[Guidance Overview] HHS Notice Addresses Rules for Insurers That Meet or Exceed Medical Loss Ratio Standards
"The extended notice requirement will hopefully reduce confusion that may have otherwise occurred when some individuals received rebates and others, in different insurance plans, did not. Importantly, the electronic disclosure rules for providing SBCs, which are referenced in the extended notice requirements for MLRs, were recently addressed in DOL frequently-asked-questions[.]" (Practical Law Company)
New Jersey Governor Vetoes Health Insurance Exchange
"Democrats in the Legislature had billed the exchange as one-stop shopping for people or businesses seeking health insurance, allowing consumers to compare the benefits and the costs of participating plans. The Web site it proposed would have also allowed people to apply for tax credits or other subsidies toward the cost of insurance. In his veto message, the governor said he was concerned about the potential costs of the exchange." (The New York Times; free registration required)
Proposed Meaningful Use Stage 2 Regs Draw Strong Reaction
"[A few paragraphs in the 68-page comment letter from the American Hospital Association have] drawn the attention and ire of patient and consumer advocate groups. Citing HIPAA concerns, the AHA disagrees with the Centers for Medicare & Medicaid Services proposal 'to provide patients with the ability to view, download, and transmit large volumes of protected health information via the Internet.'" (HealthLeaders Media)
[Opinion] Text of Comments by Consumer-Purchaser Disclosure Project to CMS on Health IT Meaningful Use Program (PDF)
"Stage 2 of Meaningful Use marks a significant step toward national commitment to effective management of health information to improve health outcomes. [The Project urges] CMS to finalize the progressive strides it makes in the proposed rule, especially those that enhance patient and family engagement. However, the proposed rule does not do enough to: (1) drive providers to share information with each other and (2) build the capability to report on quality measures that indicate whether providers are improving their ability to deliver high-value, coordinated care. [This letter elaborates and offers] recommendations on these points[.]" (Consumer-Purchaser Disclosure Project)
Online Health Care Price Transparency Tools Trend Upward
"[Castlight] certainly isn't the only online comparison tool available to consumers. Insurance company Cigna unveiled a similar tool for its customers in February that allows patients to search costs for 200 common medical procedures and estimate prices for specialists, doctors and hospitals based on their coverage, and WellPoint has offered similar resources to some of its customers since 2009." (FierceHealthIT)
[Guidance Overview] Electronic Delivery of Disclosures under the Participant Fee Disclosure Regulation (PDF)
"The interim e-delivery guidance under Technical Release 2011-03R provides more liberal and user friendly options for e-delivery of plan-related information than for investment-related information. To provide all required disclosures using the same e-delivery option one of the two general e-delivery options described ... must be used, however both are complex and challenging to administer." (ING)
[Guidance Overview] Medical Professional Association Hit with HIPAA Penalty Over Health Information in Insecure Emails and Text Messages
"The small size of the covered entity is notable, and the News Release delivers the message clearly: '[The Office for Civil Rights] expects full compliance no matter the size of a covered entity.' As usual, the CAP's provisions exceed the regulatory requirements, reminding us that compliance may be more onerous after an alleged violation. But the allegations and CAP provisions regarding email are somewhat surprising." (Thomson Reuters/EBIA)
Health Care Remains a Key Concern for Americans; Wellness Near Top of List
"Nearly half (42 percent) of people prefer to receive preventive care appointment reminders via email; however, preference for text messages providing reminders doubled in the past year, from eight to 16 percent. While the use of technology is growing, the research also indicates that more traditional forms of communication such as direct mail and print newsletters are still a valued resource for consumers." (Krames StayWell)
Major Reported PHI Breaches Hits 400 with Theft as Primary Type of Breach
"As the first postings on the HHS List occurred on March 4, 2010, it took almost exactly two years to reach the 400 level, which means that an average of 200 postings of List Breaches have been occurring each year." (Fox Rothschild LLP)
Proposed Health Plan Identifier Requirement Could Cost Health Plans More Than $1 Billion
"'The [Health Plan Identifier] is expected to yield the most benefit for [health care] providers, while health plans will bear most of the costs,' HHS flatly states in the preamble to the proposed rules. 'Costs to all commercial and government health plans together ... are estimated to be $650 million to $1.3 billion,' the agency explained, but 'plans are expected to make up those costs in savings.'" (Thompson)
Health Plans Invest in Trigger-Based Communications With Focus on Health and Wellness
"More than 50 percent of health plans will invest in trigger-based communications to prompt consumers to take action, according to a new IDC Health Insights research study ... Trigger-based communications use data analytics to detect a consumer's current status, and automatically initiate relevant communications to inspire consumer action." (MarketWatch)
Cyber Liability Insurance: Protecting Public Sector Plans against Inappropriate Participant Information Disclosures (PDF)
"Plan sponsors that are considering purchasing cyber liability insurance should review the different coverage options available in the market to help make the proper choice for their unique needs. This is important because policies can be very different in the scope of coverage they provide." (Segal)
[Guidance Overview] Proposed HIPAA Regs Address Unique Health Plan Identifier and ICD-10 Compliance Date
"With little progress under the original HIPAA directive, health care reform prompted action by requiring HHS to implement a standard for a unique health plan identifier by October 1, 2012. The preamble to the proposed regulations notes that health plans will bear the administrative cost of complying with the HPID requirement, while providers (which must identify health plans for billing and other transactions) will likely reap most of the benefits through increased automation." (Thomson Reuters/EBIA)
[Official Guidance] Text of HHS Proposed Rule on Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for ICD-10-CM and ICD-10-PCS Medical Data Code Sets (PDF)
"This proposed rule would implement section 1104 of the [PPACA] by establishing new requirements for administrative transactions that would improve the utility of the existing [HIPAA] transactions and reduce administrative burden and costs. It proposes the adoption of the standard for a national unique health plan identifier (HPID) and requirements or provisions for the implementation of the HPID. This rule also proposes the adoption of a data element that will serve as an other entity identifier (OEID), an identifier for entities that are not health plans, health care providers, or 'individuals,' that need to be identified in standard transactions." (Department of Health & Human Services)
[Guidance Overview] Official 'Fact Sheet': HHS Proposes HIPAA Standard for a Unique Health Plan Identifier
"[A committee in 2010] addressed the need for an identifier for entities such as health care clearinghouses, third party administrators (TPAs), and repricers, that are not health plans but that perform certain health plan functions. These entities are currently identified in the standard transactions in the same fields and using the same types of identifiers as health plans, but are not health plans and so cannot obtain a health plan identifier. Based on the [committee's] recommendations, HHS is proposing to adopt an 'other entity' identifier (OEID).' ... [C]overed entities, excluding small health plans, would be required to be in compliance with the HPID on October 1, 2014. Small health plans would be required to be in compliance with the HPID on October 1, 2015." (U.S. Department of Health and Human Services)
[Official Guidance] Text of Proposed HHS Regs Requiring Health Plan Identifiers and Extending Compliance Date for ICD-10 Code Sets for Billing (PDF)
"This proposed rule would implement section 1104 of the Patient Protection and Affordable Care Act ... by establishing new requirements for administrative transactions that would improve the utility of the existing [HIPAA] transactions and reduce administrative burden and costs. It proposes the adoption of the standard for a national unique health plan identifier (HPID) and requirements or provisions for the implementation of the HPID." (U.S. Department of Health and Human Services)
Wireless Medical Monitors May Transform Patient Care; Might Be Expensive for Health Plans
"Some experts predict that in the near future, tens of millions of Americans will use gadgets that automatically send their vital signs to medical professionals, relatives and concerned friends. The technology has already generated an industry worth well over $1 billion a year." (Dallas Morning News)
Final HITECH Rules Reach OMB
"In addition to finalizing the HITECH changes to HIPAA's privacy, security and enforcement rules proposed in July 2010 by [HHS], the rules will finalize genetic privacy rules that HHS proposed in 2009, as well as HITECH rules on enforcement and breach notification that the agency issued in 2009 in interim final form." (Thompson)
Strong Privacy and Security Rules Crucial to Success of Health Insurance Exchanges Mandated by Health Care Reform
"These exchanges will require new and unique exchanges of data among state agencies, the federal government, private health plans, businesses, individuals and the exchange itself. This process will trigger the creation, collection, exchange, and disclosure of personally identifiable information. Exchanges will handle, at a minimum, basic demographic information, financial information, immigration information, incarceration information and Social Security Numbers." (Center for Democracy & Technology)
IRS Newsletter Discusses Plan Loan Interest Rates, Form 5558 Errors, and RMD Calculations
"The newsletter also includes a calendar of retirement plan events for March and April, a summary of the DOL's final regulations on fiduciary-level service provider disclosures ..., an explanation of the DOL's revised interim policy on electronic disclosure for participant-level fee disclosures ..., and a notation that the IRS's 401(k) Fix-It Guide (a useful checklist of potential plan mistakes and permissible corrections) has been updated." (Thomson Reuters/EBIA)
Record Keeper Survey Re: DOL Technical Release 2011-03: Final Survey Results (PDF)
Memorandum dated January 20, 2012. "Set forth ... are the results from the survey regarding [DOL] Technical Release 2011-03.... Preliminary results were reported on November 15, 2011 and The SPARK Institute indicated that it was conducting further research regarding the cost estimates (questions 9, 10 and 11) in order to improve the accuracy of the information. Except for the updated results reported for questions 9 through 11, the report is unchanged.... The results are shown in the same order as the questions appeared." (The SPARK Institute)
[Opinion] Trade Industry Letter to EBSA on Electronic Delivery Guidance under Section 404(a) of ERISA (PDF)
"[The trade industy appreciates] that the Department is engaged in a review of the current electronic disclosure safe harbor. [The trade industy has] survey data to share regarding EBSA's Technical Release 2011-03R and electronic disclosures generally. From survey results and discussions with various companies, [The trade industy is] concerned that this interim guidance does not provide meaningful incentives or make it more feasible for employee benefit plan sponsors and their service providers to use electronic media instead of paper. With the compliance date of the participant fee disclosure rule fast approaching, [the trade industy is] also concerned that the Department's most recently issued regulatory agenda does not include guidance on electronic disclosure." (The SPARK Institute)
The Promise and Peril of Health Care Forecasting
"The growing use and increased sophistication of electronically mediated patient-level forecasting presents challenges for ethical use and opportunities for innovative applications. Health plans, method developers, and policy makers should adopt strategies that directly address these issues in order to maximize the benefit of healthcare forecasting on the longterm health of patients." (The American Journal of Managed Care)
Impact of an Online Prescription Management Account on Medication Adherence
"Patients who utilized an online prescription management account had higher rates of medication adherence as compared with nonusers. Additional studies are needed to assess which specific components of the prescription management account have the biggest impact on adherence." (The American Journal of Managed Care)
[Guidance Overview] Insurer Pays $1.5 Million in First Settlement Resulting from HIPAA Breach Report
"This is the latest development in a rising tide of HIPAA privacy and security enforcement activity. The news release's characterization of the HITECH Act's notification requirements as 'an important enforcement tool' suggests that more investigations may be commencing this way. With HHS's audit program also underway ..., covered entities and business associates need to be vigilant about compliance. As this settlement demonstrates, there's no avoiding the requirement to perform a HIPAA security risk analysis, and to periodically revisit it." (Thomson Reuters/EBIA)
Data Breach Leads to First HITECH Enforcement Settlement
"Though the settlement is the first relating to HITECH's breach reporting requirements, there likely are more enforcement actions in the pipeline. Since launching its breach notification website in February 2010 as required by HITECH, HHS has received, on average, 17 breach reports each month. Six of those reports involved breaches involving PHI of more than one million patients. HHS has initiated audits on many (if not all) of the significant reported breaches to date and we anticipate further enforcement action settlements to follow." (Ballard Sphar LLP)
Aetna Launches Updated iTriage App
"The new iTriage app allows [A]etna customers to research symptoms, locate a nearby provider and book appointments[.]" (FierceHealthPayer)
[Opinion] Electronic Health Records: A Study and Perspective
"[T]he study is another piece of evidence, among many, in the debate surrounding electronic health records. And it's worth keeping in mind that the debate is really about the best way to adopt the technology, and at what pace -- not whether moving from paper records to the computer age makes sense." (The New York Times; free registration required)
Do Electronic Medical Records Save Money?
"A new study published in Health Affairs [suggests] that office-based physicians who have access to electronic records of patient care are actually more likely to order additional imaging tests and laboratory tests than doctors who rely on paper records." (The New York Times; free registration required)
Giving Office-Based Physicians Electronic Access to Patients' Prior Imaging and Lab Results Did Not Deter Ordering of Tests
"Policy-based incentives for health care providers to adopt health information technology are predicated on the assumption that, among other things, electronic access to patient test results and medical records will reduce diagnostic testing and save money." (Health Affairs)
Digital Records May Not Cut Health Costs, Study Cautions
"[Research published March 5, 2012] in the journal Health Affairs found that doctors using computers to track tests, like X-rays and magnetic resonance imaging, ordered far more tests than doctors relying on paper records." (The New York Times; free registration required)
Use of Electronic Distribution of SPDs Continues to Grow
"Employers are realizing that not only does electronic distribution of Summary Plan Descriptions (SPDs) save money; it results in faster distribution of SPDs that better reflect current plan provisions than materials distributed as printed hard copies." (HighRoads)
[Guidance Overview] DOL'S Electronic Guidelines for New 2012 Participant Investment and Fee Disclosures
"Technical Release 2011-03R is intended as temporary guidance until the DOL completes its review of its existing electronic distribution rules. In the meantime, prior to August 2012, plan sponsors and administrators of calendar-year plans should familiarize themselves with Technical Release 2011-03R to determine what mandatory disclosures will be made in electronic format (if any), and whether their plans have sufficient systems and administrative capabilities to provide the mandatory disclosures in an electronic format." (McDermott Will & Emery)
The Doctor Is 'In' with Digital Data, Details, Diagnoses
"Physicians are one of the last professions to embrace email for communicating with patients. Overall, 6.7 percent of all office-based physicians nationally emailed their patients routinely in 2008, according to the Center for Studying Health Systems Change. Even in highly integrated group -- staff-model HMOs -- only half the physicians regularly used email." (telegram.com)
IRS Newsletter Highlights Leased Employee Compliance Project, Electronic Signatures, and More
"The newsletter also includes a discussion of current priorities of the IRS Employee Plans Examinations office, including the 401(k) Compliance Check Questionnaire Project. And there is a summary of recent changes to Form 5300, including a requirement to provide information on pending IRS or DOL Voluntary Correction Program applications." (Thomson Reuters/EBIA)
First HIPAA Enforcement Action Against a Business Associate (and the Plot Thickens with Transparency Demands)
"On Jan. 19, 2012, in the wake of the theft of an unencrypted laptop computer containing approximately 23,500 patients' records, the Minnesota attorney general brought the first formal enforcement action against a business associate, Accretive Health, Inc., for an alleged violation under [HIPAA], using her authority under the [HITECH] Act. Additionally, the attorney general appears deeply unsettled by the amount of information that Accretive Health collected about patients without the patients' knowledge, alleging that this lack of transparency represents deceptive and fraudulent practices under Minnesota law." (Davis Wright Tremaine LLP)
5010 HIPAA Transaction Standards Deadline Extended, but Threat Remains, Says AMA
"Expressing serious concerns about the ability of physician practices and payers to make the conversion to the 5010 electronic transaction standards and ICD-10 (a new code set for medical diagnoses) in time, both MGMA and the AMA are calling for change. The two agencies say that the government needs to form a comprehensive contingency plan permitting health plans to adjudicate claims that may not have all the required data content, or the government needs to call an outright halt to the transition." (HealthLeaders Media)
Lowe's Sued over Cancelling Health Plan Participants' Coverage
"A lawsuit was filed on behalf of all participants in Lowe's Companies' Group Medical Plan who had their health coverage terminated and were denied medical benefits by Lowe's for part or all of the 2011 calendar year." (PLANSPONSOR.COM)
[Opinion] Health Care Consumers Have Uphill Battle in Pushback Against High Prices
"To an economist it is astonishing that Americans have been content for so long to allow an economic sector that has absorbed an increasing portion of their incomes -- 18 percent of their gross domestic product now and 20 percent before too long -- to operate without any meaningful price transparency." (New York Times; free registration required)
[Guidance Overview] EEOC Issues Final Rule Extending Title VII And ADA Recordkeeping Requirements to GINA
"The EEOC issued a final rule extending the existing recordkeeping requirements under Title VII and the ADA to entities covered by Title II of the Genetic Information Nondiscrimination Act of 2008 (GINA). Effective April 3, 2012, employers with 15 or more employees must retain all personnel and employment records for at least one year, and must retain documents relevant to charges filed under GINA until their final disposition." (Practical Law Company)
Electronic Health Records Still Need Work
"America may be a technology-driven nation, but the health care system's conversion from paper to computerized records needs lots of work to get the bugs out, according to experts who spent months studying the issue." (BenefitsPro)
[Guidance Overview] Labor Department Offers Guidance on Electronic Disclosure But Not Much Relief
"The Release provides little relief to plan administrators who want to satisfy the disclosure requirements of the Regulation electronically but are stymied by the cumbersome requirements of the Safe Harbor as to Group 2 participants. Inexplicably, however, Method 2 in the Release is more difficult to implement than the consent procedures in the Safe Harbor for Group 2 participants." (McGuireWoods LLP)
[Guidance Overview] HHS Regulations Adopt Standards for HIPAA Electronic Funds Transfers
"[HHS] issued interim final regulations addressing standards for electronic funds transfers (EFTs) applicable to health care claims payments transmitted by health plans to health care providers." (Practical Law Company)
[Guidance Overview] HHS Adopts HIPAA Transaction Standards for Health Care Electronic Funds Transfer and Remittance Advice
"HHS confirmed that a health plan may rely on its financial institution to translate payment instructions into the new file format requirements without the financial institution necessarily becoming subject to HIPAA's requirements. But, as the preamble warns, the health plan, and not its financial institution, will be ultimately responsible for compliance." (Thomson Reuters/EBIA)
Guidance Provided on Electronic Health Record Incentives
"[M]edical providers must comply with standards for use of the technology and properly account for the incentive payments in an area where accounting principles are in an infant stage. [Last] week, the Healthcare Financial Management Association (HFMA) published an issue analysis to provide clarity on accounting for incentive payments received under the Health Information Technology for Economic and Clinical Health . . . Act." (American Institute of Certified Public Accountants)
Healthrageous Releases Mobile Health App
"[The Boston-based company said] that it has launched a mobile app called 'h!GO,' which is available to participants of the company's employer-sponsored online health management plans. The app presents a user with his or her individual health measurements on a handheld device . . . ." (Xconomy, Inc.)
[Official Guidance] Interim Final HHS Regs: Adoption of Standards for Health Care Electronic Funds Transfers and Remittance Advice (PDF)
"This interim final rule with comment period implements parts of section 1104 of the Affordable Care Act which requires the adoption of a standard for electronic funds transfers (EFT). It defines EFT and explains how the adopted standards support and facilitate health care EFT transmissions. . . . These regulations are effective on [the date of publication in the Federal Register, expected to be January 10, 2012]." (U.S. Department of Health & Human Services)
Affordable Care Act Provision Cuts Red Tape, Saves Up to $4.5 Billion
"New standards for electronic funds transfers in health care, required by the Affordable Care Act, will reduce up to $4.5 billion off administrative costs for doctors and hospitals, private health plans, states, and other government health plans, over the next ten years, according to estimates included in new rules published today by [HHS]." (U.S. Department of Health & Human Services)
2011 Saw Surge in HIPAA Compliance Issues
"According to a recent Ponemon research study, data breaches alone have risen by 32%. Ninety-two percent of all healthcare institutions report they've experienced one in the past two years, and each such incident costs an average of $2.2 million." (Forbes.com LLC)
Estimating Social Security Benefits
"In a cost-saving move, Social Security has suspended the annual mailing of personal benefit estimates, which traditionally arrived a few months before each covered worker's birthday. To estimate future benefits, workers below retirement age now must rely on online calculators, such as the worksheet available at www.ssa.gov/estimator[.]" (BenefitsPro)
[Guidance Overview] Technical Update on New Form 5500 Guidance
"The DOL will continue to process a Form 5500 that is filed with an invalid electronic signature (e.g., signing credentials that have not been activated). Such filings will receive a 'filing stopped' status and the preparer will need to amend the Form 5500, obtain a valid electronic signature and re-file the form (as an amended return) with the DOL." (SunGard Relius)
[Guidance Overview] Electronic Signatures on Forms 5500 and 5500-SF Become Mandatory for 2012
"[Beginning January 1, 2012, employer,] plan sponsors or plan administrators must electronically sign a Form 5500 or Form 5500-SF before they submit the form to the IRS and Department of Labor (DOL). Any individual who e-signs an original or amended return must have a valid EFAST2 user identification and personal identification number." (SmartHR)
Rewarding Patients for Cheaper Care
"This program provides cash rewards ranging from $10 to $75 for members that seek lower cost care for non-emergency outpatient procedures such as colonoscopies, MRI and CT scans, mammograms, lab work, bone density studies and ultrasounds. Members can call a toll-free number and to speak to a nurse who informs them of any lower cost plan providers in their area." (WGA InsureBlog)
Findings from The 2011 EBRI/MGA Consumer Engagement in Health Care Survey
"A significant portion of the population reported using a smartphone, and 1 in 5 reported using a tablet. Among them, about one-quarter reported using an app for health-related purposes. Among those not using an app, nearly one-half were interested in using one." (Empoyee Benefits Research Institute)
[Guidance Overview] DOL Clarifies and Reissues Interim Policy on Electronic Distribution of Participant-Level Fee Disclosures
"As the revised policy acknowledges, numerous parties have asked the DOL to extend the more lenient rules of FAB 2006-03 to all fee and expense information required under the participant-level fee disclosure rules. For now, though, the DOL is still declining to go that far." (Thomson Reuters/EBIA)
[Guidance Overview] DOL Revises Electronic Fee Disclosure Guidance for Pension Plans
"Administrators should review, and update as necessary, their methods for delivering participant-level fee disclosures to ensure that the methods comply with the requirements set forth in Technical Release 2011-03R." (Littler Mendelson P.C.)
[Guidance Overview] DOL Slightly Expands E-Delivery Options for Participant Fee Disclosures
"The alternative delivery system involves emailing information to participants who opt-in. The new guidance allows 24/7 web delivery via a secure web site, but only for participants who opt-in, in accordance with the alternative delivery system." (SunGard Relius)
[Guidance Overview] DOL Clarification of Electronic Fee Disclosure Guidance
"The revised release addresses two specific points relating to the use of continuous-access websites for disclosure purposes . . . ." (Morgan, Lewis & Bockius LLP)
Sprint Expands Wellness Efforts through Social Media
"Telecom giant Sprint estimates it saved approximately $1.1 million through a social media wellness challenge it launched last summer." (Employee Benefit News)
[Guidance Overview] DOL's Interim Guidance on Electronic Disclosures to Participants (PDF)
"This guidance applies to participant-directed defined contribution plans (including 403(b) plans) that are subject to ERISA. This rule does not apply to governmental plans, church plans that do not elect to be covered by ERISA ('nonelecting church plans'), or non-ERISA 403(b) plans." (The Prudential Insurance Company of America)
Colorado Creating Online Price List of Health Care Procedures
"[14] states have or are setting up searchable databases designed to help people shop and compare health care options based on price and quality. Colorado is launching its All Payer Claims Database this fall. [The project] is the result of 2010 legislation and is expected to have data from most of the claims in the state in 2013." (Kaiser Health News)
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