WellPoint To Ban Coverage Rescissions Before Affordable Care Act Fall 2010 Deadline

April 28, 2010

WellPoint, Inc. will suspend the practice of rescinding patients’ coverage May 1, 2010, months in advance of this Fall’s deadline for insurers stop this practice established by the Affordable Care Act. The nation’s largest health insurer announced here its plans to implement the change in its practices regarding individual market rescissions on April 27, 2010.  

Beginning this Fall, the Affordable Care Act will prohibit insurance companies from rescinding policies, except in cases of fraud or intentional misrepresentation of material fact. Wellpoint’s termination of individual policy rescissions announced this week comes months ahead of the effective deadline for terminating rescissions contained in the legislation.  The ban against rescissions is one of a number of new federal restrictions on health insurers and group health plans enacted as part of the Affordable Care Act scheduled to take effect this Fall.  Wellpoint previously announced it also would change its dependent coverage policies to extend the period that a dependent child can remain on his parent’s coverage to age 26 before the deadline required by the Affordable Care Act.

WellPoint’s announcement comes after Health & Human Services Secretary Kathleen Sebelius sent a letter on April 22 urging the company to immediately stop the practice of rescinding coverage for patients who become ill.  Wellpoint recently drew criticism from Secretary Sebelius and others for targeting breast cancer victims for rescission of their policies.  Secretary Sebelius’ initial letter to WellPoint can be found here or at here.

For Assistance With Health Industry Concerns

If your organization needs advice or assistance with the proposed regulation, preparing or submitting comments on the regulation or with other health care matters, contact Cynthia Marcotte Stamer at (469) 767-8872 or via e-mail here

Vice President of the North Texas Health Care Compliance Professionals Association, Exempt Organization Vice-Coordinator of the Southern States IRS TEGE Council, a Council Member of the ABA Joint Committee On Employee Benefits Council, Past Chair of the ABA Health Law Section Managed Care & Insurance Section, the former Board Compliance Chair of the National Kidney Foundation of North Texas and former Board President of the Richardson Development Center for Children (now Warren Center), Ms. Stamer has more than 22 years experience advising health industry clients about health care operations, regulatory and compliance, reimbursement, staffing, risk management, public policy and other matters.    A popular lecturer and widely published author on health industry matters, Ms. Stamer advises hospitals and other health industry clients about responding to and using these and other quality measures and other related concerns.  Ms. Stamer also publishes and speaks extensively on health and managed care industry quality, regulatory, reimbursement, and other operations, risk management and public policy concerns.  Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.  For additional information about Ms. Stamer, her experience, involvements, programs or publications, see here.  

Other Recent Developments & Resources

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

We hope that this information is useful to you.  If you need assistance with auditing or defending these or other health care compliance, risk management, transaction or operation concerns, please contact Cynthia Marcotte Stamer, at (469) 767-8872 or to cstamer@solutionslawyer.net. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other internal controls and risk management matters. 

You can review other recent health care and internal controls resources and additional information about the health industry and other experience of Ms. Stamer here.  If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information to here.

©2010 Cynthia Marcotte Stamer.  All rights reserved.


Veterans Health Administration Invites Public Comment on Information To Be Required To Make Online Copayment Payments

April 28, 2010

June 28, 2010 is the deadline for interested persons to submit comments on the information that the Veterans Health Administration (VHA) proposes to collect as a condition of allowing individuals claiming veterans health benefits to pay their medical care copayment online. VHA proposes to use Resource Center Medical Center Payment Form (VA Form 10-0505, OMB Control Number: 2900–New (10-0505) to allow claimants with medical care copayment debts to pay online with a credit card or Automated Clearing House transaction.  For additional information about the proposal or instructions for submitting comments, see here.

For Assistance With Health Industry Concerns

If your organization needs advice or assistance with the proposed regulation, preparing or submitting comments on the regulation or with other health care matters, contact Cynthia Marcotte Stamer at (469) 767-8872 or via e-mail here

Vice President of the North Texas Health Care Compliance Professionals Association, Exempt Organization Vice-Coordinator of the Southern States IRS TEGE Council, a Council Member of the ABA Joint Committee On Employee Benefits Council, Past Chair of the ABA Health Law Section Managed Care & Insurance Section, the former Board Compliance Chair of the National Kidney Foundation of North Texas and former Board President of the Richardson Development Center for Children (now Warren Center), Ms. Stamer has more than 22 years experience advising health industry clients about health care operations, regulatory and compliance, reimbursement, staffing, risk management, public policy and other matters.    A popular lecturer and widely published author on health industry matters, Ms. Stamer advises hospitals and other health industry clients about responding to and using these and other quality measures and other related concerns.  Ms. Stamer also publishes and speaks extensively on health and managed care industry quality, regulatory, reimbursement, and other operations, risk management and public policy concerns.  Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.  For additional information about Ms. Stamer, her experience, involvements, programs or publications, see here.  

Other Recent Developments & Resources

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

We hope that this information is useful to you.  If you need assistance with auditing or defending these or other health care compliance, risk management, transaction or operation concerns, please contact Cynthia Marcotte Stamer, at (469) 767-8872 or to cstamer@solutionslawyer.net.  Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other internal controls and risk management matters. 

You can review other recent health care and internal controls resources and additional information about the health industry and other experience of Ms. Stamer here.  If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information to here. To unsubscribe, e-mail here.

©2010 Cynthia Marcotte Stamer.  All rights reserved.


CMS Proposes FY 2011 Acute Care & Long-Term Care Inpatient Policy & Payment Rate Changes

April 20, 2010

June 18, 2010 is the deadline for health care providers and other concerned parties to comment on proposed Medicare inpatient acute care and long-term are hospital stay policy and payment rate changes announced by the Centers for Medicare & Medicaid Services (CMS) on Monday, April 19 2010.  CMS intends to publish a final rule by August 1, 2010.

CMS issued the proposed fiscal year (FY) 2011 policies and payment rates for inpatient services furnished to people with Medicare by both acute care hospitals and long-term care hospitals on Monday.  The proposed rule does not address inpatient hospital related provisions of the recently enacted Patient Protection and Affordable Care Act, as amended by the Health Care and Education Affordability Reconciliation Act (collectively the “Affordable Care Act”).  

In the proposed Medicare payment rates announced April 19, CMS proposes update acute care hospital rates by a slight 2.4 percent for inflation and to apply an adjustment of -2.9 percentage points to recoup one-half of the estimated excess spending in FY 2008 and 2009 aggregate payments, due to changes in hospital coding practices that CMS says did not reflect increases in patients severity of illness.  Legislation passed in 2007 requires CMS to recoup the entire amount of FY 2008 and 2009 excess spending from changes in hospital coding practices by FY 2012.  CMS estimates that payments to general acute care hospitals under the proposed rule for operating expenses in FY 2011 will decline by 0.1 percent, or $142 million, compared with FY 2010, and taking into account all factors that would affect spending.

CMS concurrently is similarly proposing to update long-term care hospital (LTCH) rates by 2.4 percent for inflation and apply an adjustment of -2.5 percentage points for the estimated increase in spending in FYs 2008 and 2009 due to documentation and coding that did not reflect increases in patients’ severity of illness.  Based on these two proposed provisions and other proposed changes, CMS estimates that payments to LTCHs would increase by 0.8 percent or $41 million. 

Interested parties may review the proposed regulation here. More information about the proposed rule, including the documentation and coding adjustment and the RHQDAPU changes and HACs discussion, can be found in Fact Sheets on the CMS Website here. CMS warns that the projected inflation updates for both types of hospitals may be revised in the final rule based on more recent data.

The proposed rule would apply to approximately 3,500 acute care hospitals paid under the Inpatient Prospective Payment System (IPPS), and approximately 420 long-term care hospitals paid under the Long-Term Care Hospital Prospective Payment System (LTCH PPS), beginning with discharges occurring on or after October 1, 2010.  Proposed payment rates are based on the most recently available data and may be revised in the final rule to reflect more current data.

Under current law, hospitals that successfully report quality measures included in the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program will receive the full update for 2011.  Hospitals that do not participate in the quality reporting program will get the update less two percentage points.  Based on the required reporting in 2009, 96 percent of participating hospitals are receiving the full update this year. 

CMS is proposing to add 45 measures to the RHQDAPU set for reporting in 2011.  However, only 10 of the proposed measures, including rates of occurrence for eight of 10 categories of conditions that are subject to the hospital-acquired conditions (HACs) policy, will be considered in determining a hospital’s FY 2012 update.  The remaining 35 measures would be considered in determining the hospital’s FY 2013 update, and hospitals would not be required to report all of the proposed registry-based measures.  The proposed use of registries would prevent hospitals from having to report the same data twice.  In addition, CMS is proposing to retire one existing measure for reporting mortality for selected surgical procedures.

For Assistance With Health Industry Concerns

If your organization needs advice or help with the proposed regulation, preparing or submitting comments on the regulation or with other health care matters, contact Cynthia Marcotte Stamer at (469) 767-8872 or via e-mail here

Vice President of the North Texas Health Care Compliance Professionals Association, Exempt Organization Vice-Coordinator of the Southern States IRS TEGE Council, Chair of the American Bar Association (ABA) Real Property, Probate & Trust Section Employee Benefits & Other Compensation Arrangements Group, a Council Member of the ABA Joint Committee On Employee Benefits Council, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 22 years experience advising health industry clients about these and other matters.    A popular lecturer and widely published author on health industry matters, Ms. Stamer advises hospitals and other health industry clients about responding to and using these and other quality measures and other related concerns.  Ms. Stamer also publishes and speaks extensively on health and managed care industry quality, regulatory, reimbursement, and other operations, risk management and public policy concerns.  Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.  For additional information about Ms. Stamer, her experience, involvements, programs or publications, see here.  

Other Recent Developments & Resources

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

We hope that this information is useful to you.  If you need assistance with auditing or defending these or other health care compliance, risk management, transaction or operation concerns, please contact Cynthia Marcotte Stamer, at (469) 767-8872 or to cstamer@solutionslawyer.net.. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other internal controls and risk management matters. 

You can review other recent health care and internal controls resources and additional information about the health industry and other experience of Ms. Stamer here.  If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information to here.

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here.  To unsubscribe, e-mail here.

©2010 Cynthia Marcotte Stamer.  All rights reserved.


Agencies Seek Public Input On New Insurer Premium Revenue Reporting Obligations Added By Patient Protection and Affordable Care Act

April 15, 2010

By Cynthia Marcotte Stamer

The Departments of Treasury (IRS), Labor (DOL) and Health & Human Services (HHS) are inviting public comments on impending new federal requirements that will compel health insurance issuers offering individual or group medical coverage to send annual reports to HHS on the percentages of premiums that the coverage spends on  reimbursement for clinical services and activities that improve health  care quality, and to provide rebates to enrollees if this spending does  not meet minimum standards for a given plan year added as Section 2718  of the Public Health Service Act (PHS Act), by the Patient Protection and Affordable Care Act  (PPACA), Public Law 111-148, enacted on March 23, 2010.

Among other things, Section 2718 of  the PHS Act, Section 715 of the Employee Retirement Income Security Act  of 1974 (ERISA) and Section 9815 of the Internal Revenue Code of 1986  (the Code) will require  health  insurance issuers offering group or individual  coverage to report to HHS annually:

  • The ratio of the incurred loss (or incurred claims) plus the  loss adjustment expense (or change in contract reserves) to earned  premiums (also known as the medical loss ratio (MLR)); and
  • The percentage of total premium revenue–after accounting for collections or receipts for risk  adjustment and risk corridors and payments of reinsurance–that the  coverage spends: (1) on reimbursement for clinical services provided to enrollees; (2) for activities that improve health care quality;  and (3) on all other non-claims costs, including an explanation of the  nature of these costs, and excluding Federal and State taxes and  licensing or regulatory fees.

PPACA also requires that HHS make these reports available to the public on the Internet Web site of HHS.  To review the request for comments and its instructions for commenting on the new requirements, see here.

For Assistance With This Opportunity Or Other Health Industry Concerns

If your organization needs advice or help with commenting on the request for comments or to evaluate or respond to other health care reform regulations or other health care matters, contact Cynthia Marcotte Stamer at (469) 767-8872 or via e-mail here

Vice President of the North Texas Health Care Compliance Professionals Association, Exempt Organization Vice-Coordinator of the Southern States IRS TEGE Council, Chair of the American Bar Association (ABA) Real Property, Probate & Trust Section Employee Benefits & Other Compensation Arrangements Group, a Council Member of the ABA Joint Committee On Employee Benefits Council, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 22 years experience advising health industry clients about these and other matters.    A popular lecturer and widely published author on health industry matters, Ms. Stamer advises hospitals and other health industry clients about responding to and using these and other quality measures and other related concerns.  Ms. Stamer also publishes and speaks extensively on health and managed care industry quality, regulatory, reimbursement, and other operations, risk management and public policy concerns.  Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.  For additional information about Ms. Stamer, her experience, involvements, programs or publications, see here.  

Other Recent Developments & Resources

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

For More Information

We hope that this information is useful to you.  If you need assistance with auditing or defending these or other health care compliance, risk management, transaction or operation concerns, please contact Cynthia Marcotte Stamer, at (469) 767-8872 or to cstamer@solutionslawyer.net.. Ms. Stamer has extensive experience advising clients and writes and speaks extensively on these and other health industry and other internal controls and risk management matters. 

You can review other recent health care and internal controls resources and additional information about the health industry and other experience of Ms. Stamer here.  If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information to here.

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here.  To unsubscribe, e-mail here.

©2010 Cynthia Marcotte Stamer.  All rights reserved.


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