Health Care Reform Update: Lab Rules; ERRP; Wellpoint Purchase

Our partners at UBA have helped us to bring you this week's latest in the Health Care Reform Updates:

U.S. Plan Would Boost Access to Lab Results

The Obama administration proposed a new rule that would allow patients to have direct access to electronic medical records, including lab results without waiting to hear them from a doctor. At present, patients can only obtain lab results if their physicians provide authorization, or if they reside in a few states which allow such access.

The rules proposed by the Department of Health and Human Services are part of a broader effort to give patients greater access to medical data electronically so they can become more engaged in their care. They would replace a confusing patchwork of state laws and privacy statutes and affect more than 6 billion lab tests a year.

CMS Issues Changes to Claims Submissions for Early Retiree Reinsurance Program
The Centers for Medicare and Medicaid Services (CMS) has announced several changes to improve and streamline the process of submitting claims data for Early Retirement Reinsurance Program (ERRP) reimbursement requests.

On Monday, Oct. 3, 2011, CMS will begin providing specific, claim line-level feedback to sponsors who submit claim lists through a new, fully automated review system.

• Given this expedited feedback, all claim lists submitted on or after Oct. 3 must be error-free (it must pass the automated review) in order for the plan sponsor to be able to submit a reimbursement request, and then be approved for payment.
• If a claim list is determined to be invalid as a result of the automated review and cancelled from the system, the sponsor may resubmit a corrected claim list.
• Similarly, before the automated processing system becomes effective in October 2011, Claim lists and reimbursement requests that have errors will be cancelled from the system, and plan sponsors may resubmit them.

To provide plan sponsors with sufficient time to prepare for this level of review, the deadline for plan sponsors to submit error-free claim lists in support of reimbursements received based on a summary of aggregated claims has been extended from Dec. 31, 2011, to March 30, 2012.

Finally, CMS is granting sponsors additional flexibility in submitting detailed claims information, offering options on some elements while maintaining fiscal integrity. Plan sponsors should refer to the updated claim list layouts provided on http://www.errp.gov/  for guidance on how to supply required data, and to the questions and answers provided below.

Plan sponsors that have questions or additional information should contact the ERRP Center at http://www.errp.gov/contact_us.shtml 

For more information, visit:

http://www.errp.gov/newspages/20110912-cms-claim-list-update.shtml.



WellPoint Buys Insurance Exchange to Compete With State-Run Health Markets
WellPoint and two nonprofit health insurers purchased a 78 percent stake today in Bloom Health, a closely held benefits company in Minneapolis, for an undisclosed sum. Bloom is a two-year-old online private health-insurance exchange that offers a menu of health plans to about 20,000 workers at almost 50 companies.

Private exchanges compete for employers with the U.S. state-run marketplaces set to open in 2014 under President Barack Obama's health care overhaul. Using a private exchange such as Bloom would limit an employer's costs and provide consistency compared with separate state-run exchanges, each with their own regulations.

A study by New York-based consulting firm McKinsey & Co. said that as many as one-third of U.S. companies are considering giving up employer-sponsored health plans. Instead, they would send their workers to state-run exchanges for coverage, paying a federally mandated fine.

Under the Bloom model, companies pay employees a fixed amount to cover a portion of their health care coverage and workers provide the rest based on the plans they select. The Bloom exchange allows employers to maintain their tax deduction on the money paid annually into an employee's health reimbursement account to help cover the cost of insurance. It also allows workers to pick a plan that suits their health care needs and how much they are willing to spend.

The idea of the private health care exchange and its defined contribution model is similar to the trend in retirement benefits in which employers have been abandoning defined benefit pension plans for the relative financial safety of a 401(k) that allows companies to control how much they spend.

WellPoint's partners in the Bloom purchase are Chicago- based Health Care Services Corp., which operates former Blue Cross plans in Texas, Illinois, New Mexico and Oklahoma, and Blue Cross Blue Shield of Michigan.

It now will be able to offer employers choices of health plans in the 19 states where Bloom operates, which represent about 60 percent of the U.S. population. The objective of Bloom's new owners is to be in all 50 states in the next year.

Extend Health Inc. of San Mateo, California is currently the largest private exchange covering 300,000 participants. Its customers include Union Pacific Corp. in Omaha, Nebraska, and U.S. automakers Ford Motor Co., General Motors Co. and Chrysler Group LLC.