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April 25, 2017 logo logo
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The Payment Reform Landscape: For Employers, Keep Pushing Ahead
"While employers are sure to be affected in many ways by changes to federal health care laws, much of the cost and quality conundrum that has troubled our health care system for decades can be influenced by ongoing payment reforms and benefit design efforts in the private sector.... If employers and other health care purchasers work together to demand change from health insurance companies, they can bring their purchasing power to bear on the issues that keep them awake at night."
Health Affairs


Managing Benefit Options for Part-Time, Seasonal and Hourly Employees

Sponsored by Lorman and BenefitsLink

May 11 webinar. Learn about the unique range of planning opportunities available to you in providing a range of welfare and retirement benefits to your part-time, seasonal and hourly employees. Discount for BenefitsLink readers.

HSA Plans and Onsite Clinics: Can This Marriage Be Saved?
"Under rules for HSA-eligible plans, only preventive services can be provided at no cost; employees need to pay the full cost of a non-preventive visit before they satisfy the plan deductible. Some employers with onsite clinics may be unknowingly disqualifying employees, understating their own tax liability, and incorrectly filing employment tax forms."
Mercer/Signal: US Health News

The PBM Story: What They Say, What They Do, and What Can Be Done About It
"Pharmacy benefit managers (PBMs) say they reduce drug prices and increase patient access, but the facts just don't bear that out.... PBMs got their start as useful claims processors but then morphed into large corporations more interested in extracting profits from the prescription drug supply chain than in ensuring medication affordability and access. And that's the real story: PBMs have done more to enrich themselves over the past 25 years than they have done to bring down drug costs."
National Community Pharmacists Association [NCPA]

American Health Care Is So Unintelligible That an Entire Industry Has Been Created to Help Navigate It
"Medical bill advocates and other such third-party businesses have sprung up in the gaps and blind spots of America's complicated, fragmented health care system. These services make sense of health bills for consumers and even fix errors in them.... [T]hey've become even more important as high-deductible health plans -- which put employees on the line for thousands of dollars in out-of-pocket expenses -- have increased in popularity. But these services face a persistent challenge: many employees don't know that they have access to them."

$2.5 Million Settlement Shows That Not Understanding HIPAA Requirements Creates Risk
"In January 2012, CardioNet reported to the HHS Office for Civil Rights (OCR) that a workforce member's laptop was stolen from a parked vehicle outside of the employee's home. The laptop contained the ePHI of 1,391 individuals. OCR's investigation ... revealed that CardioNet had an insufficient risk analysis and risk management processes in place at the time of the theft. Additionally, CardioNet's policies and procedures implementing the standards of the HIPAA Security Rule were in draft form and had not been implemented."
U.S. Department of Health and Human Services [HHS]


2017 Health Savings Accounts Facts

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The Costly Consequences of Failing to Enter Into Written Business Associate Agreements
"The Filefax investigation was likely launched after news reports at the time revealed that medical records held by the company were found in a dumpster. CCDH had used Filefax to store its inactive paper medical records since 2003. Further investigation revealed that CCDH had disclosed the PHI of at least 10,728 individuals to Filefax without obtaining Filefax's satisfactory assurances in the form of a written business associate agreement that it would safeguard the PHI in its possession or control."
Drinker Biddle

Latest HIPAA Resolution Agreement Drives Home Importance of Maintaining Current, Signed Business Associate Agreements
"[A]ll health plans, health care providers and other covered entities and business associates should focus on the adequacy of their BAAs and their BAA recordkeeping. HIPAA compliance surveys reflect deficiencies with the BAA rules are common throughout the industry. These findings and the involvement of BAs in data breaches or other OCR enforcement activities suggest a high probability that many other covered entities and business associates may be sitting ducks for similar sanctions."
Solutions Law Press

The Effects of Ending ACA Cost-Sharing Reduction Payments
"There would be a significant amount of uncertainty for insurers in setting premiums to offset the cost of cost-sharing reductions.... Under a worst case scenario -- where only people eligible for sharing reductions enrolled in silver plans -- the required premium increase would be higher than 19%, and many insurers might request bigger rate hikes."
Henry J. Kaiser Family Foundation

HHS, States Move to Help Insurers Defray Costs of Sickest Patients
"This fix is a well-known insurance industry practice called reinsurance. Claims above a certain amount would be paid by the government, reducing insurers' financial exposure and allowing them to set lower premiums.... On March 13, [HHS] Secretary Tom Price sent a letter to all 50 governors soliciting proposals for reinsurance and other options to help cover the costs of consumers with expensive medical conditions."
Kaiser Health News

Correcting Misconceptions About Invisible Risk-Sharing
"The Invisible Risk-Sharing Program (IRSP) will stabilize the individual insurance market and lower premiums while concurrently providing guaranteed access to coverage and protecting those with pre-existing conditions.... Is there enough money allocated? ... Is this program too complex for insurers? ... Is Maine a good example to predict a national outcome? ... Does the past experience of some prospective programs for small business tell us about future success in the individual market? ... How is this different from the ACA's reinsurance? ... Additional policies to consider."
Health Affairs

Press Releases

Anna Rappaport Receives PSCA Lifetime Achievement Award
PSCA [Plan Sponsor Council of America]

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Holly Horton, Business Manager

BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2017, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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