The Connecticut House of Representatives responded on Wednesday to medical billing concerns patients expressed over undisclosed and unexpected facility fees by unanimously passing a bill that requires notice. Many patients expressed that the additional charges were a surprise when they received their bill. The legislation now moves to the state Senate for a vote.
The charges, often referred to as "facility fees" are charged to patients by medical offices that are owned by hospitals for outpatient care. These fees are separate from doctor fees. Facility fees range from several hundred to thousands of dollars.
The bill to require notice to patients about fees possible extra charges for outpatient care at medical offices owned by hospitals. The bill specifically requires that patients with scheduled appointments at medical offices where facility fees are charged receive notice about the fees in plain language before they receive treatments scheduled so long as the appointment is scheduled at least 10 days in advance. If the exact nature of the services or insurance coverage is unknown the patients would be provided with an estimate based on typical charges at the facility. Notice for patients receiving emergency care would need to be delivered as soon as practicable after the patient is stabilized. The bill does not impact the offices' ability to charge facility fees.
Other provisions in the bill are include requirements that the office prominently displays that the facility is connected to a hospital, what hospital the office is affiliated with, and states that the patient may be incur higher charges than if they were treated at a facility that isn't hospital-based.
Showing posts with label State. Show all posts
Showing posts with label State. Show all posts
Thursday, April 24, 2014
Thursday, March 15, 2012
Policies Give States Flexibility to Establish Affordable Insurance Exchanges
Health and Human Services Secretary Kathleen Sebelius announced policies to assist states in building Affordable Insurance Exchanges. Starting in 2014, these one-stop marketplaces will allow consumers and small businesses to choose a private health insurance plan and offer the public the same kinds of insurance choices as members of Congress.
The policies released will help states in designing their Exchanges to best meet the needs of their consumers. They offer states substantial flexibility as they design a marketplace that works for their residents.
“These policies give states the flexibility they need to design an Exchange that works for them,” said HHS Secretary Kathleen Sebelius. “These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business. More competition will drive down costs and Exchanges will give individuals and small businesses the same purchasing power big businesses have today.”
The policies provide states with the guidance and certainty they need as they continue to work to build these marketplaces for their residents for operation in 2014. The policies offer guidance about the options on how to structure Exchanges in two key areas:
- Setting standards for establishing Exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an Exchange, and certifying health plans for participation in the Exchange;
- Establishing a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.
The final rule builds on the flexibility and resources provided by HHS already to build state-based Exchanges. A majority of states have taken significant steps in building Exchanges. Previously, HHS awarded 49 states and the District of Columbia $50 million to begin planning their Exchanges, and as announced recently, 33 states and the District of Columbia have received over $667 million in Establishment Grants to begin building their Exchanges.
The announcement builds on over two years’ worth of work with states, small businesses, consumers, and health insurance plans. The administration examined models of Exchanges; convened numerous meetings and regional listening sessions across the country with stakeholders; and consulted closely with state leaders, consumer advocates, employers and insurers. To finalize the rules announced today, HHS accepted public comment over 75 days to learn from states, consumers, and other stakeholders on how the rules could be improved, and HHS modified the proposals based on feedback from the American people.
For more information, visit:
http://www.healthcare.gov/news/factsheets/2011/07/exchanges07112011a.html
For more information on Exchanges, including fact sheets, visit http://www.healthcare.gov/exchanges.
Source: HHS News Release
The policies released will help states in designing their Exchanges to best meet the needs of their consumers. They offer states substantial flexibility as they design a marketplace that works for their residents.
“These policies give states the flexibility they need to design an Exchange that works for them,” said HHS Secretary Kathleen Sebelius. “These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business. More competition will drive down costs and Exchanges will give individuals and small businesses the same purchasing power big businesses have today.”
The policies provide states with the guidance and certainty they need as they continue to work to build these marketplaces for their residents for operation in 2014. The policies offer guidance about the options on how to structure Exchanges in two key areas:
- Setting standards for establishing Exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an Exchange, and certifying health plans for participation in the Exchange;
- Establishing a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.
The final rule builds on the flexibility and resources provided by HHS already to build state-based Exchanges. A majority of states have taken significant steps in building Exchanges. Previously, HHS awarded 49 states and the District of Columbia $50 million to begin planning their Exchanges, and as announced recently, 33 states and the District of Columbia have received over $667 million in Establishment Grants to begin building their Exchanges.
The announcement builds on over two years’ worth of work with states, small businesses, consumers, and health insurance plans. The administration examined models of Exchanges; convened numerous meetings and regional listening sessions across the country with stakeholders; and consulted closely with state leaders, consumer advocates, employers and insurers. To finalize the rules announced today, HHS accepted public comment over 75 days to learn from states, consumers, and other stakeholders on how the rules could be improved, and HHS modified the proposals based on feedback from the American people.
For more information, visit:
http://www.healthcare.gov/news/factsheets/2011/07/exchanges07112011a.html
For more information on Exchanges, including fact sheets, visit http://www.healthcare.gov/exchanges.
Source: HHS News Release
Friday, February 17, 2012
HHS Says Consumers Get Better Value for Their Health Insurance Dollar
Health and Human Services Secretary Kathleen Sebelius announced that consumers will soon begin receiving unprecedented information on the value of their health insurance coverage, and some will receive rebates from insurance companies that spend less than 80 percent of their premium dollars on health care.
The Affordable Care Act requires that insurance companies this year begin notifying customers how much of their premiums they have spent on medical care and quality improvement. Beginning in 2011, insurers were required to spend at least 80 percent of total premium dollars they collect on medical care and quality improvement. Insurance companies that do not meet the 80/20 standard (also known as the Medical Loss Ratio) are required to pay rebates to their customers this year.
"Before the Affordable Care Act, insurance companies could spend your premium dollars on administrative red tape and marketing," said Secretary Sebelius. "With today's notice, we're taking a big step toward making insurers accountable to consumers. Some of these insurance companies have already changed their behavior by lowering premiums or spending more on medical care and quality improvement, while the remainder will need to refund this money to their customers this year."
The proposed consumer notices about whether their insurance company has met the new standard have been posted on HealthCare.gov, and HHS is seeking public comment to help ensure the notices are useful transparency tools for consumers.
In the individual market, the Affordable Care Act allows the Secretary to adjust the medical loss ratio standard for a state if it is determined that meeting that standard may destabilize the state’s individual insurance market. HHS has concluded its review of 18 state requests for adjustments to the medical loss ratio rule. As a result of HHS’ decision to deny insurance companies the ability to spend more premium dollars on administrative overhead costs rather than on medical claims, consumers will receive up to $323 million in rebates this year compared to what would have been owed if all state adjustment requests were fully granted, according to data from state regulators and issuer reports.
These adjustment request determinations were made as a result of a transparent and data-driven process, and the documentation related to each state’s request has been publicly posted.
In total, HHS determined that no adjustment was necessary in ten states, approved an altered adjustment in six states, and approved the request sought by one state. This includes a denied adjustment for Wisconsin, and an altered adjustment for North Carolina.
The announcement is part of the Obama Administration’s effort to increase transparency in the health insurance marketplace. The notification will let consumers know if their insurer did not meet the 80/20 standard -- and that they or their employer will receive a rebate. HHS is also considering requiring insurers notify consumers if their insurer did meet the 80/20 standard.
For the text of these proposed notifications, please visit: http://cciio.cms.gov/resources/other/index.html#mlr
For more information on the MLR provision in the Affordable Care Act, please visit: http://www.healthcare.gov/news/factsheets/2010/11/medical-loss-ratio.html
For documentation of state requests for MLR adjustments, including specific information on rebates saved by HHS’ MLR adjustment determinations, visit: http://cciio.cms.gov/programs/marketreforms/mlr/index.html
For more information on how the Affordable Care Act is creating a transparent market for health insurance, visit: http://www.healthcare.gov/news/factsheets/2010/12/increasing-transparency.html
Source: HHS News Release
The Affordable Care Act requires that insurance companies this year begin notifying customers how much of their premiums they have spent on medical care and quality improvement. Beginning in 2011, insurers were required to spend at least 80 percent of total premium dollars they collect on medical care and quality improvement. Insurance companies that do not meet the 80/20 standard (also known as the Medical Loss Ratio) are required to pay rebates to their customers this year.
"Before the Affordable Care Act, insurance companies could spend your premium dollars on administrative red tape and marketing," said Secretary Sebelius. "With today's notice, we're taking a big step toward making insurers accountable to consumers. Some of these insurance companies have already changed their behavior by lowering premiums or spending more on medical care and quality improvement, while the remainder will need to refund this money to their customers this year."
The proposed consumer notices about whether their insurance company has met the new standard have been posted on HealthCare.gov, and HHS is seeking public comment to help ensure the notices are useful transparency tools for consumers.
In the individual market, the Affordable Care Act allows the Secretary to adjust the medical loss ratio standard for a state if it is determined that meeting that standard may destabilize the state’s individual insurance market. HHS has concluded its review of 18 state requests for adjustments to the medical loss ratio rule. As a result of HHS’ decision to deny insurance companies the ability to spend more premium dollars on administrative overhead costs rather than on medical claims, consumers will receive up to $323 million in rebates this year compared to what would have been owed if all state adjustment requests were fully granted, according to data from state regulators and issuer reports.
These adjustment request determinations were made as a result of a transparent and data-driven process, and the documentation related to each state’s request has been publicly posted.
In total, HHS determined that no adjustment was necessary in ten states, approved an altered adjustment in six states, and approved the request sought by one state. This includes a denied adjustment for Wisconsin, and an altered adjustment for North Carolina.
The announcement is part of the Obama Administration’s effort to increase transparency in the health insurance marketplace. The notification will let consumers know if their insurer did not meet the 80/20 standard -- and that they or their employer will receive a rebate. HHS is also considering requiring insurers notify consumers if their insurer did meet the 80/20 standard.
For the text of these proposed notifications, please visit: http://cciio.cms.gov/resources/other/index.html#mlr
For more information on the MLR provision in the Affordable Care Act, please visit: http://www.healthcare.gov/news/factsheets/2010/11/medical-loss-ratio.html
For documentation of state requests for MLR adjustments, including specific information on rebates saved by HHS’ MLR adjustment determinations, visit: http://cciio.cms.gov/programs/marketreforms/mlr/index.html
For more information on how the Affordable Care Act is creating a transparent market for health insurance, visit: http://www.healthcare.gov/news/factsheets/2010/12/increasing-transparency.html
Source: HHS News Release
Friday, January 13, 2012
Health Care Reform Law's Rate Review Provision Holding Insurance Rates Down
Health insurance premium increases in five states have been deemed “unreasonable” by the U.S. Department of Health and Human Services, HHS Secretary Kathleen Sebelius announced .
After independent expert review, HHS determined that Trustmark Life Insurance Company has proposed unreasonable health insurance premium increases in five states—Alabama, Arizona, Pennsylvania, Virginia, and Wyoming. The excessive rate hikes would affect nearly 10,000 residents across these five states.
To make these determinations, HHS used its “rate review” authority from the Affordable Care Act (the health care reform law of 2010) to determine whether premium increases of over 10 percent are reasonable.
"Before the Affordable Care Act, consumers were in the dark about their health insurance premiums because there was no nationwide transparency or accountability," said Secretary Kathleen Sebelius. "Now, insurance companies are required to disclose rate increases over 10 percent and justify these increases. It’s time for Trustmark to immediately rescind the rates, issue refunds to consumers or publicly explain their refusal to do so."
In these five states, Trustmark has raised rates by 13 percent. For small businesses in Alabama and Arizona, when combined with other rate hikes made over the last 12 months, rates have increased by 27.2 percent and 18.1 percent, respectively. These increases were reviewed by independent experts to determine whether they are reasonable. In this case, HHS determined that the rate increases were unreasonable because the insurer would be spending a low percent of premium dollars on actual medical care and quality improvements, and because the justifications were based on unreasonable assumptions.
In addition to the review of rate increases, many states have the authority to reject unreasonable premium increases. Since the passage of the health care reform law, the number of states with this authority increased from 30 to 37, with several states extending existing “prior authority” to new markets.
Examples of how states have used this authority include:
- In New Mexico, the state insurance division denied a request from Presbyterian Healthcare for a 9.7 percent rate hike, lowering it to 4.7 percent;
- In Connecticut, the state stopped Anthem Blue Cross Blue Shield, the state’s largest insurer, from hiking rates by a proposed 12.9 percent, instead limiting it to a 3.9 percent increase;
In Oregon, the state denied a proposed 22.1 percent rate hike by Regence, limiting it to 12.8 percent.
- In New York, the state denied rate increases from Emblem, Oxford, and Aetna that averaged 12.7 percent, instead holding them to an 8.2 percent increase.
- In Rhode Island, the state denied rate hikes from United Healthcare of New England ranging from 18 to 20.1 percent, instead seeing them cut to 9.6 to 10.6 percent.
- In Pennsylvania, the state held Highmark to rate hikes ranging from 4.9 to 8.3 percent, down from 9.9 percent.
HHS' announcement comes the same week that a report showed that health care spending has grown at remarkably low rates. According to an analysis done each year by the Centers for Medicare & Medicaid Services (CMS), U.S. health care spending experienced historically low rates of growth in 2009 and 2010. A recent study released by Mercer Consulting also showed a slow-down in the average employee health benefit cost to businesses.
The Affordable Care Act includes several policies, including rate review, to continue this slow growth. By fighting fraud, better coordinating care, preventing disease and illness before they happen and creating a new state-based insurance marketplace, it helps keep health care cost growth low.
For more information on the specific determinations made today, please visit http://companyprofiles.healthcare.gov/
For general information about rate review, visit: http://www.healthcare.gov/law/features/costs/rate-review/
Source: HHS News Release
After independent expert review, HHS determined that Trustmark Life Insurance Company has proposed unreasonable health insurance premium increases in five states—Alabama, Arizona, Pennsylvania, Virginia, and Wyoming. The excessive rate hikes would affect nearly 10,000 residents across these five states.
To make these determinations, HHS used its “rate review” authority from the Affordable Care Act (the health care reform law of 2010) to determine whether premium increases of over 10 percent are reasonable.
"Before the Affordable Care Act, consumers were in the dark about their health insurance premiums because there was no nationwide transparency or accountability," said Secretary Kathleen Sebelius. "Now, insurance companies are required to disclose rate increases over 10 percent and justify these increases. It’s time for Trustmark to immediately rescind the rates, issue refunds to consumers or publicly explain their refusal to do so."
In these five states, Trustmark has raised rates by 13 percent. For small businesses in Alabama and Arizona, when combined with other rate hikes made over the last 12 months, rates have increased by 27.2 percent and 18.1 percent, respectively. These increases were reviewed by independent experts to determine whether they are reasonable. In this case, HHS determined that the rate increases were unreasonable because the insurer would be spending a low percent of premium dollars on actual medical care and quality improvements, and because the justifications were based on unreasonable assumptions.
In addition to the review of rate increases, many states have the authority to reject unreasonable premium increases. Since the passage of the health care reform law, the number of states with this authority increased from 30 to 37, with several states extending existing “prior authority” to new markets.
Examples of how states have used this authority include:
- In New Mexico, the state insurance division denied a request from Presbyterian Healthcare for a 9.7 percent rate hike, lowering it to 4.7 percent;
- In Connecticut, the state stopped Anthem Blue Cross Blue Shield, the state’s largest insurer, from hiking rates by a proposed 12.9 percent, instead limiting it to a 3.9 percent increase;
In Oregon, the state denied a proposed 22.1 percent rate hike by Regence, limiting it to 12.8 percent.
- In New York, the state denied rate increases from Emblem, Oxford, and Aetna that averaged 12.7 percent, instead holding them to an 8.2 percent increase.
- In Rhode Island, the state denied rate hikes from United Healthcare of New England ranging from 18 to 20.1 percent, instead seeing them cut to 9.6 to 10.6 percent.
- In Pennsylvania, the state held Highmark to rate hikes ranging from 4.9 to 8.3 percent, down from 9.9 percent.
HHS' announcement comes the same week that a report showed that health care spending has grown at remarkably low rates. According to an analysis done each year by the Centers for Medicare & Medicaid Services (CMS), U.S. health care spending experienced historically low rates of growth in 2009 and 2010. A recent study released by Mercer Consulting also showed a slow-down in the average employee health benefit cost to businesses.
The Affordable Care Act includes several policies, including rate review, to continue this slow growth. By fighting fraud, better coordinating care, preventing disease and illness before they happen and creating a new state-based insurance marketplace, it helps keep health care cost growth low.
For more information on the specific determinations made today, please visit http://companyprofiles.healthcare.gov/
For general information about rate review, visit: http://www.healthcare.gov/law/features/costs/rate-review/
Source: HHS News Release
Wednesday, November 30, 2011
HHS Awards Affordable Insurance Exchange Funds to States
The Department of Health and Human Services (HHS) awarded nearly $220 million in Affordable Insurance Exchange grants to 13 states to help them create Exchanges, giving these states more flexibility and resources to implement the Affordable Care Act. The health care reform law gives states the freedom to design Affordable Insurance Exchanges – one-stop marketplaces where consumers can choose a private health insurance plan that fits their health needs and have the same kinds of insurance choices as members of Congress.
The Department also released several Frequently Asked Questions providing answers to key questions states need to know as they work to set up these new marketplaces. Critical among these are that states that run Exchanges have more options than originally proposed when it comes to determining eligibility for tax credits and Medicaid. And states have more time to apply for “Level One” Exchange grants.
The awards bring to 29 the number of states that are making significant progress in creating Affordable Insurance Exchanges. States receiving funding today include: Alabama, Arizona, Delaware, Hawaii, Idaho, Iowa, Maine, Michigan, Nebraska, New Mexico, Rhode Island, Tennessee, and Vermont.
“We are committed to giving states the flexibility to implement the Affordable Care Act in the way that works for them,” HHS Secretary Kathleen Sebelius said. “Exchanges will give consumers more choices and make it easy to compare and shop for insurance plans.”
In the new Exchanges, insurers will provide new information such as an easy-to-understand summary of benefits and costs to consumers. The level of detail will sharpen competition between carriers which will drive costs down.
HHS also released a set of Frequently Asked Questions (FAQs) in anticipation of state legislative sessions beginning in January. Answers will help advance state policy development for Exchanges. For example, they clarify that Exchange grants can be used to build a state Exchange that is operational after 2014; that state-based Exchanges will not be charged for accessing Federal data needed to run Exchanges in 2014; and that state insurance rules and operations will continue even if the Federal government is facilitating an Exchange in the state. HHS will also allow greater flexibility in eligibility determinations, allowing, for example, a state-based Exchange to permit the Federal government to determine eligibility for premium tax credits.
Of the 13 states awarded grants today, 12 are receiving Level One grants, which provide one year of funding to states that have already made progress using their Exchange planning grant. The 13th state, Rhode Island, is receiving the first Level Two grant, which provides multi-year funding to states further along in the planning process.
Forty-nine states and the District of Columbia have already received planning grants, and 45 states have consulted with consumer advocates and insurance companies. Thirteen states have passed legislation to create an Exchange.
States have many opportunities to apply for funding. To accommodate state legislative sessions and to give states more time to apply, HHS also announced a six-month extension for Level One establishment grant applications. Applications now will be accepted until June 29, 2012 (the original deadline was December 30, 2011).
For the FAQs, visit http://cciio.cms.gov/resources/regulations/index.html#hie.
For more information on Affordable Insurance Exchanges, visit http://www.HealthCare.gov/law/features/choices/exchanges/index.html
For more information on the states receiving grants, visit http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html
Source: HHS News Release
The Department also released several Frequently Asked Questions providing answers to key questions states need to know as they work to set up these new marketplaces. Critical among these are that states that run Exchanges have more options than originally proposed when it comes to determining eligibility for tax credits and Medicaid. And states have more time to apply for “Level One” Exchange grants.
The awards bring to 29 the number of states that are making significant progress in creating Affordable Insurance Exchanges. States receiving funding today include: Alabama, Arizona, Delaware, Hawaii, Idaho, Iowa, Maine, Michigan, Nebraska, New Mexico, Rhode Island, Tennessee, and Vermont.
“We are committed to giving states the flexibility to implement the Affordable Care Act in the way that works for them,” HHS Secretary Kathleen Sebelius said. “Exchanges will give consumers more choices and make it easy to compare and shop for insurance plans.”
In the new Exchanges, insurers will provide new information such as an easy-to-understand summary of benefits and costs to consumers. The level of detail will sharpen competition between carriers which will drive costs down.
HHS also released a set of Frequently Asked Questions (FAQs) in anticipation of state legislative sessions beginning in January. Answers will help advance state policy development for Exchanges. For example, they clarify that Exchange grants can be used to build a state Exchange that is operational after 2014; that state-based Exchanges will not be charged for accessing Federal data needed to run Exchanges in 2014; and that state insurance rules and operations will continue even if the Federal government is facilitating an Exchange in the state. HHS will also allow greater flexibility in eligibility determinations, allowing, for example, a state-based Exchange to permit the Federal government to determine eligibility for premium tax credits.
Of the 13 states awarded grants today, 12 are receiving Level One grants, which provide one year of funding to states that have already made progress using their Exchange planning grant. The 13th state, Rhode Island, is receiving the first Level Two grant, which provides multi-year funding to states further along in the planning process.
Forty-nine states and the District of Columbia have already received planning grants, and 45 states have consulted with consumer advocates and insurance companies. Thirteen states have passed legislation to create an Exchange.
States have many opportunities to apply for funding. To accommodate state legislative sessions and to give states more time to apply, HHS also announced a six-month extension for Level One establishment grant applications. Applications now will be accepted until June 29, 2012 (the original deadline was December 30, 2011).
For the FAQs, visit http://cciio.cms.gov/resources/regulations/index.html#hie.
For more information on Affordable Insurance Exchanges, visit http://www.HealthCare.gov/law/features/choices/exchanges/index.html
For more information on the states receiving grants, visit http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html
Source: HHS News Release
Friday, October 14, 2011
ONC/FHA Call For Participants in HIMSS 2012 Interoperability Showcase
Is your organization successfully using nationally recognized standards to securely share patient data with other organizations? Demonstrate your successes within the Office of the National Coordinator for Health IT (ONC) and Federal Health Architecture (FHA) area in the HIMSS 2012 Interoperability Showcase!
ONC and FHA are looking to highlight cutting-edge interoperable health information exchange at HIMSS 2012, with a focus on ONC-related initiatives, including:
Nationwide Health Information Network
CONNECT
Direct Project
State HIE Programs
S&I Framework
SHARP Program
Regional Extension Centers
Beacon Communities
All nominated demonstrations must include interoperable health information exchange among at least three end user organizations. End users include healthcare organizations (hospitals, clinics, state or federal agencies, etc.) and health information exchanges, not health IT vendors or IT service providers. All demonstrations must be live. No canned demonstrations or static presentations will be considered.
A panel of ONC staff will evaluate all nominations and determine which nominated demonstrations will be included within the ONC/FHA area of the Interoperability Showcase. Only nominations directly related to ONC programs will be considered. Nominations are due October 26th at 5:00 p.m. ET, and the determination of who will be included will be made by November 2nd.
Complete information is here:
http://www.connectopensource.org/forms/himss12-call-for-participants
Source: ONC/FHA News Release
ONC and FHA are looking to highlight cutting-edge interoperable health information exchange at HIMSS 2012, with a focus on ONC-related initiatives, including:
Nationwide Health Information Network
CONNECT
Direct Project
State HIE Programs
S&I Framework
SHARP Program
Regional Extension Centers
Beacon Communities
All nominated demonstrations must include interoperable health information exchange among at least three end user organizations. End users include healthcare organizations (hospitals, clinics, state or federal agencies, etc.) and health information exchanges, not health IT vendors or IT service providers. All demonstrations must be live. No canned demonstrations or static presentations will be considered.
A panel of ONC staff will evaluate all nominations and determine which nominated demonstrations will be included within the ONC/FHA area of the Interoperability Showcase. Only nominations directly related to ONC programs will be considered. Nominations are due October 26th at 5:00 p.m. ET, and the determination of who will be included will be made by November 2nd.
Complete information is here:
http://www.connectopensource.org/forms/himss12-call-for-participants
Source: ONC/FHA News Release
Thursday, September 29, 2011
Children's Hospitals Growing; Raises Questions About Spending
A news report by Kaiser Health News says that children's hospitals are growing and this growth spurt has led to questions about spending. The report says that the hospitals have hired lobbyists to obtain ensure special treatment by Congress and ensure that the highest insurance rates are paid to their facilities.
Source: Kaiser Health News Article
Source: Kaiser Health News Article
Study: Health Insurers Pushing Premiums Higher; Outpaces Worker Pay
After several years of relatively modest premium increases, annual premiums for employer-sponsored family health coverage increased to $15,073 this year, up 9 percent from last year, according to a recently released Kaiser Family Foundation/Health Research & Educational Trust 2011 Employer Health Benefits Survey. On average, workers pay $4,129 and employers pay $10,944 toward those annual premiums.
Premiums increased significantly faster than workers’ wages (2.1 percent) and general inflation (3.2 percent). Since 2001, family premiums have increased 113 percent, compared with 34 percent for workers’ wages and 27 percent for inflation.
"This year’s nine percent increase in premiums is especially painful for workers and employers struggling through a weak recovery," Kaiser President and CEO Drew Altman, Ph.D. said.
According to Maulik Joshi, Dr.P.H., president of HRET and senior vice president for research at the American Hospital Association, "survey findings related to the impact of early provisions in health reform provide valuable insight for employers, providers, consumers, and policymakers as they prepare for additional provisions to take effect by 2014."
The 13th annual Kaiser/HRET survey of small and large employers provides a detailed picture of trends in private health insurance costs and coverage. This year’s survey also looked at employers’ experiences with several already implemented provisions of the 2010 health reform law affecting employer coverage.
In particular, the survey estimates that employers added 2.3 million young adults to their parents’ family health insurance policies as a result of the health reform provision that allows young adults up to age 26 without employer coverage on their own to be covered as dependents on their parents’ plan. Young adults historically are more likely to be uninsured than any other age group.
"The law is helping millions of young adults to obtain health coverage. In the past, many of these young adults would have lost coverage when they left home or graduated college," said study lead author Gary Claxton, a Kaiser vice president and co-executive director of the Kaiser Initiative on Health Reform and Private Insurance.
The study also finds 31 percent of covered workers are in high-deductible health plans, facing deductibles for single coverage of at least $1,000, including 12 percent facing deductibles of at least $2,000. Covered workers in smaller firms (3-199 workers) are more likely to face such high deductibles, with half of workers in smaller firms facing deductibles of at least $1,000, including 28 percent facing deductibles of $2,000 or more.
These numbers in part reflect the rise of consumer-driven plans, which are high-deductible plans that include a tax-preferred savings options such as a Health Savings Account or Health Reimbursement Arrangement. Over the past two years, more firms have started to offer these plans, and the share of covered workers enrolled in this type of plan has doubled, from 8 percent in 2009 to 17 percent in 2011. Plans that can be used with a Health Savings Account have lower premiums than other plan types, but must have annual deductibles of at least $1,200 for an individual and $2,400 for a family this year.
The survey finds that 56 percent of covered workers are in "grandfathered" plans as defined under health reform. Grandfathered plans are exempted from some health reform requirements, including covering preventive benefits with no cost sharing and having an external appeals process. To obtain this status, employers cannot make significant changes to their plans that reduce benefits or increase employee cost.
One in four covered workers (23 percent) are in plans that changed their cost-sharing requirements for preventive services as a result of a requirement of the health reform law that non-grandfathered plans provide certain preventive benefits without cost sharing. In addition, 31 percent of covered workers are in plans that changed the list of preventive services due to health reform.
Other findings from the study include:
- Worker-only coverage. Premiums for worker-only health coverage increased 8 percent in 2011 to reach $5,429 annually. Workers on average pay $921 toward this coverage.
Offer rate. The share of firms offering health insurance to their workers is 60 percent this year, comparable to the levels in 2009 and earlier years. Last year’s survey found an unexplained sharp increase in the share of the smallest firms (3-9 workers) offering coverage, boosting the overall offer rate; this year’s results suggest that the one-year bump did not reflect a change in the long-term trend.
- Cost-sharing for office visits and drugs. Covered workers facing copayments for in-network physician office visits on average pay $22 for primary care and $32 for specialty care. For covered workers with three- and four-tier drug plans, average copayments are $10 for generic drugs, $29 for preferred brand-name drugs, $49 for non-preferred brand-name drugs, and $91 for specialty drugs.
- Retiree health benefits. Among large firms (200 or more workers), about one in four (26 percent) offer retiree health benefits in 2011, unchanged from last year and down significantly from 32 percent in 2007.
Full survey results are available online at http://ehbs.kff.org.
Now in its 13th year, the survey is a joint project of the Kaiser Family Foundation and the Health Research & Educational Trust. The survey was conducted between January and May of 2011 and included 3,184 randomly selected, non-federal public and private firms with three or more employees (2,088 of which responded to the full survey and 1,096 of which responded to a single question about offering coverage). A research team at Kaiser and HRET conducted and analyzed the survey, led by Kaiser’s Gary Claxton and including researchers at the NORC at the University of Chicago (working on the project under contract to HRET). For more information on the survey methodology, please visit the Survey Design and Methods Section at http://ehbs.kff.org.
A New York Times article on the study may be viewed here.
Source: Kaiser Family Foundation News Release
Monday, September 12, 2011
HHS Awards Affordable Care Act Funds to Improve e-Reporting
Health Resources and Services Administration (HRSA) Administrator, Dr. Mary Wakefield, and Department of Health and Human Services (HHS) National Coordinator for Health Information Technology, Dr. Farzad Mostashari, announced awards of $8.5 million to 85 community health center programs located in 15 of the 17 Beacon Communities throughout the United States. The funds, made available through HRSA under the Affordable Care Act, help support health centers with the adoption of health information technology (HIT) to support long-term improvements in quality of care, health outcomes and cost efficiencies.
Beacon Communities receive funds through the Office of the National Coordinator for Health Information Technology (ONC) to build and strengthen their HIT infrastructure and exchange capabilities to improve care coordination, increase the quality of care, and slow the growth of health care spending. The awards from HRSA are intended to enable existing health centers located in Beacon Communities to participate in community-wide health care improvement initiatives that include a strong information technology component. Recipients include health centers in cities across the country, from Cincinnati, Ohio and Detroit, Mich. to Spokane, Wash. and San Diego, Calif.
“Beacon Communities are about empowering doctors, nurses, patients, and community leaders to come together and use technology to make tangible differences in the lives of everyday Americans,” said HRSA Administrator Mary Wakefield, Ph.D., R.N. “The health information technology they use is a vital tool in reaching and treating the vulnerable populations we serve, and the partnerships strengthened through these awards will strengthen health centers’ efforts to deliver comprehensive, high-quality primary health care.”
“These communities have already demonstrated their commitment to cutting edge health information technology,” said HHS National Coordinator for Health Information Technology Dr. Farzad Mostashari. “Today’s awards are an important step in giving these communities the resources they need to implement home-grown programs that work for them and that can be sustained for years to come.”
The awards are another part of the Obama Administration’s efforts to improve the quality of care, increase Americans’ access to information and empower them to become active participants in their health. Eligible applicants included existing Health Center Program grantees located within a Beacon Community Program service area. A list of health center Beacon community supplemental funding grantees by organization and state is available at www.hrsa.gov/about/news/2011tables/beaconawards.html.
For more information about the Office of the National Coordinator for Health Information Technology and the Beacon Community Program, please visit http://healthit.hhs.gov.
To learn more about the Affordable Care Act, visit www.healthcare.gov.
For more information about HRSA’s Community Health Center Program, visit http://bphc.hrsa.gov/about/index.html.
To find a health center in your area, visit http://findahealthcenter.hrsa.gov.
Source: HHS News Release
Beacon Communities receive funds through the Office of the National Coordinator for Health Information Technology (ONC) to build and strengthen their HIT infrastructure and exchange capabilities to improve care coordination, increase the quality of care, and slow the growth of health care spending. The awards from HRSA are intended to enable existing health centers located in Beacon Communities to participate in community-wide health care improvement initiatives that include a strong information technology component. Recipients include health centers in cities across the country, from Cincinnati, Ohio and Detroit, Mich. to Spokane, Wash. and San Diego, Calif.
“Beacon Communities are about empowering doctors, nurses, patients, and community leaders to come together and use technology to make tangible differences in the lives of everyday Americans,” said HRSA Administrator Mary Wakefield, Ph.D., R.N. “The health information technology they use is a vital tool in reaching and treating the vulnerable populations we serve, and the partnerships strengthened through these awards will strengthen health centers’ efforts to deliver comprehensive, high-quality primary health care.”
“These communities have already demonstrated their commitment to cutting edge health information technology,” said HHS National Coordinator for Health Information Technology Dr. Farzad Mostashari. “Today’s awards are an important step in giving these communities the resources they need to implement home-grown programs that work for them and that can be sustained for years to come.”
The awards are another part of the Obama Administration’s efforts to improve the quality of care, increase Americans’ access to information and empower them to become active participants in their health. Eligible applicants included existing Health Center Program grantees located within a Beacon Community Program service area. A list of health center Beacon community supplemental funding grantees by organization and state is available at www.hrsa.gov/about/news/2011tables/beaconawards.html.
For more information about the Office of the National Coordinator for Health Information Technology and the Beacon Community Program, please visit http://healthit.hhs.gov.
To learn more about the Affordable Care Act, visit www.healthcare.gov.
For more information about HRSA’s Community Health Center Program, visit http://bphc.hrsa.gov/about/index.html.
To find a health center in your area, visit http://findahealthcenter.hrsa.gov.
Source: HHS News Release
Thursday, July 14, 2011
Study: E-Health Project Boosts Physicians' Ability To Use Patient Registries
The results of a new Agency for Healthcare Research and Quality-funded (AHRQ) study shows that Massachusetts physicians taking part in a 4-year, $50 million health information technology (IT) program increased their ability to generate and use registries that provide information about laboratory test results and medication use.
The ability to use patient registries, or lists of patients with specific conditions, medications or test results, is considered an essential tool for improving health care and is in the “meaningful use” criteria developed by the Centers for Medicare and Medicaid Services.
A total of 163 physicians from 134 practices in 3 communities participated in the health IT program between 2005 through 2009. Sponsored by the Massachusetts eHealth Collaborative, the program consisted of robust electronic health records and work-flow redesign and technical support at no cost to the practices. Compared with all physicians who were surveyed in 2005, all respondents in 2009 were more likely to be able to generate significantly more laboratory and medication registries. The free abstract is available on PubMed at http://www.ncbi.nlm.nih.gov/pubmed/21734198.
Source: AHRQ News Release
The ability to use patient registries, or lists of patients with specific conditions, medications or test results, is considered an essential tool for improving health care and is in the “meaningful use” criteria developed by the Centers for Medicare and Medicaid Services.
A total of 163 physicians from 134 practices in 3 communities participated in the health IT program between 2005 through 2009. Sponsored by the Massachusetts eHealth Collaborative, the program consisted of robust electronic health records and work-flow redesign and technical support at no cost to the practices. Compared with all physicians who were surveyed in 2005, all respondents in 2009 were more likely to be able to generate significantly more laboratory and medication registries. The free abstract is available on PubMed at http://www.ncbi.nlm.nih.gov/pubmed/21734198.
Source: AHRQ News Release
Supreme Court Strikes Down Vermont's Rx Privacy Law
By a vote of 6-3, the U.S. Supreme Court struck down a Vermont law prohibiting the sale of prescription information to data mining companies for marketing purposes.
In the case, IMS Health Inc. v. Sorrell, the Supreme Court ruled that the Vermont statute violates the First Amendment speech rights of data mining firms. Writing for the majority, Justice Kennedy explained that Vermont laws already allow the collection of prescription information but that this law unfairly targeted the speech rights of the pharmaceutical representatives who market drugs to doctors.
For further information about this case, please click here.
Source: The Washington Post
In the case, IMS Health Inc. v. Sorrell, the Supreme Court ruled that the Vermont statute violates the First Amendment speech rights of data mining firms. Writing for the majority, Justice Kennedy explained that Vermont laws already allow the collection of prescription information but that this law unfairly targeted the speech rights of the pharmaceutical representatives who market drugs to doctors.
For further information about this case, please click here.
Source: The Washington Post
Thursday, July 7, 2011
UCLA Health System Settles HIPAA Charges
Following an investigation by the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR), the University of California at Los Angeles Health System (UCLAHS) has agreed to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules for $865,500 and has committed to a corrective action plan aimed at remedying gaps in its compliance with the rules.
The resolution agreement resolves two separate complaints filed with OCR on behalf of two celebrity patients who received care at UCLAHS. The complaints alleged that UCLAHS employees repeatedly and without permissible reason looked at the electronic protected health information of these patients. OCR’s investigation into the complaints revealed that from 2005-2008, unauthorized employees repeatedly looked at the electronic protected health information of numerous other UCLAHS patients.
Through policies and procedures, entities covered under HIPAA must reasonably restrict access to patient information to only those employees with a valid reason to view the information and must sanction any employee who is found to have violated these policies.
“Covered entities are responsible for the actions of their employees. This is why it is vital that trainings and meaningful policies and procedures, including audit trails, become part of the everyday operations of any health care provider,” said OCR Director Georgina Verdugo. “Employees must clearly understand that casual review for personal interest of patients’ protected health information is unacceptable and against the law.”
The corrective action plan requires UCLAHS to implement Privacy and Security policies and procedures approved by OCR, to conduct regular and robust trainings for all UCLAHS employees who use protected health information, to sanction offending employees, and to designate an independent monitor who will assess UCLAHS compliance with the plan over 3 years.
“Covered entities need to realize that HIPAA privacy protections are real and OCR vigorously enforces those protections. Entities will be held accountable for employees who access protected health information to satisfy their own personal curiosity,” said Director Verdugo.
The HHS Resolution Agreement and CAP can be found on the OCR website at http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/UCLAHSracap.pdf.
Source: Department of Health and Human Services press release
The resolution agreement resolves two separate complaints filed with OCR on behalf of two celebrity patients who received care at UCLAHS. The complaints alleged that UCLAHS employees repeatedly and without permissible reason looked at the electronic protected health information of these patients. OCR’s investigation into the complaints revealed that from 2005-2008, unauthorized employees repeatedly looked at the electronic protected health information of numerous other UCLAHS patients.
Through policies and procedures, entities covered under HIPAA must reasonably restrict access to patient information to only those employees with a valid reason to view the information and must sanction any employee who is found to have violated these policies.
“Covered entities are responsible for the actions of their employees. This is why it is vital that trainings and meaningful policies and procedures, including audit trails, become part of the everyday operations of any health care provider,” said OCR Director Georgina Verdugo. “Employees must clearly understand that casual review for personal interest of patients’ protected health information is unacceptable and against the law.”
The corrective action plan requires UCLAHS to implement Privacy and Security policies and procedures approved by OCR, to conduct regular and robust trainings for all UCLAHS employees who use protected health information, to sanction offending employees, and to designate an independent monitor who will assess UCLAHS compliance with the plan over 3 years.
“Covered entities need to realize that HIPAA privacy protections are real and OCR vigorously enforces those protections. Entities will be held accountable for employees who access protected health information to satisfy their own personal curiosity,” said Director Verdugo.
The HHS Resolution Agreement and CAP can be found on the OCR website at http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/UCLAHSracap.pdf.
Source: Department of Health and Human Services press release
Wednesday, April 27, 2011
Drug Companies Challenge Vermont Data Mining Law in Supreme Court
A lawsuit brought by pharmaceutical manufacturers challenging a Vermont law that prohibits the sale of information about the medicines that doctors are prescribing to their patients was argued in the U.S. Supreme Court on April 26.
The Vermont law prohibits the sale of the information without obtaining permission from the doctor first.
Source: http://www.npr.org/templates/story/story.php?storyId=135737160
The Vermont law prohibits the sale of the information without obtaining permission from the doctor first.
Source: http://www.npr.org/templates/story/story.php?storyId=135737160
Tuesday, April 26, 2011
High Court Rejects Request for Fast Track Decision on Health Care Reform Law
On April 25, the U.S. Supreme Court rejected a request from the Commonwealth of Virginia to issue an immediate ruling on the constitutionality of the Patient Protection and Affordable Care Act enacted last year to reform the nation's health care system.
The Supreme Court indicated that it would wait until all of the pending cases challenging the act reached them before considering the controversy. The cases could reach the court as early at this fall.
Source: http://www.washingtonpost.com/politics/supreme-court-turn-down-virginias-request-to-expedite-review-of-health-care-law/2011/04/15/AFr7U5hE_story.html
The Supreme Court indicated that it would wait until all of the pending cases challenging the act reached them before considering the controversy. The cases could reach the court as early at this fall.
Source: http://www.washingtonpost.com/politics/supreme-court-turn-down-virginias-request-to-expedite-review-of-health-care-law/2011/04/15/AFr7U5hE_story.html
Thursday, March 24, 2011
Washington State Uses Panels to Make Coverage Determinations
A recent article in The New York Times highlights a Washington state panel which uses evidence-based measures to make coverage determinations for state employees, Medicaid patients, and injured workers.
The Health Technology Assessment committee, which was created in 2006 with bipartisan support, is a panel of healthcare professionals that evaluates the cost and effectiveness of medical devices and procedures before deciding to grant or deny coverage.
Committees such as this one were criticized during the healthcare reform debate as being examples of "rationing care." However, the committee argues that it has been balanced in its decision making.
To read the full article, click here:
http://www.nytimes.com/2011/03/22/business/22care.html?pagewanted=2&emc=eta1
Source: The New York Times
The Health Technology Assessment committee, which was created in 2006 with bipartisan support, is a panel of healthcare professionals that evaluates the cost and effectiveness of medical devices and procedures before deciding to grant or deny coverage.
Committees such as this one were criticized during the healthcare reform debate as being examples of "rationing care." However, the committee argues that it has been balanced in its decision making.
To read the full article, click here:
http://www.nytimes.com/2011/03/22/business/22care.html?pagewanted=2&emc=eta1
Source: The New York Times
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