A recent article in the New York Times outlined some disturbing trends in health care records breaches and what law makers under the current administration are ding about it. Care providers are especially at risk with the passing of the HITECH additions to the current HIPPA laws. I would recommend reading the article ad then getting in touch with one of our risk management professionals to discuss how you protect your organization.
Breaches Lead to Push to Protect Medical Data
By Milt Freudenheim, New York Times. May 30, 2011
While the Obama administration makes the push toward getting the health industry switched over to electronic record systems, concerns over breaches of medical privacy prevail. In fact a government webpage displays a list of almost 300 doctors, hospitals and insurance companies that have reported major privacy breaches in the last two years.
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UBI NEWS Tags:
Assisted Living Centers,
Breaches,
Care Providers,
Cyber liability,
Health Care,
HIPPA,
HITECH,
Hospitals,
Insurance,
Risk Management
The New Stimulus COBRA Changes
How Stimulating Are They?
Presenters: AJ Bentley, Ben-X
Ken Trowbridge, WanSutter
Tim Blair, WanSutter
This seminar will discuss:
• What employers need to know
• Next steps for compliance
• How much will these changes cost?
• What is the impact on employers and ex-employees?
Wednesday April 8, 2009
8:00 AM to 9:30 PM
6360 South 3000 East Suite 205 Salt Lake City, UT 84121
Phone (801) 943-8844 Fax (801) 937-8990
Email: rsvp@ubinsurance.com
Posted in
UBI NEWS Tags:
COBRA,
Health Care,
Insurance,
stimulus
Purpose. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction
Equity Act of 2008 will end health insurance benefits inequity between mental
health/substance use disorders and medical/surgical benefits for group health plans with
more than 50 employees. When the law is enacted, 113 million people across the country
will have the right to non-discriminatory mental health coverage, including 82 million
individuals enrolled in self-funded plans (regulated under ERISA), who cannot be
assisted by State parity laws.
The Parity Requirement. The bill amends the Mental Health Parity Act of 1996 to
require that a group health plan of 50 or more employees (or coverage offered in
connection with such a plan)—that provides both medical and surgical benefits and
mental health or substance use benefits—to ensure that financial requirements and
treatment limitations applicable to mental health/substance use disorder benefits are no
more restrictive than those requirements and limitations placed on medical/surgical
benefits.
· Equity coverage will apply to all financial requirements, including deductibles,
copayments, coinsurance, and out-of-pocket expenses, and to all treatment
limitations, including frequency of treatment, number of visits, days of coverage, or
other similar limits.
· The bill builds on the current 1996 parity law, which already requires parity coverage
for annual and lifetime dollar limits.
· Mental health and substance use disorder benefits are defined broadly to mean
benefits with respect to services for mental health conditions and substance use
disorders, as defined under the terms of the plan and in accordance with applicable
Federal and State law.
· A plan may not apply separate cost sharing requirements or treatment limitations to
mental health and substance use disorder benefits.
· If a plan offers two or more benefit packages, the requirements of this Act will be
applied separately to each package.
· As under the current Federal parity law, mental health or substance use benefit
coverage is not mandated. However, if a plan offers such coverage, it must be
provided at parity in accordance with this Act.
Out-Of-Network Benefits. A group health plan (or coverage) that provides out-ofnetwork
coverage for medical/surgical benefits must also provide out-of-network
coverage, at parity, for mental health/substance use disorder benefits.
Benefits Management and Transparency. As under the 1996 Mental Health Parity Act,
a group health plan (or coverage) may manage the benefits under the terms and
conditions of the plan. A plan will make mental health/substance use disorder medical
2
necessity criteria available to current or potential participants, beneficiaries or providers
upon request. A plan must also make reasons for payment denials available to
participants or beneficiaries on request or as otherwise required.
Preservation of State Law. The current HIPAA preemption standard applies. This
standard is extremely protective of State law. Only a State law that “prevents the
application” of this Act will be preempted which means that stronger State parity and
other consumer protection laws remain in place.
Small Employer Exemption. As with the current 1996 Federal parity law, small
employers of 50 or fewer employees are exempt from the requirements of the Act. State
parity laws will continue to apply to these employers, as well as to individual plans.
Cost Exemption. If a group health plan (or coverage) experiences an increase in actual
total costs with respect to medical/surgical and mental health/substance use benefits of
1% (2% in the first plan year that this Act is applicable), the plan can be exempted from
the law.
· An employer may elect to continue parity coverage regardless of this cost increase.
· The exemption shall apply for one plan year.
· A qualified actuary (member of American Academy of Actuaries) shall determine
and prepare a written report regarding a plan’s cost increase after a plan has complied
with the Act for the first six months of the plan year involved.
· A plan shall promptly and timely notify the Department of Labor (if self-funded) or
the Department of Health and Human Services (if fully-insured), the appropriate State
agencies, and participants and beneficiaries when it elects an exemption. Plan
notification to Labor or HHS is confidential and will provide a description of covered
lives in the plan and the actual costs for which the exemption is sought.
· Labor or HHS (as appropriate) and State agencies may audit a plan to determine
compliance with the Act when the plan has elected an exemption.
Compliance Report. By 2012 and every two years after, the Labor Secretary shall submit
to Congress a report on group health plan (or coverage) compliance with this Act. The
report will include the results of any compliance audits or surveys, and if necessary, an
analysis of reasons for any failures to comply with the law.
GAO Study. GAO will conduct a study that analyzes the specific rates, patterns and
trends in coverage, any exclusion of specific mental health and substance use diagnoses
by health plans, and the impact of this Act on such coverage and costs. GAO will
provide a report to Congress within three years (and an additional report after five years)
on the results of the study.
Consumer Assistance. The Labor Secretary, in cooperation with the HHS and Treasury
Secretaries, shall publish and disseminate guidance and information for plans,
participants and beneficiaries, applicable State agencies, and the National Association of
Insurance Commissioners concerning the requirements of this Act. This information will
3
include assistance with questions and how participants and beneficiaries can obtain
assistance from State consumer and insurance agencies.
Enforcement. As under the 1996 law, Labor, HHS, and Treasury will continue to
coordinate enforcement of the Federal mental health parity requirements and are required
to issue regulations to carry out changes made in this Act not later then one year after the
enactment date. Treasury may continue to impose an excise tax on any plan for failure to
comply with the requirements of the Act.
Effective Date. The Act will apply to plans beginning in the first plan coverage year that
is one year after the date of enactment. For most plans, this will mean the effective date
begins on January 1, 2010. Plans maintained under collective bargaining agreements
ratified before the enactment date are not subject to the Act until they terminate (or until
January 1, 2009, if this is a later date). The current 1996 parity act requirements for
annual and lifetime dollar limits remain in effect for all plans, while the annual sunset in
the 1996 parity act is eliminated, effective January 1, 2009.
Posted in
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Health Care,
mental health parity bill
Gov. Huntsman testifies on need for health care reform
February 13th, 2009 @ 3:47pm
By Richard Piatt
Utah lawmakers are making progress in giving people more options on health insurance. Gov. Jon Huntsman testified today on behalf of health system reform.
The insurance component was one of three health care related bills that passed to the full House. The first bill is intended to give consumers more health insurance options. House Speaker David Clark says the bill will increase transparency and affordability in the health care market. The other two bills that passed seek to simplify the business side of health care. Another requires state contractors to provide health insurance.
In all cases, legislators are being thanked for recognizing the system needs fixing. They say this is a starting point, with more significant reforms coming when the economy recovers.
Health care advocate Judi Hilman said, “In order to do comprehensive health system reform, you need a lot of money. And this year you don’t have any money, you have the opposite of money, there are deficits as far as the eye can see. So I appreciate that, that we are just not ready to tackle the beast.”
All three bills will now go to the full House for debate.
Legislators also say they’ll continue to work on revamping the health care system, which they say is in need of reform in many ways.
Advocates for the poor are still concerned that health insurance is way too expensive for a lot of people. That issue remains a challenge for lawmakers.
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UBI NEWS Tags:
Health Care,
Insurance,
Reform,
Utah
