Monday, January 31, 2011

Florida judge rules individual mandate unconstitutional

U.S. District Court Justice, Roger Vinson, ruled today that the individual mandate of President Obama’s health reform legislation is unconstitutional.

The question raised by the lawsuit against the individual mandate is whether or not buying insurance constitutes interstate commerce. Vinson stated in his ruling that “it would be a radical departure from existing case law to hold that Congress can regulate inactivity under the Commerce Clause.” In other words, the Commerce Clause has not been used in the past to force someone to do something they weren’t already doing, such as purchasing health insurance.

If his ruling stands it would void the entire health reform bill passed last year.

According to Vinson, “because the individual mandate is unconstitutional and not severable, the entire Act must be declared void. This has been a difficult decision to reach, and I am aware that it will have indeterminable implications.”

Reports suggest the case is likely to go to the U.S. Supreme Court; however, it is believed to be unlikely that the case would move quickly enough to be heard this year.

Friday, January 28, 2011

BCBSNC launches customer market research panel

BCBSNC announced Thursday that the company is establishing a customer market research panel. The panel, managed entirely through email, is intended to provide an efficient, cost-effective method for reaching customers directly to conduct research on issues related to health care and health insurance.

Members from the three segments listed below will be sent an email invitation to participate beginning this week. The recruitment process will continue until the end of February. Members will be given the chance to opt out of email communications related to this program.

BCBSNC hopes to achieve at least the following participation numbers:
• 2,000 individual members ages 18 to 64
• 2,000 group members ages 18 to 64
• 750 of which will be small business group administrators

Please note that BCBSNC employees, State Health Plan and Federal Employee Program members will not be asked to participate in this program.

Panel members will begin receiving surveys in early March. Surveys will be sent to members targeted by customer segment and/or demographics on an as-needed basis. Each time a member completes a survey, he or she will have the opportunity to enter a drawing for a gift card of varying value, depending on the survey.

Thursday, January 27, 2011

New medications have moved to UHC’s Select Designated Pharmacy Program

As a reminder, some medications under UnitedHealthcare (UHC) recently moved to the Select Designated Pharmacy Program, effective January 1, 2011. These medications include:
• Lexapro (depression)
• Symbicort (asthma)
• Novolin/NovoLog (insulin)
• Ascensia, Breeze, Contour, FreeStyle, Glucometer Dex, Precision (test strips)

The Select Designated Pharmacy program encourages members on select high cost Tier 3 medications to make lower cost medication and pharmacy decisions. It also requires members to use mail order pharmacy or switch to a lower cost medication for continuation of in-network benefits.

Members are allowed two grace fills of their current medication at the retail pharmacy before they must select a new option. UHC has implemented the following communication plan to provide members taking a medication in the program the information they need to choose the option that makes sense for them:
• Letters – After making the first grace fill, members will receive a letter explaining the program. Members can call their doctors directly or contact UHC for more information or to make a change.
• Phone Calls – Members will also receive a phone call after their first grace fill to help explain their medication and savings options.
• At The Pharmacy – During each grace fill, UHC encourages pharmacists to educate members about lower-cost options that will allow continued use of the retail pharmacy and network benefits.

Members who take a Select Designated Pharmacy medication can choose any of the following options for network coverage:
• Move to mail and continue on current medication.
• Move to a lower tier drug and stay at the retail pharmacy.
• Do both. Move to the mail order pharmacy and move to lower tier drug.

For more information, please view the UHC Select Designated Pharmacy Program Summary.

Monday, January 24, 2011

UnitedHealthcare to change reimbursement of non-network laboratory claims

Effective February 13, 2011, UnitedHealthcare (UHC) will reimburse non-participating outpatient laboratory claims based on the network status of the servicing laboratory. This applies to fully insured members whose employer groups are sitused in: AL, AR, AZ, CA, CT, DC, DE, GA, IA, ID, IN, KS,KY, LA, ME, MI, MS, NC, ND NE, NM, NV, OK, OR, RI, SC, SD, TN, UT, VA, WA, WI, WV, WY on a Certificate of Coverage 2002 or newer Choice Plus Insurance product (excluding HMO and EPO) with both network and non-network benefits.

Currently, claims for members who are using non-network outpatient laboratories are reimbursed based on the network status of their referring health care professionals.

By aligning the reimbursement of outpatient laboratory claims from non-network laboratories with the member's non-network benefits, as provided in the applicable Certificate of Coverage, UHC believes they will see:
• Potentially lower overall costs for laboratory services.
• The referral of members to network laboratory facilities to maximize benefits and provide access to affordable health care.
• Increased laboratory data used to support physician care plans through our disease management programs.

Letters regarding this policy were sent to affected members and network physicians at least 30 days prior to February 13, 2011.

Thursday, January 20, 2011

House votes to repeal health reform law

The House of Representatives voted 245 to 189 Wednesday to repeal Obama’s health care reform legislation. Three Democrats joined the entire Republican caucus in the majority vote. House Republicans are now expected to begin proposing legislative alternatives, delegating this task to committees as early as today.

Current reports indicate it is unlikely that the Democratic-controlled Senate will take up the repeal measure. In the event that repeal could pass in the Senate, it would not withstand presidential veto.

Wednesday, January 19, 2011

BCBSNC issues update on Medicare Secondary Payer demands and federal debt notices

Due to problems with the data shared between the U.S. Department of Treasury (Treasury) and the Medicare Secondary Payer Recovery Contractor (MSPRC), BCBSNC was unable to submit timely responses to Treasury demands sent to employer groups in November and December of 2010.

Although the initial data issues have been resolved, employer groups may nevertheless face the following challenges:
• Once the MSPRC has sent over debts to the Treasury, the collection efforts are out of the MSPRC’s control. Therefore, if the MSPRC mistakenly sent a debt to the Treasury, it is difficult to stop the Treasury’s collection efforts.
• When the Treasury’s records indicate that there is a debt outstanding, employer groups can be denied federal grants or other monies owed to them.

Details About These Issues
• In November and December, the Treasury could provide neither BCBSNC nor its employer groups with identifying information related to letters that the Treasury issued to insurers and employer groups around November and December of 2010.
• During this time, the MSPRC, and in turn, BCBSNC, could not match FedDebt# information to its corresponding MSP demand. (The FedDebt# is the number that the Treasury assigns to each demand that is received from the MSPRC.)
• Because BCBSNC was unable to identify Treasury letters appropriately or trace these letters to their corresponding MSP demands, they were unable to respond to Treasury demands in a timely manner.

Resolution to the Data Problem
On January 6, 2011, BCBSNC received information allowing them to identify the Treasury letters issued in November and December of 2010 and trace them to MSP demands as appropriate. BCBSNC is now working to identify the Treasury letters that were previously unidentified and respond to the Treasury as quickly as possible.

What Employer Groups Can Do
If employers receive a Treasury letter, a letter from a private collection agency (PCA), or even a phone call from a PCA, they should forward that information immediately to the MSP area at BCBSNC via one of the following channels: (and attach a PDF of the Dept of Treasury letter or PCA letter)
• Send a fax to the BCBSNC secure fax line at 919-287-8782
• Mail to: BCBSNC MSP Dept., PO Box 2291, Durham NC 27707
It is imperative that BCBSNC receive this information as soon as possible, in order to prevent offsets from occurring.

Long-Term Resolution for These Types of Issues
The BCBS Association (BCBSA) has been working with Plans and CMS to resolve these issues on both a case-by-case and systemic basis. BCBSA has been advocating for a more efficient and responsive process within the MSPRC.

Tuesday, January 11, 2011

BCBSNC and UNC Health Care announce partnership to launch model practice

Today, BCBSNC published a News Release announcing a joint venture with UNC Health Care to open a new type of health care practice. This practice will extend beyond what is currently called the ‘medical home’ and will position teams of health care providers to work collaboratively with patients and families in delivering higher quality, coordinated care.

BCBSNC believes this approach will result in better health and fewer complications—both of which will help control rising health care costs. While several of the details have yet to be determined, this pilot practice is expected to open in the fourth quarter of 2011 in Orange or Durham County.

Friday, January 7, 2011

Webinar on consumer-driven health care compliance issues

Senn Dunn Insurance invites you to participate in an Assurex Global webinar on January 27, 2011 from 1:00 - 2:00 PM Eastern.
Reserve your seat now at:

As employers offer different types of consumer-driven health plans, new and complicated compliance issues must be addressed. This webinar will review HSA, HRA and Health FSA compliance issues including employer contribution rules, HSA eligibility, HRA plan document requirements, and more.

Presenter: Bob Radecki, President, Benefit Comply, LLC
Bob Radecki has more than 25 years experience in the HR and employee benefits industry helping employers deal with difficult benefit and compliance matters. Previously, Bob founded and served as President of A.E. Roberts Company, a nationally recognized compliance consulting and training firm. He has served as the principal HIPAA consultant to a number of health insurance companies, and is recognized as a leading expert on a variety of benefit compliance issues including COBRA, FMLA, Health Reform and more. Bob has been the featured speaker at numerous industry events and conferences, and has published a number of articles concerning various compliance issues.

Saturday, January 1, 2011

IRS allows use of FSA debit cards for over-the-counter medications

On December 23rd, the IRS issued new guidance, Notice 2011-5, as well as answers to frequently asked questions regarding the use of FSA debit cards for the purchase of over-the-counter (OTC) medications in 2011.

Previous guidance indicated that most OTC medicines and drugs could no longer be purchased with the debit card due to the need to present a written prescription from a licensed provider.

Based on the new IRS guidance, debit cards may continue to be used after January 1, 2011, to purchase OTC medicines and drugs at drug stores and pharmacies and mail order and web-based vendors, contingent on the following:

• The individual must present a valid written prescription from a licensed provider to the pharmacy prior to purchasing the OTC item. In order for the OTC item to be paid through your FSA debit card, the pharmacist will have to assign an Rx number and then dispense the OTC medicine or drug.
• The pharmacy is required to retain a record of the transaction, including the Rx number, name of purchaser (or name of the person to whom the prescription applies), and the date and amount of the purchase.
• These records must be available for inspection by the employer or its agent, such as the employer’s FSA vendor.
• The debit card system must not accept an OTC drug or medicine unless an Rx number has been assigned.
• The debit card system must meet existing IRS requirements that are intended to limit use of the debit card to only tax-qualified medical care expenses. Among other requirements, prior to using the card, the employee/individual must attest he will use the card only for tax-qualifying expenses.

Reimbursement for OTC medicines or drugs purchased in 2010, but filed for reimbursement in 2011, will not be subject to these new procedures.

IRS releases notice to postpone nondiscrimination rules for insured health plans

On December 23rd, the IRS released Notice 2011-1, exempting insured group health plans from the new PPACA nondiscrimination rules until final regulations are issued. The Notice provides that the Section 105(h) nondiscrimination rules will apply to insured plans beginning "a specified period after issuance" of final regulations. Prior to this Notice, non-grandfathered health plans were to comply with the nondiscrimination rules as of their first plan renewal after September 23, 2010.

Regulations are projected as early as the summer of 2011. For calendar year plans, the earliest the rules will apply is January 1, 2012; however, the effective date could be later.

Self-funded health plans are not impacted by the Notice and must continue to comply with the current Section 105(h) nondiscrimination rules.