Health reform implementation

Wednesday was just the warm up: President Obama introduced it yesterday, but it's Thursday — the six month anniversary of health reform passage — that the Patient's Bill of Rights takes effect. It won't go down with a whimper.

Health Care for America Now (HCAN), a liberal supporter of the reform law, is hosting a slew of nationwide gatherings designed to explain the insurance reforms to a public that remains skeptical of the law's benefits. Venues will range from churches and universities to L.A.'s Cedars-Sinai Medical Center.

"Polls show that the more people know about the [reform law], the more they support it," reads an HCAN release.

The Patient's Bill of Rights — a central component of the reform law — will ban insurance companies from denying coverage for sick kids; prohibit insurers from using technical errors to drop coverage when patients get sick; and prevent plans from setting lifetime dollar limits on coverage. 

The law will also allow young adults to remain under their parents' coverage up to age 26, and require all new plans to cover a minimum set of preventive care services. http://nyti.ms/cgzS5i

Don't try to convince John Boehner: The House minority leader issued a statement Wednesday saying the reform bill "represents everything that’s gone wrong with our government." 

Iowa has asked federal regulators to give its individual market health plans until 2014 to comply with the healthcare reform law's medical loss ratio requirement. The law requires the plans to spend at least 80 percent of premiums on care starting next year.

"Iowa enjoys some of the lowest health insurance rates in the country," Iowa Insurance Commissioner Susan Voss writes in a letter sent Tuesday to Health and Human Services Secretary Kathleen Sebelius. "And our market provides for not only one very large health insurance carrier, but several small insurance carriers as well in the individual market. Already we are seeing several of our carriers with small numbers of insureds in the individual market announce their intent to cease business in our state.  This will impact the choices available to Iowa consumers."

Smaller carriers, Voss adds, "will not meet the initial 80% medical loss ratio factor in 2011.  They will need a phase-in period.  Without such a waiver provision, I believe the federal standard will disrupt our individual health insurance market. This in turn will negatively impact many Iowans who have enjoyed their coverage benefits through these smaller carriers."

Maine asked for a waiver from the medical loss ratio requirement in July.

Several other states are believed to be considering a similar request.

Members of the National Association of Insurance Commissioners met with Obama administration officials to discuss provisions of the healthcare law.

Sen. Mike Enzi (R-Wyo.) on Wednesday began urging his colleagues to demand a vote on a resolution of disapproval to overturn the grandfathering clause of the healthcare reform law.

The provision exempts existing employer-sponsored plans from a number of provisions in the new law, such as having to offer benefits without cost-sharing. But some business groups, including the U.S. Chamber of Commerce, argue that the grandfathering regulations are too strict and would lead to many employers losing their right to offer their current plans.

"Throughout the health care debate, the President continually promised, 'If you like what you have you can keep it'," Enzi said in a statement. "The grandfathered health plan rule breaks the President’s promise."

An Enzi spokesman clarified that the senator wants federal regulators to revisit the grandfathering clause and make it "better tailored to the needs and demands of small businesses."

The Department of Health and Human Services released preliminary regulations in June. They state that plans would lose their grandfathered status if coinsurance and copayments increase more than a specified amount, for example.

According to HHS estimates:

_ 40 percent to 67 percent of individual policies will lose grandfathered status by 2011;

_ 34 percent to 64 percent of large employer group plans (100 or more employees) will lose their grandfathered status by 2013: and

_ 49 percent to 80 percent of small employer group plans (three to 99 employees) will lose their grandfathered status by 2013.

President Obama on Wednesday welcomed the arrival of some of the most significant and widely anticipated insurance reforms in the Democrats' new healthcare law: the Patient's Bill of Rights.

Those protections — which take effect Thursday, six months after the law passed — represent "the most important patient's bill of rights that we've ever seen in our history," Obama told a small backyard audience in Falls Church, Va., just outside of Washington.

Read more...

Lawmakers and mental health advocates said Wednesday that the U.S. has a long way to go before mental and physical health are treated on an even keel.

They called on Congress to pass several pending bills and on federal regulators to implement the new healthcare reform law with an eye towards mental health parity. The comments came during a policy forum sponsored by AstraZeneca and hosted by The Hill.

Rep. Paul Tonko (D-N.Y.), a first-term congressman who helped pass a mental health parity law in Albany, said there were "four keys to a successful implementation of healthcare reform for the mentally ill and for people with serious addiction disorders":

- The Centers for Medicare and Medicaid Services "must mount a vigorous outreach and enrollment program";

- Regulators must ensure parity in state exchanges and Medicaid and quickly issue guidance regarding parity in Medicare managed care plans;

- Intensive community based services and residential addiction services should be included in the mandatory minimum benefits package offered through the new state exchanges;

- Community mental health centers must be part of every medical home funded via the law's Health Home State Option.

Tonko also raised the issue of Medicare reimbursement cuts to psychiatrists, psychologists and social workers, and with state budget cuts for mental health programs.

Rep. Tim Murphy (R-Pa.), a child psychologist, pressed for passage of legislation that would extend federal health information technology incentives to behavioral health services. The legislation, introduced by Rep. Patrick Kennedy (D-R.I.), would make behavioral and mental health providers eligible for federal grants to acquire electronic health records that are interoperable, integrated, intelligent and easy to use.

But bills improving access to mental health services "only matter if we make sure we integrate care together," Murphy said. "Mental health services are not stand-alone and that is something we need to continue to educate the community around."

Murphy also said his bill extending federal medical liability protections to volunteers at community health centers might come up for a vote Wednesday.

Linda Rosenberg, the president and CEO of the National Council for Community Behavioral Healthcare, also pressed for passage of Kennedy's bill and for "vigilance in ensuring that the Affordable Care Act’s Health Home State Option meets the needs of people with serious mental illness."

She also requested support for the Community Mental Health and Addiction Safety Net Equity Act, which would replace community mental health centers with Federally Qualified Behavioral Health Centers - entities designed to serve individuals with serious mental illnesses and addiction disorders. The bill, introduced by Rep. Doris Matsui (D-Calif.), has six co-sponsors.

Federal regulators have agreed to give some health plans until July 1, 2011, to comply with internal appeals and external review rules set to go into effect Thursday.

New "safe harbor" guidance from the departments of Labor and Health and Human Services delays enforcement action against group health plans and health insurance issuers in the group or individual market who are "acting in good faith" to implement the new rules, created by the healthcare reform act. The plans, according to a memo to members of America's Health Insurance Plans (AHIP), must show they are doing their best to: 

• respond to urgent-care claims within 24 hours after receipt of the claim; 
• provide notices in a "culturally and linguistically appropriate" manner;
• include diagnosis and procedure codes and other content on notices of adverse determination; and
• allow claimants to initiate external review or legal action if the plan or insurer fails to strictly adhere to all requirements.

AHIP had requested the safe harbor out of concern that health plans would face "significant challenges" in complying with the new rules by Thursday. 

In addition, the new guidance also addresses grandfathered plans, dependent coverage for children up to age 26 and coverage for out-of-network emergency services.

Dems, consumer groups welcome Patient's Bill of Rights: Six months ago tomorrow the Democrats passed their healthcare reform bill into law — an anniversary most significant for the arrival of many of the insurance reforms that were central to the mammoth bill.

On Wednesday, President Obama will mark the imminent anniversary by meeting with a handful of patients benefiting from the changes, including a previously uninsured New Hampshire woman with non-Hodgkin's lymphoma who's now enrolled in a high-risk insurance pool.

The White House this week also plans to release reports indicating how the reforms will affect each state, and to launch an overhauled website (www.WhiteHouse.gov/HealthReform) detailing the changes.

The reforms taking effect Thursday will:

• Ban insurance companies from denying coverage for kids based on preexisting conditions. (In 2014, this rule will be expanded to apply to patients of all ages.)

• Prohibit insurers from using unintentional application errors to drop coverage when patients get sick.

• Allow young adults to remain on their parents' health plans until age 26.

• Prohibit plans from setting lifetime dollar limits on coverage. (In 2014, annual limits will be banned as well.)

• And require all new health plans to cover a minimum set of preventive care services.

All but the last provision apply to all insurance plans, even those in existence when the law was enacted in March.

Good news for MA patients, taxpayers: Tuesday's news that Medicare Advantage (MA) plans will offer more benefits next year at a lower cost to patients brought cheers from a group that's been critical of the program since its inception seven years ago: liberal Democrats.

"Medicare Advantage beneficiaries will actually get more benefits from their plans, not less," Rep. John D. Dingell (D-Mich.) said in a statement. "And the insurers are not suffering because of the changes – they are gaining new enrollees."

The figures fly in the face of reform critics who'd warned that requiring MA plans to cover additional benefits would inevitably cause premiums to jump. Instead, Medicare officials were able to leverage the bulk-purchasing power of more than 11 million MA beneficiaries to negotiate lower costs for the same folks. Read more...

President Obama will drop by an administration meeting with state insurance commissioners on Wednesday ahead of his comments on the six-month anniversary of healthcare reform. Topics under discussion will include health insurance rate review, the definition of what constitutes "unreasonable" rate increases and the medical loss ratio, senior administration officials said.

The medical loss ratio conversation could be especially important, one policy analyst notes, because the National Association of Insurance Commissioners subpanel tackling the issue is expected to release draft legislation by Monday. The NAIC is set to vote on the regulation next month following a public comment period.

The administration does not want to publicly override the commissioners, the analyst said, so it makes sense to iron out any differences before the commissioners send their product to the secretary of Health and Human Services for certification. Last month, the chairmen of the House and Senate committees of jurisdiction over healthcare said only that taxes pertaining to the healthcare reform law should be excluded when calculating the ratio; the NAIC is leaning in the direction of excluding many more taxes, which means health plans wouldn't have to spend as much on care to meet their medical loss ratio requirements under the new law.

But NAIC President Jane Cline tells The Hill that the administration has not weighed in on the tax piece of the ratio. Cline, the West Virginia insurance commissioner, added that she does not expect the White House to do so Wednesday.

Administration officials, she said, "have been very respectful of our work."

"They recognize that it's important that we get the medical loss ratio definitions to them as soon as possible so that they have the opportunity to put forward their regulations and the industry knows what is expected of them," she said.

Under the health reform law, large group plans must spend at least 85 percent of premium dollars on care; plans in the small group and individual market have an 80 percent requirement. The provision applies to plan years starting in 2011, with rebates to consumers beginning in 2012.

"Plain and simple, insurance companies can't be trusted," Ways and Means health panel Chair Pete Stark (D-Calif.) said Tuesday in the latest salvo after health plans announced they were dropping their children's coverage.

Several major insurance companies — including WellPoint, Cigna and CoventryOne — have decided to stop issuing children's policies just days before the start of new rules forbidding them from turning down sick children. The prohibition is among several provisions of the healthcare-reform law that kick in Thursday and that Democrats plan to highlight ahead of the midterm elections.

Democrats are especially galled by the announcement because the industry's lobbying arm, America's Health Insurance Plans, had appeared to support the measure.

"Six months ago, the insurance industry trade association promised that their members would 'fully comply' with the provision in the health reform law outlawing discrimination against children with pre-existing conditions, " Stark said in a statement. "Now with this consumer protection about to go into effect, we find out they didn't really mean it. The insurance industry has once again shown their reckless disregard for the well-being of consumers, which is why we need the health reform law that holds them accountable."