Health Reform Legislation Threatens Mini-Med Plans

If there has been one clear victim of the new health plan regulations, Mini-Med Plans are it. Last year when the new MLR percentages became reality, hundreds of Mini-Meds began seeking alternative measures to survive. HHS has provided a solution for 1,040 such plans. Out of all the Mini-Med Plans that applied, 94% have been granted a waiver, allowing the plans to be considered exempt from the new law. The exemption lasts only for one year, but is renewable until the full weight of the reform falls in 2014.

The waivers are required because the Mini-Med Plans, which provide care for over 2.6 million people, do not meet the minimum annual dollar limit on essential benefits as outlined in the reform legislation. This limit starts at $750,000 in 2011, increasing to $2 million in 2013. By 2014, the law states that there is to be no annual limit on essential benefits.

Mini-Med Plans cater to low-income or part-time workers, who often do not qualify for more expensive plans. Unless the reform legislation is re-written to account for these smaller providers, 2014 will see the end of Mini-Meds, and those employees will be forcefully folded into the government-created health exchange planned for 2014.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

HHS, IT Infrastructure and Health Insurance Exchanges

Last week, HHS announced a new initiative that will provide competitive funding opportunities for states to design and initiate IT infrastructures that will be necessary for the operation of Health Insurance Exchanges. Because these Exchanges will need to be designed to present a large number of individuals and small businesses with affordable health care options by 2014, new and advanced IT systems will be necessary well before then.

Exchanges, as we know, will provide a form of one-stop shopping for individuals and small businesses, with interested parties being able to examine, select, and enroll in one of many available plans offered at competitive, affordable prices. However, while many are focused and debating the policy aspect of this initiative, what gets lost is the IT infrastructure that will need to be constructed in order to make this (or any) end goal possible. The infrastructure will need to be well thought out and be based on several best practice examples (especially in the areas of simplicity and approachablity) in order to allow the Exchanges to operate like other similar consumer industry sites.

To assist with this aspect, states can apply, through HHS, for “Early Innovator Grants.” The grants will provide states with the capital to get a head start on building these necessary infrastructure models. States are to be chosen based on their current efforts toward consumer-friendly IT infrastructure, as well as their leadership in cost-effective solutions.

The first round of winners will be announced before February 15^th, 2011, and will be followed by additional award announcements which all states – including those that already received funding – will be eligible to receive.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

HHS Strengthens Health Information Privacy and Security through New Rules

“To improve the health of individuals and communities, health information must be available to those making critical decisions, including individuals and their caregivers. While health information technology will help America move its health care system forward, the privacy and security of personal health data is at the core of all our work.”

--U.S. Health and Human Services Secretary Kathleen Sebelius

On July 8, Secretary Sebelius announced important new rules to strengthen the Health Insurance Portability and Accountability Act of 1996 (HIPAA), improve the privacy of health information and help all Americans understand their rights and the resources available to safeguard their personal health data.

In short, the proposed rule would strengthen and expand enforcement by:

• Expanding individuals’ rights to access their information and to restrict certain types of disclosures of protected health information to health plans;
• Requiring business associates of HIPAA-covered entities to be under most of the same rules as the covered entities;
• Setting new limitations on the use and disclosure of protected health information for marketing and fundraising; and
• Prohibiting the sale of protected health information without patient authorization.
  

“The benefits of health IT can only be fully realized if patients and providers are confident that electronic health information is kept private and secure at all times,” said Georgina Verdugo, Office for Civil Rights director at HHS. “This proposed rule strengthens the privacy and security of health information, and is an integral piece of the administration’s efforts to broaden the use of health information technology in health care today.”

In addition, HHS also launched a privacy website to help visitors easily access information about existing HHS privacy efforts and the policies supporting them. The site emphasizes the deep commitment to privacy in the collection, use and exchange of personally identifiable information. This new resource provides Americans with confidence that their personal information is secure and underscores HHS’ goal of greater openness and transparency in government.

For more information about the new rule, click HERE.

For other HHS Recovery Act programs, click HERE.