eValue8™ Innovations Awards

WASHINGTON – November 21, 2014 – The National Business Coalition on Health (NBCH), a non-profit organization of purchaser-led business and health coalitions, honored Anthem Blue Cross and Blue Shield, BlueCross BlueShield of Tennessee, and Health Net with the 2014 eValue8™ Innovations Awards at its annual conference. The awards recognize the innovative work of plans to develop programs that engage members in managing their own health.

“A healthy and productive workforce is critical to the success of U.S. businesses competing in a global economy and we’re proud to recognize the innovations implemented by these plans,” said Foong-Khwan Siew, director of eValue8 for NBCH. “Motivating and empowering consumers to be active participants in their health and health care is a key component to a healthy and productive workforce, and the eValue8 award winners and finalists are excellent examples of leaders working to improve member health.”

The Ugly Cost of Developing New Drugs

Forbes has a well-informed and balanced discussion of what it costs to develop new drugs. While the average cost remains astonishingly high, variation can be 10-20 fold between developers. A worthwhile read.

Thursday, November 20, 2014

EBSA Issues Updated Guidance for Compliance with PPACA, Mental Health Parity Rules

NBCH thanks the American Benefits Council for the information provided in this post.

The Employee Benefit Security Administration (EBSA) of the U.S. Department of Labor (DOL) released an updated version of its Compliance Assistance Guide – Health Benefits Coverage Under Federal Law on November 19. This document, designed to help sponsors and issuers of health insurance coverage comply with current law, was updated to reflect changes attributable to the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

The MHPAEA prohibits large employer and group health plans that provide medical and surgical benefits and mental health or substance use disorder benefits from applying financial requirements or quantitative treatment limitations (such as a limit on the number of outpatient visits or inpatient days covered) that are more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical and surgical benefits. Final regulations, released in November 2013, apply to plan and policy years (for grandfathered and non-grandfathered plans) beginning on and after July 1, 2014 (January 1, 2015, for most calendar year plans).

The guide includes general descriptions of the various health care laws and frequently asked questions, self-compliance tools and tips, charts summarizing the notices a plan must provide and model notices. The November 19 update reflects changes to the mental health parity portion of the self-compliance tool section and the mental health parity provisions "questions and answers" section.

Tuesday, November 18, 2014

HHS Extends Deadline for Submitting Enrollment Counts for PPACA Transitional Reinsurance Program

NBCH thanks the American Benefits Council for the information provided in this post.

The U.S. Department of Health and Human Services announced late on November 16 that it is extending the deadline for contributing entities to submit their 2014 enrollment counts for transitional reinsurance program contributions until 11:59 p.m. on December 5, 2014. The deadline was originally set for November 15, 2014.

Section 1341 of the PPACA established a transitional reinsurance program (2014 through 2016) intended to stabilize premiums in the individual insurance market. Health insurance issuers and certain self-insured group health plans are assessed a per-enrollee contribution to fund this transitional reinsurance program. The HHS Centers for Medicare and Medicaid Services (CMS) recently released the form for submitting the TRP annual enrollment count.

The current deadlines for remitting the first (or combined) contribution amount (January 15, 2015) and the second contribution amount (November 15, 2015) remain the same. Additional information on the TRP is available on the dedicated CMS website.

Thursday, November 13, 2014

The Glass is Half Full

Many health care executives and professionals are wary, glass-half-empty people, conditioned by long experience to dwell on business risks. However, today’s health care environment is actually full of good news. Reflect on the following:
Expanding coverage. We’re on the way to cutting the number of uninsured Americans in half. No, we didn’t get to universal coverage with the Affordable Care Act. And its implementation has not been a pretty sight. But after decades of political failure, tens of millions of Americans are receiving coverage, no longer having to postpone care for serious health risks. Hospitals are already seeing their uncompensated care decline rapidly, especially in those states that expanded their Medicaid programs.

New Survey of U.S. Workers Reveals Two in Five Survey Participants Missed Work due to Depression and More than Half Reported Challenges Related to Thinking on the Job Resulting in Reduced Productivity

Canton, OH, Nov. 12, 2014 - Nearly a quarter (23 percent) of U.S. respondents indicated they have been diagnosed with depression in their lifetime and two in five (nearly 40 percent) of those patients reported taking time off of work – an average of 10 days a year – as a result of their diagnosis. These findings are just a few of the key outcomes stemming from The Impact of Depression at Work Audit(IDeA), evaluating the societal and economic burden of depression in the workplace. Employers Health, an Ohio-based employer coalition, announced results for the U.S. survey at the National Business Coalition on Health annual meeting in Washington, D.C. on November 12.

Read the full release here.

NBCH Honors Pittsburgh Business Group on Health with 2014 Membership Award

WASHINGTON and PITTSBURGH – November 12, 2014 – The Pittsburgh Business Group on Health (PBGH) was recognized with the 2014 Membership Award by the National Business Coalition on Health (NBCH) for their leadership and efforts to improve the quality and efficiency of the health care delivery system, control health care expenditures and improve health at the community level.

A member of NBCH, PBGH is an employer-led, non-profit coalition of organizations representing over 105 organizations in various business segments including private and public employers, government and education.

“We are extremely proud of the hard work our employer-members have been doing to recognize the importance of creating and sustaining successful health and benefits programs,” said Jessica Brooks, PBGH executive director. “And, we are particularly excited that more and more employer-members find value in our unique programs and use them to improve the lives of their employees.”

PBGH has demonstrated leadership through its Annual Symposium which garners more than 400 attendees each year; several key initiatives including prescription drug, health care, auditing services and flu vaccine programs, and Living My Life Diabetes management program. Additionally PBGH serves as a vocal advocate to support employers impacted by the Highmark Blue Cross Blue Shield and University of Pittsburgh Medical Center contract dispute, working with the Governor, Department of Health and Department of Insurance.

Pictured L-R: Chuck Smithers (NBCH), Diane McClune (PBGH), Jessice Brooks (PBGH), and Cheryl DeMars (NBCH Board Chair)

East Penn Manufacturing Company Honored by NBCH for Employer Excellence in Health Care

Award recognizes efforts to improve quality and efficiency of health care delivery system

WASHINGTON – November 12, 2014 – East Penn Manufacturing Company was presented with the 2014 Employer Excellence Award by the National Business Coalition on Health (NBCH) at its annual conference. The organization was recognized for its leadership and efforts to improve the quality and efficiency of the health care delivery system, control health care expenditures at the community level and improve employee health.

An active member of the Lehigh Valley Business Coalition on Healthcare (LVBCH) for more than 20 years, East Penn is a private, family-owned company operating the largest single-site, lead-acid battery manufacturing facility in the world.

“The NBCH award recognizes East Penn Manufacturing’s leadership in partnering with health care providers and health plans to improve the quality and cost of health care for their employees and the community,” said Tom Croyle, president of LVBCH.

The second largest employer in Berks County, Penn., East Penn has a long history of being an employer of choice in the region. They received the “Top Places to Work in Pennsylvania” designation for 14 consecutive years due in part to the emphasis placed on providing affordable and comprehensive employee health benefits, as well as their focus on employee safety. 
  
Pictured L-R: Chuck Smithers (NBCH), Dawn Dreibelbis (Reading Health System), Vicki Doule (Capital BlueCross), Rick Jones (Capstone Health Consulting), Bob Johnston (East Penn), Tom Croyle (LVBCH), Cheryl DeMars (NBCH Board Chair) and Scott Fair (First Niagra/Banyan Consulting)

Wednesday, November 12, 2014

Engaging Workers Year Round Ranks among Employers' Top Communications Challenges, According to Benz Communications and NBCH Survey

Employers missing out on big and meaningful chances to communicate with employees in frequent, personalized and accessible ways

WASHINGTON — Nov. 11, 2014 — Most employers (56%) say improving employees’ understanding and perceived value of benefits is their main focus, yet companies still lack personalized benefits communication at a time when it’s commonly expected by employees. These are among the findings of a new survey of more than 330 employers conducted by the non-profit National Business Coalition on Health and Benz Communications.

A collaborative effort, the 2014 Inside Benefits Communication Survey gathered key data from HR/benefits professionals about their benefits communication approaches, strategies and results.These findings are the second of two reports — the first report, released last month, detailed employers’ views on benefits through the lens of the Affordable Care Act (ACA) and other industry mandates and trends.

Saturday, November 8, 2014

Supreme Court Takes the Obamacare Subsidy Case--Justices Will Rule Before July 1

Robert Laszewski

Originally posted 11/07/14 on Health Policy and Marketplace Review

Note from Brian: For more background and context on why this case is so important to the future of the ACA, see this Vox article by Sarah Kliff.


In a wow moment, the Supreme Court announced Friday that they will take one of the four pending "Halbig" cases––specifically King v. Burwell.

The issue is over whether the new health law actually authorizes the payment of premium subsidies in the 37 states that will rely upon the federal government to run their exchange in 2015.

This effort is being made on a number of fronts but has been generally know as the "Halbig" challenge. I guess we will now call it the King challenge.

If the Supreme Court eventually affirms this challenge, anyone receiving a health insurance subsidy in the 37 states run by the feds would immediately lose it. Given that the bulk of those currently getting subsides are at the lower income range for those subsidy eligible, most would likely drop their Obamacare insurance unless they were so sick it made sense for them to beg, borrow, or steal the money they would need to continue making premium payments.

The result would be a much smaller Obamacare insurance pool disproportionately filled with sick people.

Thursday, November 6, 2014

Federal action on specialty drug costs sought by Medicaid directors

The National Association of Medicaid Directors is urging House and Senate leaders to take "immediate federal action" to address specialty drugs' high prices. The directors in the letter said lawmakers have failed to address the cost and reimbursement issues associated with high-cost specialty drugs. “Federal thinking on Medicaid financing must reflect” the reality of specialty drug costs, the directors said. “Simply put, the federal Medicaid statute is not designed to allow states to respond to this new pricing approach for pharmaceuticals.”

You can read the full article via Bloomberg BNA here.

Wednesday, November 5, 2014

IRS Issues FAQs on Transitional Reinsurance Program

NBCH thanks the American Benefits Council for the information provided in this post.

On October 31, the Internal Revenue Service (IRS) updated a set of frequently asked questions (FAQs) on the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (PPACA) with two questions regarding the treatment of contributions made under the reinsurance program as ordinary and necessary business expenses.

Section 1341 of the PPACA established a transitional reinsurance program (2014 through 2016) intended to stabilize premiums in the individual insurance market. Health insurance issuers and certain self-insured group health plans will be assessed a per-enrollee contribution to fund this transitional reinsurance program. The contribution is $63 per covered life for 2014.

Specifically, the FAQs state that:
  • a health insurance issuer may treat the contributions under the Reinsurance Program as ordinary and necessary business expenses; and 
  • a sponsor of a self-insured group health plan may treat contributions (including contributions made directly or through a Third Party Administrator or an Administrative Services Only contractor) under the Reinsurance Program as ordinary and necessary business expenses. 
The U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) recently released the form for submitting the TRP annual enrollment count. The deadline for the 2014 benefit year’s annual enrollment count submission is November 15, 2014.

IRS closes ACA minimum value health plan loophole

The Internal Revenue Service, in a surprise move Tuesday, said it will not qualify employer-sponsored health plans that fail to cover inpatient hospitalization as meeting the minimum value health plan standard under the Affordable Care Act.

In a notice issued under the public radar on Election Day, the IRS says it, the Treasury Department and the Department of Health and Human Services believe that plans that fail to provide substantial coverage for inpatient hospitalization services or for physician services (or for both) do not provide minimum value intended by the ACA’s minimum value requirement. The departments will shortly propose regulations to this effect, with the intention of finalizing them in 2015, the notice adds.

Read more via Employee Benefit Adviser.