HHS delays final agreement with insurers over federal health exchanges

(Reuters) — The Obama administration has delayed a step crucial to the launch of the new health care law, the signing of final agreements with insurance plans to be sold on federal health insurance exchanges starting Oct. 1.The U.S. Department of Health and Human Services notified insurance companies on Tuesday that it would not sign final agreements with the plans between Sept. 5 and 9, as originally anticipated, but would wait until mid-September instead, according to insurance industry sources.

Nevertheless, Joanne Peters, a spokeswoman for HHS, said the department remains “on track to open” the marketplaces on time on Oct. 1.

The reason for the holdup was unclear. Sources attributed it to technology problems involving the display of insurance products within the federal information technology system.

Ms. Peters said only that the government was responding to “feedback” from the companies, “providing additional flexibility and time to handle technical requests.”

Coming at a time when state and federal officials are still working to overcome challenges to the information technology systems necessary to make the exchanges work, some experts say that even a small delay could jeopardize the start of the six-month open enrollment period.

U.S. officials have said repeatedly that the marketplaces, which are the centerpiece of President Barack Obama’s signature health care reform law, would begin on time.

But the Oct. 1 deadline has already begun to falter at the state level, with Oregon announcing plans to scale back the launch of its own marketplace and California saying it would consider a similar move.Tuesday’s notification by the Centers for Medicare and Medicaid Services, the HHS agency spearheading marketplace development, affects insurance plans that would be sold in federal exchanges that the administration is setting up in 34 of the 50 U.S. states. The remaining 16 states, including Oregon and California, are setting up their own marketplaces.

“It makes me wonder if open enrollment can start on Oct. 1,” said a former administration official who worked to implement President Obama’s health care reform.

“But having everything ready on Oct. 1 is not a critical issue. What matters to people is Jan. 1, which is when the coverage is supposed to start. If that were delayed, it would be a substantive setback.”

Obama’s Patient Protection and Affordable Care Act is expected to extend federally subsidized health coverage to an estimated 7 million uninsured Americans in 2014 through the marketplaces.

But insurance plans must be qualified to meet specific standards if they are to be sold on the exchanges. And each insurer must sign a contract with the federal government.

The new timetable for qualified plan agreements is the latest in a series of delays for Obamacare.

The most significant came in early July when the White House and the Treasury Department announced a one-year delay in a major Obamacare provision that would have required employers with at least 50 full-time workers to provide health insurance or pay a penalty beginning in 2014.

Legal and political opposition from Republicans and their conservative allies have already fragmented Obamacare’s original vision.Only about half the states have opted to expand Medicaid program for the poor to uninsured families living below the poverty level, and Republicans in Congress have denied nearly $1 billion in new implementation funding this year alone.

The Government Accountability Office cautioned in June that the law known as Obamacare could miss the Oct. 1 enrollment deadline because of missed deadlines and delays in several areas including the certification of health plans for sale on the exchanges.

Another U.S. watchdog, the HHS Office of the Inspector General, warned earlier this month that the government was months behind testing data security for the federal data hub that represents the information technology backbone of the new marketplaces.

The state of Oregon has already scaled back the Oct. 1 debut of its own health care exchange by preventing state residents from signing up for coverage on their own until mid-October. California said last week that it, too, would consider a soft launch of its exchange if tests show it is not ready to accommodate wide public access.

IRS issues final rules on Obamacare’s ‘individual mandate’

I found this article on Reuters Mobile (us.mobile.reuters.com) and thought you might find it interesting:

IRS issues final rules on Obamacare’s ‘individual mandate’

By Kim Dixon and Patrick Temple-West

WASHINGTON | Tue Aug 27, 2013 5:05pm EDT

Photo

By Kim Dixon and Patrick Temple-West

WASHINGTON (Reuters) – The Internal Revenue Service issued final rules on Tuesday for the individual mandate of President Barack Obama’s healthcare overhaul, one of the most contentious elements of the U.S. law set to go into effect next year.

A centerpiece of Affordable Care Act, also known as Obamacare, is a requirement that all individuals carry some minimum health insurance or pay a tax. The new system aims to provide insurance through state marketplaces and subsidies for tens of millions of Americans who lack it.

If individuals choose not to carry insurance, they are subject to a penalty, starting at $95 per person per year or 1 percent of income in 2014, whichever is greater, and eventually reaching $695 per person or 2.5 percent of income by 2016.

The IRS, which is administering parts of the law involving revenue collection, released the final rules spelling out the details of what constitutes minimum essential coverage, and how individuals are responsible for spouses, children and other dependents, among other topics.

The individual mandate is distinct from the employer mandate, which imposes a fee on most large employers that do not offer a minimum level of coverage. The Administration delayed that provision, putting off the effective date until 2015.

Backers of the law say that, unlike the employer mandate, the individual mandate is essential to ensure enough individuals are enrolled in the system to allow the online marketplaces to function.

The rules announced on Tuesday offered good news to employees getting health coverage through a union-sponsored plan. They clarify that these employees will not be penalized, said tax lawyers who reviewed the rules on Tuesday.

The IRS rules also said employees getting healthcare coverage from a temporary staffing agency are safe from penalties.

The 2010 healthcare law, backed by President Barack Obama, a Democrat, passed without any backing from the Republican Party, which is still is trying to derail the legislation, with little success.

“I believe the individual mandate will go into effect,” said Tim Jost, a professor at Washington and Lee University law school, who backs the law.

“It is important for people to remember that it is phased in and the first year it has very little bite. Basically the idea is to make people realize that it is there.”

That is very different from the employer mandate where the fees will be in full force immediately upon the effective date, he added.

(Reporting by Kim Dixon and Patrick Temple-West.; Editing by Howard Goller and Andre Grenon)

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How to Charge $546 for six Liters of salt water

How to Charge $546 for Six Liters of Saltwater
By NINA BERNSTEIN
Of The New York Times printed August 25 2013

Proponents of this system say it saves hospitals billions in economies of scale. Critics say the middlemen not only take their cut, but they have a strong interest in keeping most prices high and competition minimal.

The top three group-purchasing organizations now handle contracts for more than half of all institutional medical supplies sold in the United States, including the IVs used in the food-poisoning case, which were bought and taken by truck to regional warehouses by big distributors.

These contracts proved to be another black box. Debbie Mitchell, a spokeswoman for Cardinal Health, one of the three largest distributors, said she could not discuss costs or prices under “disclosure rules relative to our investor relations.”

Distributors match different confidential prices for the same product with each hospital’s contract, she said, and sell information on the buyers back to manufacturers.

A huge Cardinal distribution center is in Montgomery, N.Y. — only 30 miles, as it happens, from the landscaped grounds of the Buddhist monastery in Carmel, N.Y., where many of the food-poisoning victims fell ill on Mother’s Day 2012.

Among them were families on 10 tour buses that had left Chinatown in Manhattan that morning to watch dragon dances at the monastery. After eating lunch from food stalls there, some traveled on to the designer outlet stores at Woodbury Commons, about 30 miles away, before falling sick.

The symptoms were vicious. “Within two hours of eating that rice that I had bought, I was lying on the ground barely conscious,” said Dr. Elizabeth Frost, 73, an anesthesiologist from Purchase in Westchester County who was visiting the monastery gardens with two friends. “I can’t believe no one died.”

About 100 people were taken to hospitals in the region by ambulance; five were admitted and the rest released the same day. The New York State Department of Health later found the cause was a common bacterium, Staphylococcus aureus, from improperly cooked or stored food sold in the stalls. Mysterious Charges

The sick entered a health care ecosystem under strain, swept by consolidation and past efforts at cost containment.

For more than a decade, hospitals in the Hudson Valley, like those across the country, have scrambled for mergers and alliances to offset economic pressures from all sides. The five hospitals where most of the victims were treated are all part of merged entities jockeying for bargaining power and market share — or worrying that other players will leave them struggling to survive.

The Affordable Care Act encourages these developments as it drives toward a reimbursement system that strives to keep people out of hospitals through more coordinated, cost-efficient care paid on the basis of results, not services. But the billing mysteries in the food poisoning case show how easily cost-cutting can turn into cost-shifting.

A Chinese-American toddler from Brooklyn and her 56-year-old grandmother, treated and released within hours from the emergency room at St. Luke’s Cornwall Hospital, ran up charges of more than $4,000 and were billed for $1,400 — the hospital’s rate for the uninsured, even though the family is covered by a health maintenance organization under Medicaid, the federal-state program for poor people.

The charges included “IV therapy,” billed at $787 for the adult and $393 for the child, which suggests that the difference in the amount of saline infused, typically less than a liter, could alone account for several hundred dollars.

Tricia O’Malley, a spokeswoman for the hospital, would not disclose the price it pays per IV bag or break down the therapy charge, which she called the hospital’s “private pay rate,” or the sticker price charged to people without insurance. She said she could not explain why patients covered by Medicaid were billed at all.

Eventually the head of the family, an electrician’s helper who speaks little English, complained to HealthFirst, the Medicaid H.M.O. It paid $119 to settle the grandmother’s $2,168 bill, without specifying how much of the payment was for the IV. It paid $66.50 to the doctor, who had billed $606.

At White Plains Hospital, a patient with private insurance from Aetna was charged $91 for one unit of Hospira IV that cost the hospital 86 cents, according to a hospital spokeswoman, Eliza O’Neill.

Ms. O’Neill defended the markup as “consistent with industry standards.” She said it reflected “not only the cost of the solution but a variety of related services and processes,” like procurement, biomedical handling and storage, apparently not included in a charge of $127 for administering the IV and $893 for emergency-room services.

The patient, a financial services professional in her 50s, ended up paying $100 for her visit. “Honestly, I don’t understand the system at all,” said the woman, who shared the information on the condition that she not be named.

Dr. Frost, the anesthesiologist, spent three days in the same hospital and owed only $8, thanks to insurance coverage by United HealthCare. Still, she was baffled by the charges: $6,844, including $546 for six liters of saline that cost the hospital $5.16.

“It’s just absolutely absurd.” she said. “That’s saltwater.”

Last fall, I appealed to the New York State Department of Health for help in mapping the charges for rehydrating patients in the food poisoning episode. Deploying software normally used to detect Medicaid fraud, a team compiled a chart of what Medicaid and Medicare were billed in six of the cases.

But the department has yet to release the chart. It is under indefinite review, Bill Schwarz, a department spokesman, said, “to ensure confidential information is not compromised.”

Cases Reported in Stomach Bug Outbreak Top 600 – US News and World Report

http://health.usnews.com/health-news/news/articles/2013/08/22/cases-reported-in-stomach-bug-outbreak-top-600

Cases Reported in Stomach Bug Outbreak Top 600

By Dennis Thompson
HealthDay Reporter

THURSDAY, Aug. 22 (HealthDay News) — U.S. health officials are continuing to search for the source of a nationwide stomach bug outbreak as the number of cases has topped 600, with 601 illnesses reported in 22 states.

According to statistics released Wednesday from the U.S. Centers for Disease Control and Prevention, at least 40 people, or 9 percent, have been hospitalized with severe cases of cyclospora infection. No deaths have been reported.

The source of the outbreak in at least two states was traced earlier this month to Taylor Farms, which supplied salad mix to Olive Garden and Red Lobster restaurants and is the Mexican branch of Taylor Farms of Salinas, Calif.

Taylor Farms de Mexico has “officially informed FDA that, as of Aug. 9, 2013, the company voluntarily suspended production and shipment of any salad mix, leafy green, or salad mix components from its operations in Mexico to the United States,” according to the U.S. Food and Drug Administration.

“To date, only the salad mix has been implicated in the outbreak of cyclosporiasis in Iowa and Nebraska,” the FDA said. The agency added it is still trying to determine whether the prepackaged salad mix was the source of infections in the other states.

States that now have recorded cases of cyclospora infection include Texas (250), Iowa (155), Nebraska (86), Florida (31), Wisconsin (16), Illinois (11), Arkansas (10), New York City (7), Georgia (5), Missouri (5), Kansas (4), Louisiana (3), New Jersey (3), Connecticut (2), Minnesota (2), New York (2), Ohio (2), Virginia (2), California (1), New Hampshire (1), South Dakota (1), Tennessee (1) and Wyoming (1).

Meanwhile, U.S. health officials said the overall investigation continues.

Prior outbreaks of cyclospora infection have typically been caused by tainted produce, the CDC noted.

One expert said recently that while cyclospora can make people very ill, it is not usually life-threatening.

“On the infectious disease scale, this ranks well below the more notorious and dangerous ailments like E. coli and salmonella,” said Dr. Lewis Marshall Jr., chairman of the outpatient services at Brookdale University Hospital and Medical Center in New York City.

“It is unlikely to be fatal, but certainly can make one’s life miserable,” he added. “Symptoms include crampy abdominal pain, watery diarrhea, loss of appetite, bloating, nausea, fatigue, fever, headache and body aches.”

Cases of cyclosporiasis are caused by a single-celled parasite and cannot be spread from person to person. The parasite has to be ingested via contaminated water or foods such as fruit and vegetables, according to Dr. Monica Parise, chief of the parasitic diseases branch at the CDC.

“It can be pretty miserable, because it can give diarrhea that can last for days,” Parise said.

It takes about a week for people who are infected to become sick.

Marshall said there may be more cases of cyclospora infection out there than people realize. It is possible “that most occurrences go unreported, as many people wouldn’t recognize the symptoms as any different than a common stomach bug,” he said.

Dr. Thomas Frieden, CDC director, has urged people who have suffered from diarrhea for longer than a couple of days to be tested for cyclospora.

Marshall agreed.

“If not treated, symptoms can last from a few days to a month or longer, go away and then return later,” Marshall said. “Cyclospora can be treated with an antibiotic combination of trimethoprim-sulfamethoxazole [Bactrim].”

The best option, however, is to avoid the bug altogether.

“The safest way to protect oneself and one’s family is to always rinse fresh produce under water, and even put vegetables in a cold water bath ahead of time to properly clean them,” Marshall advised.

One expert stressed that the wash-your-produce rule includes prepackaged salads.

“Wash all your fruits and salads before ingesting,” said Dr. Salvatore Pardo, vice chairman of the emergency department at Long Island Jewish Medical Center in New Hyde Park, N.Y. “My hunch is the public does not do this to ‘prepackaged’ salad, which is normally purchased for convenience and dumped into the bowl since it tends to be free from particles — dirt, sand, critters — one would normally find in locally picked ingredients.”

More information

For more information on cyclospora, visit the U.S. Centers for Disease Control and Prevention.

Copyright © 2012 HealthDay. All rights reserved.

Randy KelleyeMail: Kelleytx
Cell (910) 352-6444

Meet the Government’s Health Insurance Salesmen

The Wall Street Journal

U.S. EDITION

Thursday, August 22, 2013 As of 2:49 PM EDT

  • August 22, 2013, 2:49 p.m. ET

Meet the Government’s Health Insurance Salesmen

By Jen Wieczner

The government announced last week that it’s spending $67 million on staff known as “navigators” to help people enroll in health insurance for next year. But at the same time, it has handed off the enrollment baton to insurance sales agents and brokers, whom insurance companies pay for signing people up for their plans.

The Centers for Medicare and Medicaid Services reached agreements with at least five online health insurance brokers, making it possible for people to get their health plans there instead of on the government exchanges–similar to the way consumers can shop for airfare on Expedia or Orbitz rather than buying tickets directly from the airlines.

Among the brokers, which primarily sell individual health plans, are eHealth(EHTH), Towers Watson (TW), HealthCompare, Getinsured, ConnectedHealth and GoHealth. And there may be others. CMS says it can’t yet confirm how many brokers have received authorization to enroll eligible consumers in tax-subsidized health plans in the 36 states where the government will operate health insurance exchanges starting Oct. 1.

“The government is essentially deputizing us to help them enroll more people, which is really important,” says Bryce Williams, managing director of Towers Watson’s exchange solutions and founder of ExtendHealth. “It’s really not the government’s bailiwick.”

There are a few reasons the government will need help–mainly that their support staff, the navigators, might not provide the same level of customer support as the private brokerages, some insurance professionals say. While the Department of Health and Human Services expanded the reach of the navigators–federal funding increased $13 million from the $54 million originally planned–it also tied their hands from performing the key role that brokers have always played in insurance enrollment: navigators are not allowed to advise consumers on which plan to choose.

In prohibiting navigators from making recommendations or directing consumers to health plans, the government intended to rid the new health exchange marketplace of the biased influence of the insurance industry–namely, agents and brokers who earn commissions for enrolling people in certain plans. The navigators are not allowed to have any ties to health insurers or carriers, and have to undergo about 30 hours of online training, which teaches them to remain neutral and avoid bias, says Tracey Keiser, president and CEO of The Keiser Group, a health care benefits strategy and consulting firm. But the rule reduces navigators to little more than hand holders, some argue. “They’re there to help the people enroll and that’s it — they’re not really there to give them advice,” says Keiser. “The only assistance they can provide is how to choose the coverage, not which coverage to choose.”

And that might not be enough for the 25 million to 30 million additional consumers expected to enroll in health insurance under the Affordable Care Act. Consumers will be hungrier for personalized advice and recommendations than ever, Keiser predicts: “Without a doubt, the average person is going to say, What should I do? And they’re going to expect someone to give them answers.”

After all, in order to find an appropriate plan, consumers will have to not only consider the upfront cost of the insurance policy, but also their specific health conditions and how the plan will cover their needs. “Matching them to the right plan is big,” Williams says. “It’s going to be more akin to having to do your taxes, and less like buying a scarf on Amazon.”

Of course, unlike the government, brokers earn commissions for enrolling people in certain insurance plans, which a fact that surely informs their advice, consumer advocates say. They might try to influence the consumer by presenting plans that don’t pay them commissions after the ones that do, or not at all if they aren’t required by law, says Caroline Pearson, vice president of Avalere, a health care research and consulting firm. “It is not a level playing field in that sense,” she says.

Consumers should be wary of sales pitches for additional products they don’t necessarily need to comply with the ACA mandate, says Laura Adams, senior insurance analyst for InsuranceQuotes.com, part of Bankrate.

That said, the commissions, which amount to about 4% to 7% of monthly premiums, are always built into the price of health plans, so people will pay the same amount no matter where they enroll, Williams says. If consumers don’t use a broker, the insurance carrier just keeps the commission.

CMS, for its part, has acknowledged that brokers and agents will play a part in the new insurance exchanges. “We anticipate that many consumers will want to obtain professional advice from agents and brokers when applying for and selecting a qualified health plan,” it writes on its website about the consumer assistance available in the marketplaces.