After independent expert review, HHS determined that Trustmark Life Insurance Company has proposed unreasonable health insurance premium increases in five states—Alabama, Arizona, Pennsylvania, Virginia, and Wyoming.  The excessive rate hikes would affect nearly 10,000 residents across these five states.

To make these determinations, HHS used its “rate review” authority from the Affordable Care Act (the health care law of 2010) to determine whether premium increases of over 10 percent are reasonable.

"Before the Affordable Care Act, consumers were in the dark about their health insurance premiums because there was no nationwide transparency or accountability," said Secretary Sebelius.  "Now, insurance companies are required to disclose rate increases over 10 percent and justify these increases.  It’s time for Trustmark to immediately rescind the rates, issue refunds to consumers or publicly explain their refusal to do so."

In these five states, Trustmark has raised rates by 13 percent.  For small businesses in Alabama and Arizona, when combined with other rate hikes made over the last 12 months, rates have increased by 27.2 percent and 18.1 percent, respectively.  These increases were reviewed by independent experts to determine whether they are reasonable.  In this case, HHS determined that the rate increases were unreasonable because the insurer would be spending a low percent of premium dollars on actual medical care and quality improvements, and because the justifications were based on unreasonable assumptions.

In addition to the review of rate increases, many states have the authority to reject unreasonable premium increases.  Since the passage of the health care reform law, the number of states with this authority increased from 30 to 37, with several states extending existing “prior authority” to new markets.

To keep your employees informed of their rights and obligations under the Patient Protection and Affordable Care Act (PPACA) of 2010, procure and display a copy of Personnel Concepts' Health Care Reform Employee Information Poster.

The performance bonus payments are funded under the Children’s Health Insurance Program Reauthorization Act (CHIPRA), one of the first pieces of legislation signed into law by President Obama in 2009.  To qualify for these bonus payments, states must surpass a specified Medicaid enrollment target. They also must adopt procedures that improve access to Medicaid and the Children’s Health Insurance Program (CHIP), making it easier for eligible children to enroll and retain coverage. 

The bonuses come one week after new data from the Centers for Disease Control and Prevention (CDC) show that the number of children with insurance increased by 1.2 million since the CHIP (Children's Health Insurance Program) reauthorization in 2009. An HHS issue brief notes that this increase has been entirely due to greater enrollment in public programs such as Medicaid and CHIP.

Employers, you can help keep your workforces informed of their children's rights under CHIPRA by posting our CHIPRA Compliance Poster. Get yours today.

As initially envisioned in the Patient Protection and Affordable Care Act (PPACA) of 2010, the Department of Health and Human Services (HHS) would set the benefit packages for the state exchanges, but now the states are being awarded some flexibility.

Insurers selling plans in the state-based exchanges, however, must still cover a basic set of benefits, including hospitalizations, emergency care, and newborn and maternity care and pediatric services, as set forth in the PPACA legislation.

Rather than issue a proposed regulation, the administration chose to advise the states through a “pre-rule bulletin,” which does not have the force of law. Unlike a rule, however, the "bulletin" cannot be overruled by Congress. The administration also does not have to provide definitive economic estimates of the proposal or determine its regulatory impact on small businesses because it is not an official rule. Official rule-making is expected to occur sometime next year.

As reported by the Los Angeles Times, the new approach seems to have left activists on both sides of the issue less than satisfied.

"What's to guarantee that the state's choice of a benchmark plan will be affordable?" asked National Retail Federation Vice President Neil Trautwein, who is helping lead a coalition of business and insurance groups. "If coverage is unaffordable today, this doesn't change the equation."

Families USA Executive Director Ron Pollack, a longtime advocate for federal health reform, also expressed reservations.

"We understand the inclination to balance flexibility, comprehensiveness of coverage, and cost," he said. "However, flexibility must yield to reliable, comprehensive coverage of benefits for consumers.… It is essential that HHS provide strong oversight and enforcement."

To keep your workforces informed of their rights and obligations under PPACA, Personnel Concepts offers a Health Care Reform Employee Information Poster. Get yours today and display it conspicuously.

A MEWA is an alternative method of providing health insurance coverage sometimes used by small employers.

The proposed rule allows the Labor Secretary to seize a MEWA under two circumstances: if the MEWA is in danger of being unable to pay its claims and if the MEWA has sustained or is sustaining a "significant loss of assets." No court order would be required.

The proposal also allows the Secretary to issue a cease and desist order if there is fraudulent conduct, or if there is “immediate danger to the public safety or welfare” or “conduct that causes or can be reasonably expected to cause significant, immediate, and irreparable injury.”

Interested employers are invited to submit comments until March 5, 2012.  Comments may be submitted electronically through the federal eRulemaking portal, by e-mail to  E-OHPSCAMEWARegistration.EBSA@dol.gov, and by regular mail to: Office of Health Plan Standards and Compliance Assistance, Employee Benefits Security Administration, Room N-5653, U.S. Department of Labor, 200 Constitution Avenue NW, Washington, DC 20210, Attention: RIN 1210—AB51; MEWA Registration Proposed Regulation.

Instead of excluding them, the HHS final rule includes broker commissions as administrative expenses and allows just 20 percent of health insurance premiums to cover administrative charges; the other 80 percent must go to health care expenses. Thus comes about what is called the 80/20 medical loss ratio (MLR).

"If your insurance company doesn't spend enough of your premium dollars on medical care or quality improvement this year, they'll have to give you rebates next year," said Centers for Medicare and Medicaid Services Acting Administrator Marilyn Tavenner in a press release. "This will bring costs down and give insurance companies the incentive to focus on what matters for patients – high quality health care."

To help businesses keep employees abreast of the provisions of PPACA, Personnel Concepts publishes a comprehensive Health Care Reform Employee Information Poster. Get yours today and display it conspicuously.

Two constitutional issues loom large: One is the individual mandate that all persons must buy health insurance if it is not provided for them otherwise; the other is the tax penalty PPACA imposes on those who refuse to purchase insurance.

The core issue is whether the Commerce Clause of the Constitution gives Congress the power to order people to purchase anything, which in this case is health insurance.

By agreeing also to review the tax penalty provision, however, the Supreme Court justices could choose to skirt the entire issue by saying the tax penalty cannot be challenged until someone has actually paid it and sought a refund. This is essentially what the Fourth U.S. Circuit Court of Appeals did, invoking the Anti-Injunction Act, which requires the tax to be paid before it can be challenged legally.

If the Supreme Court chooses the Fourth Circuit's avoidance route, PPACA would take full effect in January 2014 but no one would have to pay the tax until the next year, so judgment day could be way, way off–or even non-existent.

Employers, keep your workforces cognizant of their rights and obligations under the ACA by procuring and prominently displaying Personnel Concepts' Health Care Reform Employee Information Poster.

At issue is whether the law's individual mandate that all Americans must purchase insurance if it's not otherwise provided for them by their families, employers or others is constitutional. Backers of the bill claim the mandate is a perfectly legal extension of Congress's right to regulate interstate commerce, but opponents argue that regulating commerce is a far differ matter from mandating commerce from on high.

Previous reviews of the law by federal appeals courts are mixed, with the latest ruling in favor of the ACA being issued by Laurence Silberman, a conservative appointee of President Ronald Reagan, just this past week.

"The right to be free from federal regulation is not absolute and yields to the imperative that Congress be free to forge national solutions to national problems," Judge Silberman wrote in the 2-1 opinion for the District of Columbia Federal Appeals Court. Silberman was joined by Judge Harry Edwards, a President Jimmy Carter appointee.

Employers, keep your workforces cognizant of their rights and obligations under the ACA by procuring and prominently displaying Personnel Concepts' Health Care Reform Employee Information Poster.

When a Monday deadline passed for the Obama administration to ask the 11th Circuit Court to rehear the case, it became clear that the goal was for the Supreme Court to render a final decision. By filing its appeal with the Supreme Court on Wednesday, the Department of Justice (DOJ) is thus seeking an early hearing on the issue. A decision could come as early as June, and will no doubt—regardless of the outcome—become a heated campaign issue during the upcoming election cycle.

"The Department has consistently and successfully defended this law in several courts of appeals, and only the 11th Circuit Court of Appeals has ruled it unconstitutional," the Justice Department said in a statement. "We believe the question is appropriate for review by the Supreme Court."

Opponents of the individual mandate argue that the law's use of the commerce clause in the Constitution to justify PPACA's individual mandate that all persons must buy health insurance is wrong. That clause gives the federal government the power to regulate commerce among the many states. However, opponents point out that if an individual chooses not to buy health insurance, that person is not engaging in interstate commerce and therefore cannot be regulated, or mandated to engage in interstate health insurance commerce.

Employers, keep your employees informed of their rights and obligations under PPACA. Get a copy of Personnel Concepts' Health Care Reform Employee Information Poster and display it for all to read.

The Centers for Medicare and Medicaid Services (CMS) will conduct the reviews for nine states not qualified to do so, and the remaining 41 states will handle their own cases. CMS will conduct rate review covering both the individual and small group markets in Alabama, Arizona, Idaho, Louisiana, Missouri, Montana and Wyoming. It will conduct small-group market reviews in Pennsylvania and Virginia.

“These new rules, combined with the funding states are receiving under the Affordable Care Act, will trigger much closer scrutiny of health insurance rate hikes,” says DeAnn Friedholm, director of Consumers Union's health reform campaign.

“But ultimately, it will be up to the states to protect consumers when rate increases are found to be unreasonable. States need to make sure they have the tools necessary to prevent unreasonable rate increases from going into effect. And some states that have the authority to curb rate hikes need to act more aggressively to prevent insurers from gouging consumers.”

When an insurer submits a rate hike higher than 10 percent, CMS and the state agencies will post that justification on their Web sites, as will the insurer.

The Office for Civil Rights of the Department of Health and Human Services (HHS) is charged with enforcing the security and privacy rules of the Health Insurance Portability and Accountability Act (HIPAA), which protect individuals' personal health information (PHI) in both electronic and paper forms. Under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, OCR is further required to make an annual report to Congress on both rules and their enforcement.

The privacy rule took effect in 2003, and the security rule, dealing with electronic PHI, took effect in 2005.

In its just-released report to Congress, OCR said it has received 57,375 complaints of violations of the privacy rule since its 2003 effective date Of those, 52,339 (91 percent) have been resolved, and 5,036 (9 percent) remain open. The agency said it has received 803 security rule complaints since the rule took effect, and has resolved 577, or 72 percent, of them, leaving 226, or 28 percent, open.