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Health Reform Update

A number of developments occurred on health reform and other issues this past week, including the release of the final rule on the mandatory Summary of Benefits under PPACA.

Final Health Reform Regulations On Summary of Benefits Issued

The federal government issued final regulations related to the mandate requiring health insurers to issue comprehensive summaries of benefits for non-grandfathered plans. Insurers took issue with the comprehensiveness and tight timeframes to comply with the law when the interim regulations were issued. The final rule gives plans a six-month reprieve on the fulfillment timeframe. It will now be for policies issued or renewed on or after September 23, 2012.

In an effort to streamline the document, the summary will now only be required to show two (not three) coverage examples and premium information will not have to be included. The two examples will be maternity coverage and Type 2 Diabetes. The federal government could add additional explanation requirements in the future.

Obama Seeks To Solve Contraception Controversy

In an effort to end the growing controversy created when his administration announced that religious-affiliated employers would be required to cover contraception under the new health reform law, President Obama quickly announced a proposed compromise this past week.

Opponents are waiting for exact details of the compromise before endorsing or rejecting the proposal, but Obama administration indicated that the mandate would move from the employer to the insurer in the case of religious employers. These employers would not technically include contraception in its benefits, but insurers would be required to contact all women covered and offer such coverage post enrollment.

The administration is relying on actuarial analyses that indicate the cost of benefit packages including contraception are actually less than those that don’t. Thus, it will argue, the religious employers will not directly or indirectly be paying for such coverage through increased costs borne by the insurers for the separate contraception coverage made available directly to employees. The Catholic Church and other organizations did not outright pan the compromise, but it is very likely they will oppose the latest proposal as still a fundamental infringement on freedom of religion, arguing that the compromise forces them to indirectly cover and endorse benefits that violate moral teachings and beliefs. On their side is the fact that the mandate seems to violate existing laws regarding freedom of conscience.

Bills in both houses of Congress are seeking to outright overturn the proposal. How to handle self-insured benefit plans is still a major stumbling block. The issue could yet end up a third major lawsuit attacking certain health reform tenets.

States Pushing Duals Integration

Recently we talked about efforts at the state and federal level to meld Medicare and Medicaid policy and funding for dual eligibles. States have long pushed the idea that they can be an incubator for reform as long as they could share in some Medicare savings as well. The national health reform bill also pushes such integration by setting up a coordination office to facilitate such reforms. Efforts began last July and now CMS reports that as many as 26 states are exploring pursuing either capitated managed care or FFS demonstration pilots based on an outline and requirements proposed by CMS.

Is SGR Solution In The Making?

Congress has just a few weeks left before the 27-percent reduction in Medicare physician payments goes into effect after a 2-month reprieve. Some GOP members sympathetic to the plight of doctors and worried about election-year ramifications are warming to using savings from the Iraq and Afghan wars, but House Speaker John Boehner, R-Ohio, is not so enthusiastic. While not completely ruling out the idea, Boehner has said that any offset for the increase in spending “needs to pass the straight-face test.” Savings from troop withdrawals or reductions will save over $800 billion over the next decade. A 10-year solution to the SGR problem would be just over $300 billion. Critics argue that there really isn’t savings or an offset as the deficit and borrowing are at record levels.

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

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