Vast Majority of Enrollees for Health Care through Exchanges are Obtaining Premium Assistance

January 5, 2015 at 1:53 pm | Posted in Affordable Care Act, Health Insurance Exchanges, Health Insurance Marketplace, HHS | Leave a comment
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Last week, HHS released a report on Affordable Care Act enrollment data via the state and federal Healthcare Marketplaces/Exchanges. It is reported that approximately 87 percent of people who selected health insurance plans through HealthCare.gov for coverage beginning Jan. 1, 2015 were determined eligible for financial assistance to lower their monthly premiums, compared to 80 percent of enrollees who selected plans over a similar period last year. In addition, more than 4 million people in both the state and federal Marketplaces signed up for the first time or reenrolled in coverage for 2015 during the first month of open enrollment. That includes more than 3.4 million people who selected a plan in the 37 states that are using the HealthCare.gov platform for 2015, and more than 600,000 consumers who selected plans in the 14 states that are operating their own Marketplace platform for 2015.

 

A complete copy of the HHS Release can be found here: 87 Percent of Those Who Selected 2015 Plans in First Month of Open Enrollment Are Getting Subsidies

 

IRS Increases PCORI Fee from $2.00 to $2.08 for Plan Years Ending After October 1, 2014 and Before October 1, 2015

September 19, 2014 at 11:15 am | Posted in HHS, IRS, PCORI | Leave a comment
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In IRS Notice 2014-15, the agency announced an increase in the Patient Centered Outcome Research Institute (PCORI) Fee from $2.00 to $2.08 for policy years and plan years that end on or after October 1, 2014, and before October 1, 2015. The increase will be directly relevant to self insured clients and fully insured clients who have an HRA. The increase was driven by an adjustment to the percentage increase in the projected per capita amount of the National Health Expenditures published by HHS on September 3, 2014.  The PCORI fee is effective for policy and plan years ending after Sept. 30, 2012, and before Oct. 1, 2019.

A link to IRS Notice 2014-15 is here:

Text of IRS Notice 2014-56: Adjusted Applicable Dollar Amount for PCORI Fee (PDF)

DOL Issues Compliance Guidance for Plans Contemplating Reducing Contraception Coverage in Wake of Hobby Lobby

August 5, 2014 at 11:18 am | Posted in Affordable Care Act, Department of Labor, ERISA, Health and Human Services | Leave a comment
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On July 17th the DOL, in reaction to the Supreme Court’s recent decision in Hobby Lobby, released FAQ guidance reminding employers and plan sponsors that ERISA requires them to disclose any type of contraception exclusion in their Summary Plan Description and to utilize a Summary of Material Modification if they are contemplating removing the benefit from their current plan. The guidance follows.

Set out below is an additional Frequently Asked Question (FAQ) regarding implementation of the Affordable Care Act. This FAQ has been prepared by the Departments of Labor, Health and Human Services (HHS), and the Treasury (collectively, the Departments). Like previously issued FAQs (available at http://www.dol.gov/ebsa/healthreform/), this FAQ answers a question from stakeholders to help people understand the law and benefit from it, as intended.

Disclosure with respect to Preventive Services

Q: My closely held for-profit corporation’s health plan will cease providing coverage for some or all contraceptive services mid-plan year. Does this reduction in coverage trigger any notice requirements to plan participants and beneficiaries?

Yes. For plans subject to the Employee Retirement Income Security Act (ERISA), ERISA requires disclosure of information relevant to coverage of preventive services, including contraceptive coverage. Specifically, the Department of Labor’s longstanding regulations at 29 CFR 2520.102-3(j) (3) provide that, the summary plan description (SPD) shall include a description of the extent to which preventive services (which includes contraceptive services) are covered under the plan. Accordingly, if an ERISA plan excludes all or a subset of contraceptive services from coverage under its group health plan, the plan’s SPD must describe the extent of the limitation or exclusion of coverage. For plans that reduce or eliminate coverage of contraceptive services after having provided such coverage, expedited disclosure requirements for material reductions in covered services or benefits apply. See ERISA section 104(b)(1) and 29 CFR 2520.104b-3(d)(1), which generally require disclosure not later than 60 days after the date of adoption of a modification or change to the plan that is a material reduction in covered services or benefits. Other disclosure requirements may apply, for example, under State insurance law applicable to health insurance issuers.

HHS Releases Report on HIPAA Security, Breach Notification and Enforcement

June 12, 2014 at 9:16 am | Posted in Health and Human Services, HIPAA | Leave a comment
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Earlier this week the Office of Civil Rights for HHS submitted to Congress its most recent reports on HIPAA security, breach notification and enforcement. In regards to “lessons learned”, the following summary from the compliance report will underscore to health plans and those responsible for securing PHI of all of the steps they need to take:

  • Risk Analysis and Risk Management. Ensure the organization’s security risk analysis and risk management plan are thorough, having identified and addressed the potential risks and vulnerabilities to all ePHI in the environment, regardless of location or media. This includes, for example, ePHI on computer hard drives, digital copiers and other equipment with hard drives, USB drives, laptop computers, mobile phones, and other portable devices, and ePHI transmitted across networks.
  • Security Evaluation. Conduct a security evaluation when there are operational changes, such as facility or office moves or renovations that could affect the security of PHI, and ensure that appropriate physical and technical safeguards remain in place during the changes to protect the information when stored or when in transit from one location to another. In addition, conduct appropriate technical evaluations where there are technical upgrades for software, hardware, and websites or other changes to information systems to ensure PHI will not be at risk when the changes are implemented.
  • Security and Control of Portable Electronic Devices. Ensure PHI that is stored and transported on portable electronic devices is properly safeguarded, including through encryption where appropriate. Have clear policies and procedures that govern the receipt and removal of portable electronic devices and media containing PHI from a facility, as well as that provide how such devices and the information on them should be secured when off-site.
  • Proper Disposal. Implement clear policies and procedures for the proper disposal of PHI in all forms. For electronic devices and equipment that store PHI, ensure the device or equipment is purged or wiped thoroughly before it is recycled, discarded, or transferred to a third-party, such as a leasing agent.
  • Physical Access Controls. Ensure physical safeguards are in place to limit access to facilities and workstations that maintain PHI.
  • Training. Ensure employees are trained on the organization’s privacy and security policies and procedures, including the appropriate uses and disclosures of PHI, and the safeguards that should be implemented to protect the information from improper uses and disclosures; and ensure employees are aware of the sanctions and other consequences for failure to follow the organization’s policies and procedures.

A copy of the HHS HIPAA reports can be found here:

2011 – 2012 Report to Congress on the Breach Notification Program

Report to Congress on Privacy Rule and Security Rule Compliance

HHS Releases Simple and Informative Health Insurance Coverage Options for Graduating College Students

June 5, 2014 at 10:29 am | Posted in Health and Human Services | Leave a comment
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HHS released a simple and informative menu of health insurance coverage options for graduating college students.

College students and recent graduates have several options for finding coverage in the Health Insurance Marketplace.

1. Special Enrollment Periods for College Grads

2. Medicaid and CHIP coverage

3. Coverage on a parent’s plan

4. Catastrophic coverage

HHS Claims that Quality Improvements and the Affordable Care Act Saved 15,000 Lives and $4 Billion in Health Spending During 2011 and 2012

May 7, 2014 at 10:43 am | Posted in Affordable Care Act, Health and Human Services, Health Care, Medical, PPACA, Regulations | Leave a comment
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HHS announced today that new preliminary data show an overall 9% decrease in hospital acquired conditions nationally during 2011 and 2012. National reductions in adverse drug events, falls, infections, and other forms of hospital-induced harm are estimated to have prevented nearly 15,000 deaths in hospitals, avoided 560,000 patient injuries, and approximately $4 billion in health spending over the same period.

HHS claims that the Affordable Care Act is also helping reduce hospital readmissions. After holding constant at 19% from 2007 to 2011 and decreasing to 18.5% in 2012, the Medicare all-cause 30-day readmission rate has further decreased to approximately 17.5% in 2013. This translates into an 8% reduction in the rate and an estimated 150,000 fewer hospital readmissions among Medicare beneficiaries between January 2012 and December 2013.

A complete copy of the HHS announcement can be found here: http://www.hhs.gov/news/press/2014pres/05/20140507a.html

Failure to Secure PHI and Two Stolen Laptops Results in $1,975,220 in HIPAA Violation Fines

April 23, 2014 at 1:25 pm | Posted in Compliance, ePHI, Health and Human Services, HIPAA, Regulations | Leave a comment
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The HHS Office of Civil Rights (OCR) announced that is has levied $1,975,220 in HIPAA fines against Concentra Health Services and QCA Health Plan Inc. for their failure to encrypt PHI stored on two laptops that were stolen.

Both Concentra and QCA, who self reported the stolen laptops, had undergone a HIPAA risk analysis and were aware…but did nothing…to secure the PHI stored on the laptops. The Concentra laptop was stolen from an employee’s office. The QCA laptop was stolen from an employee’s car. Concentra was fined $1,725,220 and QCA was fined $250,000.

“Covered entities and business associates must understand that mobile device security is their obligation,” said Susan McAndrew, OCR’s deputy director of health information privacy. “Our message to these organizations is simple: encryption is your best defense against these incidents.”

A copy of the HHS OCR press release is here:
http://www.hhs.gov/news/press/2014pres/04/20140422b.html

March 31 Exchange Open Enrollment Deadline Extended With Appeal and Honor System

March 26, 2014 at 9:19 am | Posted in Health Insurance Exchanges | Leave a comment
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The Washington Post is reporting today that the Obama administration will extend the March 31 open enrollment deadline for people who say they tried to sign-up for coverage on the new healthcare exchanges but failed to complete the process on time. “Open enrollment ends March 31,” Health and Human Services spokeswoman Joanne Peters said in an email Tuesday evening. “We are experiencing a surge in demand and are making sure that we will be ready to help consumers who may be in line by the deadline to complete enrollment – either online or over the phone.” Those that tried to sign up, but missed the March 31 deadline, can appeal for an extension that will allow them to complete the enrollment process into mid-April. An official said the rule change would apply to only a “limited number of situations.” However, the Washington Post report says the appeals process will run on the “honor system,” and that consumers need only claim they tried to sign-up before the deadline to be granted an extension.

HHS Announces New Round of 2014 HIPAA Compliance Audits: Are You Ready?

March 25, 2014 at 9:18 am | Posted in Compliance, Federal Laws, Health and Human Services, Health Care, HIPAA, Medical, Regulations | Leave a comment
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Last month, the HHS Office of Civil Rights (OCR) announced that there will be a more vigorous HIPAA audit effort in 2014 of HIPAA covered entities, including health plans, and their business associates. Speaking at a February 24th health care technology conference, Susan McAndrew, OCR deputy director for health information privacy said: “Hopefully in coming months you’ll see actual activity that will start up on the audit process.” OCR soon will launch a survey of 1,200 organizations as a first step toward selecting those to be audited. McAndrew also stated that the organizations to be surveyed were selected from “a large database,” and the survey seeks to verify if the entity is a suitable candidate for a HIPAA audit.

In a February 24th notice published in the Federal Register, OCR announced that it will survey “up to 1,200 HIPAA covered entities, including health plans, healthcare clearinghouses and certain healthcare providers, and business associates, to determine suitability for the OCR HIPAA audit program.” According to the notice, the survey “will gather information about respondents to enable OCR to assess the size, complexity and fitness of a respondent for an audit.” An OCR spokesperson says the survey will target approximately 800 covered entities and 400 business associates.

If you have not done so already, at a minimum, a plan sponsor should start to self assess: (1) whether it is a HIPAA covered entity; (2) whether it receives protected health information (PHI); and (3) assuming it receives PHI, has it taken timely and reasonable steps to secure the PHI in a manner consistent with HIPAA’s regulations?

ACA Exchange Enrollment Hits 4 Million

February 26, 2014 at 2:09 pm | Posted in Affordable Care Act, Compliance, Health and Human Services, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Medical, PPACA, Regulations | Leave a comment
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HHS announced Tuesday that approximately 4 million Americans have enrolled through the end of January for coverage through the Affordable Care Act Exchanges. A full enrollment report for February will be released in mid-March.

“With individuals and families enrolling in coverage every day, we continue to see strong demand nationwide from consumers who want access to quality, affordable coverage,” Centers for Medicare & Medicaid Services administrator Marilyn Tavenner wrote in a blog post Tuesday. “Our outreach efforts are in full force with community partners and local officials participating in hundreds of events each week and enrollment assistors are helping more and more people enroll in coverage,” she continued.

Only five weeks remain in the open enrollment period.

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