Tag: health care reform

GOP Blueprint for Replacing ACA Causes Employer Concern

By David Slaughter, JD, BLR Senior Legal Editor The recently released Republican blueprint for replacing the Affordable Care Act (ACA), while generally well received by plan sponsor groups, elicited concern for its proposal to tax employer-provided health benefits above a certain threshold.

Attitude Shift: The Glacial Pace of Hospital Billing Transparency

Hospitals are still resisting transparency, and reacting in unconstructive ways to reference-based pricing. The evidence shows many health care providers have some way to go in embracing changes designed to repair our nation’s cost spiral. We in the self-funding industry can make a difference, and at the same time protect our plan members from unfair […]

Prohibited Restrictions and Rescission Clarified in Agency FAQs

Compliance with preventive health service requirements and other mandates of the health care reform law, along with disclosure obligations involving mental health parity requirements for health plans, were addressed in frequently asked questions issued by the U.S. Departments of Labor, Health and Human Services and Treasury on April 20. Affordable Care Act compliance issues covered […]

Impact on Life Duration & Quality Drives Drug Value

A prescription drug’s ability to prolong life is a top factor health plans are using when fixing benchmark prices for drug reimbursement, followed by the drug’s ability to improve the patient’s quality of life, health care stakeholders said at an April 15 briefing hosted by the Alliance for Health Reform. Steven Pearson, MD, MSc, president […]

How Health Plans Help Providers Convert to Quality & Value Models

Health care providers need help moving to value-based reimbursement and adopting accountable care models, and insurers and health plans often provide the best support, health plan executives told a recent conference. They discussed best practices for helping providers adopt value based pay and outcome-based reimbursement on April 11 at the World Health Care Congress in […]

Supreme Court Seeks New Accommodation in Birth Control Case

Religious non-profit employers that are not eligible for a church exemption seemed more likely to change the process of opting out of the Affordable Care Act requirement that health plans cover contraceptives and family planning services without cost-sharing. In a two-page order dated March 29, the U.S. Supreme Court told lawyers arguing Zubik v. Burwell, No. 14-1418 (cert. […]

Transform Market Rules to Stop Drug Price Gouging, AHIP Execs Advise

Runaway prescription drug pricing poses a threat to health plan solvency and to the financial well-being of individuals, because a distorted market allows profit-seeking entrepreneurs to game the system with anti-competitive pricing, health plan executives told attendees at AHIP’s national health policy conference on March 9. Drug spending is growing faster than any other component […]

Secrets to making reference-based pricing work

In order for reference-based pricing to work, health plan sponsors should do it in a way that involves implementing best practices for cost analysis, claim repricing, plan design, patient advocacy (including balance billing protection when necessary), and member education. Ways to Make RBP Succeed Employers, administrators, brokers and courts have begun to realize that determining the value […]

Fiduciary Duties Are Myriad, So Safeguards Matter

Monitoring the performance of service providers, making required disclosures to participants and beneficiaries, keeping good records and filing reports with the government are just a few of the important functions a fiduciary must ensure are properly executed, an enforcement official at the U.S. Department of Labor’s Employee Benefits Security Administration unit told a group of […]

IRS Extends ACA Employer Reporting Due Dates

Employers will have 60 more days to send notices to participants and beneficiaries, and about 90 more days to send notices to the IRS about health coverage offered and employees’ health coverage status, the IRS announced Dec. 28. IRS Notice 2016-4 extends the due dates of the information reporting requirements for insurers, self-insuring employers and […]