Tag Archives: Department of Financial Services

UnitedHealth says trouble looming for New York Obamacare plans

UnitedHealth Group Inc., the largest U.S. health insurer, said its rates for Obamacare plans in New York may be too low because the failure of a competing insurer last year might lead to shortfalls in payments designed to stabilize Obamacare markets.

In states like New York, health insurers participating in the Patient Protection and Affordable Care Act negotiate annually with regulators to set prices for coverage. UnitedHealth’s rates were set anticipating risk-sharing payments designed to stabilize the new insurance markets, William Golden, the company’s northeast region chief executive officer, said Wednesday at a state Senate round table in Albany. If the loss of a participant reduces the funds available to UnitedHealth, the company’s rates in New York’s Obamacare market may be insufficient, Golden said.

“I have rates that are substantially too low based on risk-adjustment payments not being paid,” he said in the meeting.

Others in the state’s health insurance industry criticized the Department of Financial Services’ rate-review process as well. Paul Macielak, who runs the New York Health Plan Association, said DFS let Health Republic charge too little for its plans.

“Prior approval is a failed state policy,” Macielak said. “As it currently exists, it provides the superintendent with unfettered discretion to set rates.”

To read the full story, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Employers Urge Repeal of Small Group Expansion

The Affordable Care Act’s mandated expansion of the definition of the small group market would limit employers’ health plan options, according to employer groups who are urging the repeal of the mandate before it takes effect in 2016.

Expanding the small group market to include groups up to 100 would not only reduce choice for this segment of the market, it means some employers would be unable to keep the insurer they currently have, according to the Society for Human Resource Management and the National Association of Health Underwriters. The industry groups and more than a dozen other employer organizations are applauding efforts to repeal the ACA mandate through legislation called the Protecting Affordable Coverage for Employees Act (PACE).

The expansion is intended to make insurance more affordable for the smallest employers by expanding the risk pool to include larger companies. It also aims to increase the number of participants in the ACA’s Small Business Health Options Program, also known as the SHOP exchanges.

The PACE bill would maintain the current definition of a small group market as 1-50 employees and give states the flexibility to expand the group size if they feel the market conditions in their state necessitate the change.

“It is in the best interest of employers and their employees that states determine the definition of their small group market,” the groups argue in a recent letter to the bill’s sponsors, Senators Tim Scott (R-SC), Jeanne Shaheen (D-NH), and Michael Bennet (D-CO).

“Repealing the ACA-mandated expansion and returning to the historical role of state determination would allow flexibility and ensure a broad array of coverage options and mitigate dramatic premium increases,” they add.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Republicans Proposed Plan to Replace The ACA

The Washington Times reports that the list of Republican plans “to deal with the potential fallout” from King v. Burwell “is growing longer, although Republicans have yet to coalesce around a game plan with just six weeks before the court is expected to rule.” Rep. Tom Price (R-GA) unveiled a “revamped version” of his ACA replacement bill last week. The proposal would repeal the health law in its entirety and offer tax credits to people to purchase insurance on their own. Another plan, from Sen. Bill Cassidy (R-LA), would allow states three ways to respond to a Supreme Court ruling against the ACA’s subsidies: “States could set up exchanges under Obamacare, do nothing and lose federal support or – and this is what the senator wants – opt into a third path titled the Patient Freedom Act.”

The Hill reported in a similar article that Republican lawmakers “are all over the map about what to do about the millions of people who could lose” subsidies if the Supreme Court rules against the ACA next month. Although Republicans agree that “they need a plan if the high court strikes down a subsidies next month,” they do “not agree about how to help people who’d lose access to healthcare – and even whether to help them at all.” Currently, “there are more than half a dozen plans floating around, with varying degrees of details.”

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

OSHA Releases New ‘It’s The Law’ Poster

The Occupational Safety and Health Administration (OSHA) has released a new version of its “Job Safety and Health – It’s The Law!” poster.

Background
Under the Occupational Safety and Health Act (OSH Act), employers have certain responsibilities, including the obligation to:

  • Provide their employees with a safe workplace;
  • Follow all relevant safety and health standards;
  • Find and correct safety and health problems in the workplace; and
  • Inform employees about workplace hazards.

Content of New Poster
The newly designed poster informs employers of their legal obligation to provide a safe workplace. It also informs workers of their right to request an OSHA inspection of their workplaces, receive information and training on job hazards, report a work-related injury or illness, and raise safety and health concerns with their employer or OSHA without being retaliated against.

Additionally, the poster has been updated to include the new reporting obligations for employers, who must now report every fatality and every hospitalization, amputation and loss of an eye. It also informs employers of their responsibilities to train all workers in a language and vocabulary they can understand, comply with OSHA standards, and post citations at or near the place of an alleged violation.

Posting and Size Requirements
Employers must display the poster in a conspicuous place where workers can see it. Reproductions or facsimiles of the poster must be at least 8 1/2 by 14 inches with 10 point type. According to OSHA,previous versions of the poster do not need to be replaced.

Note: Employers in states operating OSHA-approved state plans should obtain and post the state’s equivalent poster.

The poster is available by clicking here. Multiple languages and resolutions are available for download.

To learn about other federal notices required to be displayed in the workplace, please visit our section on Federal Poster Requirements.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

IRS Releases 2016 Health Savings Account Limits

The Internal Revenue Service (IRS) has announced the 2016 inflation-adjusted amounts for Health Savings Accounts (HSAs) as determined under the Internal Revenue Code.

Annual Contribution Limitation
For calendar year 2016, the annual limitation on deductions for an individual with self-only coverage under a high deductible health plan is $3,350. The annual limitation on HSA deductions for an individual with family coverage under a high deductible health plan is $6,750.

High Deductible Health Plan
For calendar year 2016, a “high deductible health plan” is defined as a health plan with an annual deductible that is not less than $1,300 for self-only coverage or $2,600 for family coverage, and the annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not premiums) do not exceed $6,550 for self-only coverage or $13,100 for family coverage.

You may view the IRS Revenue Procedure announcing the 2016 amounts by clicking here.

Be sure to check out our section on Health Savings Accounts for more on HSAs.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

IRS Fact Sheet: Determining Large Employer Status

Fact Sheet Includes Examples and Additional Resources

A fact sheet from the IRS helps employers determine, based on their size, whether the ACA’s employer shared responsibility (“pay or play”) and information reporting provisions apply to their company.

The fact sheet includes basic information on determining large employer status, along with information on:

  • Determining the number of full-time and full-time equivalent employees
  • Large employer determination examples
  • Employer aggregation rules
  • The exception for seasonal workers
  • New employers
  • 2015 transition relief for determining workforce size

More information about determining large employer status can be found here.

Visit our Pay or Play section for additional details.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

On Demand Doctor Apps are Here

New smartphone apps can deliver doctors to your doorstep.

Heal is a smartphone app similar to the on-demand car service Uber, but instead of a car, a doctor shows up at your door. Users download the app and then type in a few details such as address and the reason for the visit. After adding a credit card and a request for a family doctor or a pediatrician, the physician arrives in 20 to 60 minutes for a flat fee of $99. Heal began in Los Angeles in February, recently expanded to San Francisco and is set to roll out in another 15 major cities this year. Heal doctors are on call from 8 a.m. to 8 p.m., seven days a week, said Dr. Renee Dua, a founder and the chief medical officer of Heal.

Heal doctors arrive with a medical assistant and a kit stocked with the latest high-tech health gadgets, including tools needed to take your vitals or shoot high-definition video of your eardrum. Heal has a roster of doctors who have affiliations with respected hospitals and programs such as the University of California, Los Angeles; Columbia; and Stanford.

“We’re bringing back old-school techniques with new-school technology,” Dr. Dua said.

Obviously, Heal doctors can offer only limited services on a house call. Among other things, they can diagnose and treat moderate ailments like bronchitis, give flu shots, stitch up a nasty cut or write a prescription (they will even pick the prescription up for an extra $19). But you will have to file the insurance paperwork.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

New York Moving to Value-Based Payment

Like the rest of the country, New York is moving—somewhat begrudgingly—toward a future in which hospitals and doctors are paid to keep patients healthy rather than be reimbursed based on the volume of procedures they perform on sick patients. Most providers and health plans agree that this shift from fee-for-service reimbursement to a model based on quality and lower costs is inevitable. There is far less consensus on how to arrive at that point.

At a Crain’s event held Tuesday in Manhattan, senior executives from local health care providers and insurers made the case that collaboration between the two industry segments—which often are at odds during contract negotiations—is critical to making the shift to value-based payments a success.

“UnitedHealthcare can’t do this alone. We all can’t do this alone,” said Dr. Samuel Ho, chief medical officer at the Minneapolis-based insurer, which provides services to 85 million Americans.

Commercial health plans and Medicaid, which collectively insure 16.3 million New Yorkers, tie about one-third of their payments to providers to value, according to a report released last week by the New York State Health Foundation. The federal government, through Medicare, wants to accelerate the process of linking payments to health outcomes. It hopes to use the model to avoid unnecessary hospital readmissions and manage such chronic illnesses as diabetes and high blood pressure. The U.S. Department of Health and Human Services has set a goal to make half of all Medicare payments tied to value by 2018.

Numerous challenges stand in the way. Insurers differ in the ways they define quality, and smaller physician practices have limited resources to invest in the information technology systems necessary to track the data needed to receive incentive payments.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

 

Insurance Companies at The Capital to Lobby

Health insurance companies will descend on the state capital today for two days of lobbying—and might need both of them to explain the bill at the top of their agenda.

The measure would allow businesses with 51 to 100 employees to continue purchasing stop-loss insurance next year. It’s sure to trigger a lot of quizzical looks from lawmakers, and the following questions:

Who’s taking away midsize companies’ ability to buy stop-loss policies? And why?

For that matter, what is stop-loss insurance?

For the answers, the Insider turned to Patrick Gillespie, director of state government affairs for Cigna, one of the insurers that sells stop-loss policies in New York. He could probably talk about stop-loss for weeks, were anyone inclined to listen that long. Fear not—the Insider boiled the explanations he gave during a 40-minute phone interview into a ready-to-eat meal.

The big picture: Stop-loss insurance protects employers who self-fund—that is, pay their workers’ health-care bills directly, rather than cover them through a traditional insurance policy. Self-funding can save companies money, but can destroy them if one or more employees racks up extraordinarily high medical bills. A stop-loss policy kicks in if that happens, limiting what they’ll have to pay in any given year.

If the legislature doesn’t pass (and Gov. Andrew Cuomo doesn’t sign) S.2366 and A.1154 this year, on Jan. 1, about 1,700 businesses with nearly 130,000 employees will stop self-funding because they—along with about 9,300 other midsize firms—will lose their legal right to buy stop-loss policies.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

 

Data Released to The Public on Medicare Prescription Spending

The heartburn drug Nexium — whose advertisements have long been ubiquitous on television — was prescribed to 1.5 million Medicare patients in 2013, for a total cost of more than $2.5 billion, the largest amount spent on any drug prescribed through the government program, according to data released by Medicare officials on Thursday.

The data was the most detailed breakdown ever provided by government officials about the prescription claims of Medicare beneficiaries. It included information about 36 million patients, one million prescribers and $103 billion in spending on drugs under the program’s Part D in the year 2013, the most recent year available. The data did not take into account rebates that the drug manufacturers pay to the insurers that operate the Medicare beneficiaries’ drug plans.

Although the government has previously released similar data to outside entities — including ProPublica, the nonprofit news group — officials said they decided to make the information available on a public website to encourage experts to weigh in, potentially leading to new solutions for policy challenges, like how to contain costs.

“We know that there are many, many smart minds in this country,” Sean Cavanaugh, a deputy administrator at the Centers for Medicare and Medicaid Services, said in a conference call with reporters on Thursday. “We are excited to unleash those minds and see what they can find in our data.”

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary