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The HITECH Act is now here in full. The whole litany of tighter privacy and security requirements is in the long-awaited, long-delayed “omnibus” rules finalized Jan. 17 by the U.S. Department of Health and Human Services, and most of these will have to be met by this Sept. 23. The omnibus rules also include changes […]
A victory by the health plan participant in US Airways v. McCutchen, now before the U.S. Supreme Court, may erode ERISA plans’ ability to enforce plan terms as written, a legal expert tells the blog. In McCutchen, the Court has a very difficult balancing act to answer whether: (1) an ERISA health plan administrator is entitled […]
When a self-insured health plan adopts value-based purchasing and insurance design, its goal is to persuade workers to adopt a healthy lifestyle and go to the best performing providers. That’s how plan savings occur, by catching cases before they become acute care cases that harm a self-insured health plan. Self-insured health plans that want to […]
Wal-Mart, the nation’s largest private employer, is getting in on the concept of “Centers of excellence,” a method of steering referrals to providers who perform more efficiently in a bid to bend the health cost curve. With the generous coverage, the company creates good press and may counter its reputation as being skimpy on workers’ benefits. […]
Health plans and insurers long have been thinking of ways to compensate providers not for volume of care, but for value of care, as an important tool in curbing runaway health inflation. Research over the last two decades recently compiled and reviewed by the Agency of Healthcare Research and Quality shows consistent reductions in what […]
In some years, Sept. 23 represents the Autumn Equinox, but in 2012 for health plan sponsors and administrators, it triggers the compliance date for a key disclosure requirement under health reform: the distribution of summaries of benefits and coverage, beginning with open enrollment periods and/or plan years that begin on or after Sept. 23. Here […]
Retirees’ right to vested health benefits for life did not preclude a manufacturer of agricultural and construction equipment from reducing or restricting those benefits, the 6th U.S. Circuit Court of Appeals recently held in a split decision. In doing so, the circuit rejected the retirees’ argument that the company could not change the “scope” of […]
Plans face new a new erosion of their powers to recover the full amount of benefits paid in third-party recovery cases. Attorneys with Epstein Becker and Green discussed these and other trends in a Sept. 13 audio conference on benefit claim denial litigation. Plans Face Diminishing Ability to Recover The growing ability of plaintiffs to […]
Compliance with the contraceptive coverage mandate under health reform is stayed until Aug. 1, 2013 for employers that fit into a slightly expanded enforcement safe harbor described by the Center for Consumer Information and Insurance Oversight (CCIIO) in an Aug. 15 memo. Reform’s preventive care mandate requires plans and insurers to cover a host of […]
In response to health reform, some employers may stop offering health coverage and opt instead to pay a fine, give workers a raise and send them to state-run health insurance exchanges. Compensating for that , the individual mandate may drive about 4 million workers into employer plans, according to research from various sources compiled by […]