 Agent and Consultant Briefing
March 2010 |
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 By: Cheryl Demars
The U.S. Departments of Labor, Health and Human Services and the Treasury recently issued the interim final regulations governing the way employers must comply with the Mental Health Parity and Addiction Equity Act (MHPAEA). Plan years beginning after October 3, 2009, are
required to make a good faith effort to meet the requirements of MHPAEA which requires group health plans with more than 50 to align mental health/substance abuse benefits with medical/surgical benefits.
Comment Period Open
When "interim final rules" are released by federal agencies, they are followed by a public comment period to give individuals and organizations an opportunity to make concerns heard. The comment period on the new mental health parity rules is now open until May 3, 2010, although final rules may be published sooner. These rules apply to plan years beginning on or after July 1, 2010.
In this case, feedback on certain provisions of the regulations is specifically being solicited:
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Whether additional examples would be helpful to illustrate the application of the non-quantitative treatment limitation rule to other features of medical management or general plan design.
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Whether and to what extent the Act addresses the "scope of services" or "continuum of care" provided by a group health plan or health insurance coverage.
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What additional clarifications might be helpful to facilitate compliance with the disclosure requirement for medical necessity criteria or denials of mental health/substance abuse benefits.
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How to implement the new statutory requirements for the increased cost exemption under the Act, as well as information on how many plans expect to use the exemption (additional guidance on this and a number of other issues is expected once the comment period closes).
Anyone wishing to make comments may e-mail them through the federal rulemaking portal at regulations.gov. Most employers can direct comments to the Department of Labor, and should include file code RIN 1210-AB30 in the subject line. Self-funded government plans should address comments to Health and Human Services and reference CMS-4140-IFC. Comments submitted to any department will be shared with the other departments with purview. Other delivery options are detailed on the first page of the actual regulation, found here: edocket.access.gpo.gov/2010/pdf/2010-2167.pdf.
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| Save the Date: Upcoming Alliance Events |
Mark your calendar for the next two Alliance events. On April 7, 2010, we'll be hosting an Alliance Learning Circle on the Importance of Primary Care. Then on May 4, 2010, we'll have The Alliance Annual Seminar where we'll be recognizing the 20th anniversary of the cooperative, which was established in 1990.
Look for more information on both events in the coming weeks. Back to top |
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Executive Summary from February 17 Alliance Learning Circle |
The executive summary from Self-Funding: Embrace the Power and Maximize Your Plan, our February Alliance Learning Circle, is now posted In the Circle.
The Alliance is here to support members in implementing any ideas generated during our Alliance Learning Circles. If you have questions about how The Alliance can help our mutual clients with any of the topics discussed, please feel free to contact Jesse Oberloh, 800.223.4139 x 6645.
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| Resources to Help Individuals Keep those New Year's Resolutions |
We may only be a few months past the holidays, but for many that is all it takes to forget the good intentions we had when the year seemed shiny and new. Alliance Healthy Living Discounts can help individuals recommit to health and wellness in 2010.
Employees can receive discounts at participating health and fitness, yoga, nutrition and weight-loss, karate, and hearing-aid centers when they show their medical ID card featuring The Alliance logo. To find out which centers are included, visit http://www.the-alliance.org/health_wellness.aspx and click on Healthy Living Discounts.
If you have ideas about other businesses you would like to see added, contact Tierney Jensen, 800.223.4139 x 6642.
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| Complimentary Blood Pressure Screenings |
Members can help their employees monitor their health status and promote preventive care with on-site blood pressure screenings. This complimentary service is coordinated by The Alliance and is a convenient, simple way to help employees keep track of one of the body's most important health indicators.
According to the American Heart Association, high blood pressure can indicate a variety of health conditions, including high cholesterol, risk of diabetes, stroke, or congestive heart failure, vision problems, and even dementia. Detecting and managing the condition early can save on medical costs in the future.
The Alliance connects members to resources to make onsite screenings - and preventive care - part of your employees' workday. The procedure is fast, painless, and serves to promote a healthy workforce while taking advantage of the cost-savings of wellness and preventive care.
To schedule a blood pressure screening for a mutual client, please contact Michele Gjertson, 800.223.4139 x 6607.
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| Health Risk Assessments from Health Solutions, Ltd. |
Health risk assessments (HRAs) do more than merely identify an employee's health risk. A gold standard assessment can reduce health care cost, increase productivity, track improvements, demonstrate cost savings, attract talent and retain employees. When choosing which health risk assessment will best meet the needs of your organization look for one that is adaptable, offers diversity, is universal, state of the art, customizable and easy to administer to your employees. The Alliance's partnership with Health Solutions, Ltd®, delivers an HRA tool, The Advantage from Wellsource®, that not only offers an innovative health risk assessment, but also an employee portal that incorporates multiple online health education resources.
The Advantage is an online assessment that offers questions based on the most current research in a variety of health and wellness risk areas (scannable paper questionnaires are also available). The standard health risk assessment contains a total of 62 questions and has the capability to include 15 customizable questions specific to your organization. Another customizable feature is personalized messaging and branding throughout the assessment including logos, notes, taglines, Web links and photos. In order to ensure that the assessment is completed properly and that your employees are able to fully understand their results, all the information on the portal can be converted from English to Spanish (other languages are currently in production).
The Advantage health risk assessment also may have biometric lab values and demographic information automatically uploaded. This not only saves time for your employees but reduces data entry errors. Once an employee has completed the health risk assessment, they are provided with a 14-page results report arranged per the individual's health risk, which also includes recommended health actions, healthy Web links, tips to reduce their risk and a medical follow-up report used as an easy reference for your employees to discuss with their primary care provider. During subsequent years, their report will also include comparison graphs of the individual's health risks over time. This assessment also has the ability to provide support and follow up interventions to help keep employees on track with their health and wellness goals.
For more information about Health Solutions, Ltd®, and offering HRAs, members may contact Bobbi Jones, product management specialist, 800.223.4139 x 6638.
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| Prescription Patient Assistance Programs |
During these hard economic times there are programs that can help former employees or their dependents access prescription medications if they are no longer covered by a member's benefit plan. Pfizer Helpful Answers is a family of assistance programs for the uninsured and underinsured who need help getting their Pfizer medications. These programs are meant to help people who are out of work, have high medical expenses, or may have exhausted their medical benefits.
Pfizer has integrated Wyeth Patient Assistance programs into its family of plans. Individuals can find out if they qualify for prescription assistance by calling 866.706.2400 for Pfizer medications and 800.568.9938 for Wyeth medications. Pfizer hopes to have the programs fully integrated by mid-2010.
Additionally, the Pfizer MAINTAIN Program helps workers who may find themselves unemployed and need help continuing to access their medication. There are more than 70 Pfizer primary care medications available through MAINTAIN.
For more information, see PfizerHelpfulAnswers.com, pparx.org and togetherrxaccess.com.
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| HealthLeaders09 Health Plan Analysis Focuses on Purchasing Cooperatives, Value-Based Benefit Design, Features The Alliance |
Health Leaders recently released its 2009 Wisconsin Health Plan Analysis. Two of the articles included featured information about The Alliance and quotes from President & CEO Cheryl DeMars.
Wisconsin Co-ops Get Notice, But May Not Be Replicable discusses how the health-care cooperatives of Wisconsin, including The Alliance, are gaining national attention with the focus on cooperatives in the recent health care debates.
Local Wisconsin efforts at value-based benefits are discussed in Wisconsin Employers Tinker with Value-Based Benefits. Read both articles here.
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| Building Our Cooperative |
Please join us in welcoming the following new members to the cooperative:
Heartland Automotive, the largest Jiffy Lube franchisee, has joined The Alliance, effective January 1. Based in Omaha, Neb., Heartland operates nearly four hundred Jiffy Lube service centers in fifteen markets, including Austin, Boston, Chicago, Columbus, Kansas City, Las Vegas, Los Angeles, Madison, Memphis, Minneapolis, Omaha/Lincoln, San Diego, Seattle, St. Louis, and Tucson. Heartland strives to help customers properly maintain their vehicles through fast, convenient, and knowledgeable service. Beyond a standard oil change, Heartland Jiffy Lube offers battery maintenance, manual transmission service, windshield repair, and state standard emissions testing. We welcome them to The Alliance.
Schoep's Ice Cream has been part of Wisconsin history since 1928, when founder E.J. Schoephoester started making ice cream in the back of his grocery store in Madison. Twelve years later, butter maker P.B. Thomsen began selling Schoephoester's creations wholesale, and this family-owned business was born. Last year, the company produced over twelve million gallons of ice cream, and is the largest independent ice cream manufacturer in Wisconsin. They joined The Alliance February 1.
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| Alliance Provider Update |
The Alliance encourages employers to distribute the monthly Provider Update listing to their employees.
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| QualityCounts™ for Employees |
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As a member of the Wisconsin Collaborative for Healthcare Quality, The Alliance serves on its Consumer Workgroup. The Consumer Workgroup, made up of health care providers, purchasers and others, includes Alliance member Webcrafters, Inc. One of the projects the group completed within the past year was the development of materials for consumers that answer the question: what is quality health care?
The pieces present an answer to this question and others in clear, direct language. The materials outline the definitions of quality care and the options a patient has to make sure he or she is getting the care he or she needs.
We were able to obtain some of these pieces for our members, which have been customized with information about The Alliance's QualityCounts™ report, which can help employees choose care using cost and quality information. We have a limited number of printed copies of an 8 1/2" x 11" flyer and a larger poster.
To order printed materials, members may contact Jesse Oberloh at 800.223.4139 x 6645.
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| News You Can Use |
The Alliance highlights health care and benefit management news for employers in News You Can Use with a link to take you to the original story or report.
The Rise of Medical Tourism
As employers continue to look for efficient, cost-effective solutions, many are beginning to consider medical tourism. While still not mainstream, the idea is growing. A new report, Medical Tourism, Update and Implications, outlines key components in this growing field.
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| About the Agent and Consultant Briefing |
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Each month, The Alliance Agent and Consultant Briefing delivers the latest news to insurance agents and consultants about Alliance services, programs and events as well as information on health benefit trends, issues, and ideas of interest to our mutual clients.
Reader comments, suggestions and topics are always welcome.
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