Archive for August 2011
Health Care Reform Weekly June 6 2011
Week of June 6, 2011
While the Affordable Care Act’s (ACA) medical loss ratio (MLR) and rate review provisions have been getting most of the media attention, a new coalition of business organizations has come together to draw attention to another important requirement of the ACA. Calling themselves Stop the HIT on Small Business, more than 25 national business organizations have joined forces to work toward repeal of new taxes the ACA would impose on private health insurance starting in 2014. Business leaders behind the effort say that small business owners, their employees and the self-employed will ultimately bear the brunt of billion in additional health care costs in the first 10 years as a result of the new taxes. The group is planning Capitol Hill outreaches and grassroots efforts.
Federal
Support is growing in Congress (over 80 co-sponsors) for Mike Rogers’ (R-MI) and John Barrows’ (D-GA) legislation that would exclude agent commissions from the MLR calculation. Currently, commissions count as administrative expenses in calculating insurers’ MLRs. This support was highlighted in a House hearing last week before the Health Subcommittee of the Energy & Commerce Committee, where the larger issue of the MLR burden was front and center. Witnesses representing agents and brokers, insurers and academia all testified against the unintended, negative consequences of the MLR requirement, with agents and brokers in particular noting the direct financial impact to small business and individual agents and their families. The Rogers/Barrows bill would simply not factor commissions into the MLR calculation. The day before the hearing, Congressman Tom Price ((R-GA) introduced an even more aggressive bill, as his proposal would repeal outright the MLR provision of ACA. While it is unlikely that either bill will get traction in the Senate on its own, bipartisan support for the agents and genuine concern about unintended consequences puts this issue in play as part of any potential mega-deal on the budget/deficit/debt ceiling issue over the next few months. The Senate was not in Session last week; and the House is out this week.
States
COLORADO: Governor John Hickenlooper last week signed into law a bill establishing the Colorado Health Benefit Exchange. The legislation created a fair amount of controversy during the session, particularly among “Tea Party” Republicans. However, the final product represents the culmination of a bipartisan effort that remained inclusive of the business, advocacy and insurance industry constituencies.
CONNECTICUT: Although adjournment is set for June 8, a number of significant bills are still in process. The legislature passed a bill over the weekend that would create a health insurance exchange. The bill is expected to be signed by Governor Dannel Malloy, as the legislation, as passed, is an amended version of a bill proposed by the Malloy administration. It would create an 11-member exchange board and set rules and responsibilities for the exchange, but many policy decisions would be left for resolution at a later time. The exchange must be financially self-supporting by 2015, and the bill would allow the exchange to charge assessments or user fees to health insurance carriers to fund operations. Some lawmakers questioned the cost of the exchange. However, the nonpartisan Office of Fiscal Analysis says the planning process is not expected to require additional state money. The bill calls for exchange board members to have expertise in specific subjects, including small employer health insurance coverage, health care delivery systems, access issues that self-employed people face, barriers to individual health care coverage, health care finance and benefits plan administration.
Additional bills yet to be passed by both Houses include the SustiNet bill, now amended to create a health care reform advisory board and allow municipalities and not-for-profits to join the state employees plan. Also, a prohibition on “most favored nation” clauses in provider contracts and a broad rate review bill that would require public hearings for all rate increases over 10 percent have yet to be acted on.
ILLINOIS: A spring session of the General Assembly dominated by redistricting, workers’ compensation, budget, pensions and gambling adjourned on May 31, 2011. Minimal health care legislation passed by both chambers is awaiting signature by the governor. One important legislative development is that Aetna helped turn back attempts to amend the “non-participating” physician law that was passed last year and went into effect on June 1, 2011. The law protects consumers from being overbilled by certain out-of-network, hospital-based physicians (i.e., anesthesiologists, radiologists) who provide direct services in hospitals and ambulatory surgery treatment centers. Under the law, the patient is taken out of the middle as it ensures patients will pay no more than they would have paid to one of their carrier’s participating providers. In addition, the law allows either the physician or the insurer to use binding arbitration to resolve disputes over the reasonableness of charges or reimbursements.
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Other health care bills defeated including taxes/insurance assessments; reporting of extensive premium loss data; and health insurance rate review. Bills currently awaiting the governor’s signature include changes to the mental-health parity and clinical trials mandates, as well as insurer recoupment requirements that the industry ultimately agreed to. Also, a health insurance exchange bill passed both chambers that would establish an exchange and appoint a study commission of legislators to report back to the Assembly by Sept. 30, 2011 regarding parameters for an exchange. Follow-up legislation could potentially be considered in the fall veto session, beginning at the end of October 2011.
MAINE: Gov. Paul LePage and the legislature’s Republican leaders found a way to avoid an override of the Governor’s recent veto of the most-favored nation prohibition bill. The bill would bar insurers from requiring a health care provider to charge an insurance company the lowest rate the provider negotiates with any other insurance carrier. In his veto message on the bill, LePage said he strongly believes that businesses have a right to contract with each other as they deem appropriate. After some Republicans complained, LePage met last week with GOP leaders and co-chairs of the legislature’s Insurance and Financial Services Committee, which unanimously endorsed the bill last month. Republican lawmakers agreed to vote to sustain the governor’s veto when the House acts on it, and the Governor agreed to submit compromise legislation. The new bill would ban most-favored nation clauses but also allow Maine’s superintendent of insurance to issue a waiver. It is unclear what conditions an insurer would have to meet to earn a waiver. The bill’s language is not yet available to the public. With session scheduled to adjourn June 15, the legislature is likely to wait until next year to take up the bill.
Governor LePage announced that Eric Cioppa, Deputy Superintendent of the Bureau of Insurance, Department of Professional and Financial will serve as Acting Superintendent effective immediately. Cioppa replaces former Superintendent Mila Kofman who resigned recently. In his former role as deputy superintendent, Cioppa was responsible for the Examination, Market Conduct, Financial Analysis, Alternative Risk Markets, Producer Licensing, Administrative Support Unit, and Research and Statistics Units of the Bureau.
MICHIGAN: In the next couple of weeks, the state Senate is expected to vote on a 0 million paid-claims tax that would be levied on insurers and third-party administrators as proposed by Governor Snyder. Specifically, the bill would establish an entirely new tax on health insurance claims as a way to match federal Medicaid funding. The 1 percent on tax on all medical claims paid under health, dental, automobile and workers’ compensation coverage would impact fully and self-insured business. Ultimately, the cost of the tax will be borne by the sponsor of that coverage – the employer or the individual who already pays for the coverage. As introduced, the tax would begin on October 1, 2011. While working with lawmakers to help them understand the impact the tax would have on constituents, Aetna has mobilized its grassroots employee network to contact their state legislators regarding the issue. The bill has a strong chance of passing, and Aetna is urging all its constituents in the state to contact the Governor’s office and legislators to express any concerns they may have about the tax.
NEW YORK: Session is scheduled to adjourn June 20, and no official exchange legislation has been advanced. The Senate Republican majority is said to have a bill draft ready that supports a market-based exchange, but it has not been introduced yet. The Administration plans to introduce a more expansive model that reportedly will include giving the governor the majority of the board appointments, the exchange de facto rate-setting authority, and the exchange authority to selectively contract and require plans to participate. The bills are expected by the second week in June. However, with many other significant issues still on the table, compromise on an exchange bill may be swept up into a larger negotiation.
A very broad autism mandate is still in play. A set of amendments was introduced to ensure that an autism coverage mandate not be broader than for any other disease coverage mandate, For example, a pharmacy rider would be required to get pharmacy coverage, and there would be a limitation on visits but no dollar or age limits. The bill is still more expansive than last year’s version, which was vetoed by then-Governor Paterson due to its million fiscal note. Governor Cuomo has not announced his position on the proposal.
NEVADA: The 2011 legislative session is winding down toward adjournment on June 6. Governor Brian Sandoval has on his desk a rate review bill that would implement a prior approval scheme, require greater transparency and public access to rate filings, and allow a Consumer Advocate to request a public hearing. The measure is sponsored by the Democratic Speaker and has the support of the commissioner who says that some aspects of the bill are needed for the state to comply with HHS rate review requirements. The Senate-sponsored bill creating the Silver State Health Exchange continues to move toward passage in the Assembly.
PENNSYLVANIA: State government had another better-than-expected revenue collection month in May and headed into the final month of the fiscal year with a nearly 0 million surplus. The news came last week as the debate in the Capitol intensified over the depth of spending cuts sought by Governor Tom Corbett. Legislative budget analysts said the state’s updated revenue collection figure through the end of May was 2 percent, or about million, over the official estimate. That means the state has collected almost .3 billion through 11 months, or 2.3 percent above the official estimate. However, the state continues to face a projected multi-billion-dollar budget deficit in the fiscal year beginning July 1. The disappearing federal stimulus money that temporarily helped buttress the state’s recession-wracked tax collections is one of the largest contributing factors.
TEXAS: A special session of the legislature, called by Gov. Rick Perry to address education and health care issues left pending when the 140-day regular session ended May 30, got off to a slow start last week. But by the end of the week, the Senate Appropriations Committee unanimously voted in support of a massive health care measure that combines three weighty regular-session bills. Now headed for a full Senate vote, the package seeks .5 billion in Medicaid savings by expanding managed care to South Texas and restructuring insurance payment systems. It also would charge Medicaid patients for unnecessary emergency room visits and penalize doctors and hospitals for preventable complications.
Late Tuesday, Perry added another issue to the 30-day session: redrawing boundaries for Texas’ 36 congressional districts. School finance remains the main event of the overtime session. Another bill would resurrect the interstate health care compact, favored by Republicans because it would allow member states to opt out of the federal health care reform law. Democrats oppose the effort, saying Texas would save money by cutting more low-income people from Medicaid coverage. A bigger hurdle would be Congress, which must approve the compact. The special session will last a maximum of 30 days but could conclude earlier if the legislature finishes business and adjourns.
Research on Health Care System of Australia
Article by latest-health-articles.com
Health care issue is a worldwide problem, one of the most controversial and the most sensitive topics in the political life of countries. It can not be avoided by any government.
Now it has also become the focus of attention from all walks in China. Since reform and opening up, with the advance of the market economic system, the improvement of people’s standard of living, and the progress of technology and society, the medical field gradually highlights contradictions, and accompanying by an unprecedented number of new problems have arisen, the problems have become increasingly prominent, severely affected the people’s health and even on social harmony and stability. China’s medical reform had continued more than 20 years. However, because of the complexity of the problem itself and the restrictions on China’s national conditions it had not been able to achieve a major breakthrough. In the 21st we have not only to expand health care coverage, improve the quality of medical services and control health care costs such as the basic health care issues, but also to deal with the development of medical and information technology, and the challenges brought about by the aging. This makes medical reform in China face more complicated situation, higher requirements and then it is necessary to take into account more factors.
So it becomes extremely necessary and urgent to study health care systems of other countries. The article begin with the history of Australian health-care system, a comprehensive introduction to Australian health-care system in its infancy, establishment, development and reform, then analyze operational mechanism and constituent elements of the health care system in Australia. Based on the inquiry, the article brings to light the fundamental laws and inherent logic governing the formation and development of Australian health-care system. It also analyses the nature and the problems and challenges faced by Australian health-care system. Finally, it puts forward several proposals concerning the enlightenment we can gain from the experience of Australia when we improve our medical care system.
Health & Safety Issues Common to Most Businesses
Health and Safety Policy sets out how health and safety issues are managed within an organisation. A Health and Safety Policy is a commitment to planning and managing health and safety at work and is the key to achieving acceptable standards and preventing accidents and instances of work-related ill health.
If you employ five or more people you must have a written health and safety policy statement and a record of your health and safety arrangements. You need a written document so that you and your workforce are clear about who’s responsible for what.
If your business employs less than five people you are not legally required to have a written health and safety policy statement. However, you must still ensure that you work safely – a written policy can help you do this.
Why is Health & Safety Important to Small Businesses?
Your employees have rights to work in safe conditions with a regard to personal health and it is therefore important that you offer them this sort of working environment: failing to do so can result in personal injury, disease or general poor health. Such occurrences can result in legal action being taking against your business (or you personally) which could damage the business financially and its reputation (including you – as an employer).
Responsibilities of an Employer
The Health & Safety at Work Act, 1974 states that it is your responsibility to protect the health, safety and welfare of yourself, your employees, and people that may be affected by what you do. Such people include:
* Visitors to your workplace
* The public that use your product or service
* Neighbours
In other words, Employers must provide to its employees:
* a safe place of work
* a safe system of work
* adequate plant and equipment.
Displaying your Health and Safety Policy
The health and safety policy statement should be displayed in a prominent position at all work locations and sites. A copy of a Company’s health & safety policy with full details of the organisation and arrangements for implementing the safety policy should also be available at each work location and site.
The health and safety policy should be reviewed preferably on an annual basis and updated as either legislation changes or working practices change.
Difference between Risk Assessment and Health and Safety Policy
A policy is different from a risk assessment.
* Policy: general vision and arrangements for the whole business.
* Risk assessment: a regular review of how you remove or control hazards, and whether you are doing enough, or if you require further controls.
Legal Duties and Obligations around Health and Safety Policies
The Health and Safety at Work etc. Act 1974
The Act says that you must prepare a statement and bring it to the attention of all employees. The policy should be reviewed and revised as often as necessary.
The Management of Health and Safety at Work Regulations 1999
These regulations place duties on employers to assess and manage risks to their employees and others arising from work activities. How this is carried out should be included in the policy.
Involving your Employees
In practice, it can be useful to involve your employees in preparing and implementing the health and safety policy. Where employees are involved in making safety rules, or devising safe working methods, they may be more likely to adhere to them, because they will understand the reasoning behind them. Also, the person who is actually doing a job can be best placed to advise on whether the proposed safe working method will work.
Informing your Employees
There are various ways to bring the policy to the attention of employees. If it is short enough, you may decide to give a copy to each employee.
If you are a larger organisation or your policy is fairly lengthy, you could post copies on notice boards or in appropriate places. Whatever you choose to do, you must make sure that you bring the policy to the attention of all employees.
Is it Important to give Health and Safety Training
You must provide training for your employees to ensure that they:
* know how to work safely and without risks to health
* know about your health and safety policy, how you implement it and the part they have to play
* are aware of their health and safety responsibilities towards themselves, other employees and people visiting your premises.
Training is likely to be particularly important in certain circumstances. For instance, when:
* new people join your business – from employees to work-placement students
* employees change jobs within the business
* an existing risk increases – perhaps because of a greater volume of work
* a new risk is identified – perhaps when new equipment is purchased
Remember that refresher training is particularly important so that complacency doesn’t creep in.
Monitoring and Review
Monitoring that the policy is still effective is vital. There are many ways that this can be done, including carrying out spot checks or safety inspections using prepared checklists.
More formally, effective monitoring can be achieved through audits and by reviewing management reports and accident investigations.
What should be in the Policy?
A policy is a written statement and should outline the following:
* The responsibilities of those people using a certain area of the premises.
* The Health & Safety risks that arise from the work activities and how they should be controlled
* The name(s) of the employees’ representative(s) concerning Health & Safety
* Who is responsible for providing safe equipment and maintaining its safety
* The location of the Health & Safety poster
* Who is responsible for informing and training employees for Health & Safety
* Location of first aid equipment and the name of the person(s) who is responsible for recording accidents
* Who is responsible for monitoring Health & Safety
* Who is responsible for carrying out risk assessments and making sure that it is always valid and put into use
Is it Possible for Employer to Delegate Responsibility?
The organisation section of your policy should clearly say who is responsible for what. The overall responsibility for safety rests on the employer, but day-to-day responsibility can be delegated to others within the business.
In smaller businesses, it may be very easy to decide who needs to do what for the purposes of health and safety.
As businesses get larger, the organisation section of the policy may need to set out the responsibilities of staff at different levels of the hierarchy within the business.
The organisation section may include a diagram or chart showing the business structure and the responsibilities of:
* the managing director
* other managers
* supervisors or team leaders
* all employees
Construction Safety Plans
Construction safety requires skill, experience, planning, and training. No matter what type of construction you do, from putting up a building to installing a pipeline, you have to know exactly what you’re doing. The wrong materials or the wrong procedures can make for tragic accidents, fines and negative publicity.
A construction safety plan can assist principal contractors to manage their workplace health and safety obligations.
A principal contractor must prepare a construction safety plan before construction work starts.
The plan must state:
* workplace address
* name and address of the principal contractor
* principal contractor’s ABN
* whether there is a WHS committee
* whether there is a WHS Officer appointed
* expected start date
* estimated duration of the work
* type of construction
* plant provided for common use
* site rules
* the risks the principal contractor is obliged to manage
* proposed control measures for the risks
* how the controls will be implemented
* arrangements for monitoring and reviewing controls
* emergency procedures
* public safety strategies
The plan must be written so it is easy to understand, signed and dated by the principal contractor. It must be available for the length of the project.
Legal Obligations to Provide Health and Safety Policy
The obligation to provide a health and safety policy originally arises under section 2(3) of the HSWA. In cases of flagrant disregard, enforcement officers may issue improvement notices which if contravened lead to the ultimate potential sanctions of criminal penalties, including large fines and imprisonment.
Inspectors from the local authority Environmental Health Department, or HSE are responsible for enforcing health and safety law, and organisations can be prosecuted for breaches. All workplaces must be registered with either of these two bodies. Employees can report any breaches of the legislation or seek advice from them.
How should a Written Policy look?
A written health and safety policy does not need to be complicated or time consuming. It tells staff and others about your commitment to health and safety, and simply describes how you will implement and monitor your health and safety controls
Net Lawman’s health and safety templates includes following features:
* All required information under the Approved HSE Code of Practise;
* Details of the client / manager;
* Description of the project;
* Site location details;
* Timescale for completion;
* Design information including survey details;
* Health and safety regards managing construction;
* Health and safety details regards managing incoming / outgoing materials and people;
* Methods and procedures for safe work;
* Drawings and site sketches;
* Lists of hazardous materials to be used on site;
* Fire safety plan;
* Site sketch including location of amenities, stores, materials, boundaries and the location of the structure;
* Extensive notes to guide you.
Our health and safety templates have been drawn by expert Solicitor and Barrister who know what legislation is relevant to your business and the best way to implement it. Net Lawman’s health and safety policies are tailored to your companies needs.
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