R&R Insurance Blog

Medications have side-effects; so do health care laws. Is California's scramble to find a solution to the overwhelming provider access issue a sign of things to come? California may be different in many respects and the same could be said of any of the other 49 states, but on this issue, they do not stand alone. Their "solution", however, may create some new side-effects of its own.

The LA Times article cites the following:

Problem: There aren't enough doctors to treat a crush of newly insured patients.

California Lawmakers' Solution: Fill the gap by redefining who can provide healthcare. They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure. Read more...

Interesting poll results from a recent MD News.com physician poll.

Q: Would knowing the cost of a diagnostic test to the insurance company and the patient affect your opinion about the need for the test?

40 % Yes. I would try to select the least expensive testing available without compromising patient care.

33 % Maybe. I would at least weigh the pros and cons associated with more expensive diagnostic methods.

27 % No. Pricing has absolutely no place in the practice of medicine. My role is to diagnose patients regardless of costs.

Obviously, there is still a long journey ahead when it comes to physician networks, partnering with care givers that provide health care for your employee base, and educating the impact not only to employers and their employees - looks like there is more need for education on the provider side as well.

For any help with understanding health care consumerism, lowering health care costs through the implementation of proven wellness and work comp techniques, please contact me, Riley Enright, knowledgebroker and health benefits specialist at R&R Insurance Services.

(1/23, Nussbaum, Tracer - Bloomberg) reports that in an interview, National Association of Insurance Commissioners (NAIC) president Jim Donelon said that "President Barack Obama may need to delay his health-care overhaul or risk 'chaos' when subsidized insurance plans go on sale in October." He explained that "It's unclear how well the federal government or any of the participating states will perform on Oct. 1, when millions of Americans are supposed to begin shopping at online markets created by the law," and that "while the administration has shown no sign of seeking a delay, it may be in the president's best interest." Read full article.

On Jan. 24, 2013, the Department of Labor (DOL) announced that employers will not be held to the March 1, 2013, deadline. They will not have to comply until final regulations are issued and a final effective date is specified.

EXCHANGE NOTICE REQUIREMENTS
In general, the notice must:

• Inform employees about the existence of the Exchange and give a description of the services provided by the Exchange;
• Explain how employees may be eligible for a premium tax credit or a cost-sharing reduction if the employer's plan does not meet certain requirements;
• Inform employees that if they purchase coverage through the Exchange, they may lose any employer contribution toward the cost of employer-provided coverage, and that all or a portion of this employer contribution may be excludable for federal income tax purposes; and
• Include contact information for the Exchange and an explanation of appeal rights.
  This requirement is found in Section 18B of the Fair Labor Standards Act (FLSA), which was created by the ACA. The DOL has not yet issued a model notice or regulations about the employer notice requirement.

WHEN DO EMPLOYERS HAVE TO COMPLY WITH THE EXCHANGE NOTICE REQUIREMENTS?
Section 18B provides that employer compliance with the notice requirements must be carried out "in accordance with regulations promulgated by the Secretary [of Labor]." Accordingly, the DOL has announced that, until regulations are issued and become applicable, employers are not required to comply with the exchange notice requirements.

The DOL has concluded that the notice requirement will not take effect on March 1, 2013, for several reasons. First, this notice should be coordinated with HHS's educational efforts and IRS guidance on minimum value. Second, the DOL is committed to a smooth implementation process, including:

• Providing employers with sufficient time to comply; and
• Selecting an applicability date that ensures that employees receive the information at a meaningful time.

The DOL expects that the timing for distribution of notices will be the late summer or fall of 2013, which will coordinate with the open enrollment period for Exchanges.

The DOL is considering providing model, generic language that could be used to satisfy the notice requirement. As a compliance alternative, the DOL is also considering allowing employers to satisfy the notice requirement by providing employees with information using the employer coverage template as discussed in the preamble to the Proposed Rule on Medicaid, Children's Health Insurance Programs and Exchanges.

Future guidance on complying with the notice requirement under FLSA section 18B is expected to provide flexibility and adequate time to comply.

"This information is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice. © 2013 Zywave, Inc. – republished from Zywave."