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.”

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You can now open your Obamacare Account online

You can now setup your obamacare account on the exchange
Ihealthcare Updates
| Written by IHU staff writter
Filed under Healthcare Reform,In the News

You can now open your Obamacare Account online

The Health Insurance Market place does not open up officially until two months from today. However in addition to a draft of the paper application you can now take a sneak peak at the online system, and open your own personal obamacare account on the health insurance marketplace.

Health and Human Services Secretary Kathleen Sebelius announced today consumers could now go establish personal accounts by going online and creating a username and password. Selection of plans will not be available until September when additional details on insurance plans and premiums offered in local areas will become available through the online marketplace.

The new personal account feature unveiled today will only be available in English for the time being. HHS said personal accounts will be coming soon to the Spanish-language marketplace, at cuidadodesalud.gov.

This Monday’s announcement by Sebelius made clear the Market place is on track “We are on target and ready to flip the switch on Oct. 1.”

Here are the steps to create Health Insurance Marketplace/Obamacare account

Provide some basic information like your name, address, and email address
Choose a user name and password
Create security questions for added protection
While you are able to create an account, you will not be able to start shopping through the Marketplace for insurance until October 1. But by creating an account now you’ll be one step closer to applying for coverage in the Health Insurance Marketplace, comparing plans side-by-side, and enrolling in a plan.

Remember that you can apply for coverage and enroll as soon as October 1, 2013.

If you have any questions you can call 1-800-318-2596, 24 hours a day, 7 days a week. TTY users should call 1-855-889-4325.

Top 10 Best Foreign Countries for Retirement: 2013

Top 10 Best Foreign Countries for Retirement: 2013 By Dan Berman, ThinkAdvisor | July 9, 2013 Many groups and publications offer help in finding the best place to spend those retirement years. Obviously, everyone has an idea of what makes for paradise, but there are criteria that can help with the decision. Two years ago, we looked at the Top 7 Cheap, Easy Foreign Cities to Retire as enumerated by International Living magazine. This year, we are revisiting the idea of foreign locales, this time by country. International Living has rated countries on eight categories: real estate, special benefits, cost of living, ease of integration for foreigners, entertainment and amenities, health care, retirement infrastructure and climate. The magazine looked at cost for a variety of things from Internet connections to food and talked to foreigners who have made the move to measure out more subjective parameters like how easy it is to make friends. Of the 22 countries rated, the Dominican Republic finished at the bottom with an average score of 71. To find out which countries were highly rated, check out the Top 10 Best Foreign Countries for Retirement: 10. MALTA: 80.1 Real Estate: 87 Special Benefits: 72 Cost of Living: 81 Integration: 100 Entertainment & Amenities: 68 Health: 82 Retirement Infrastructure: 77 Climate: 75 Boasting a climate typical of the Mediterranean, the 415,000 residents of the Maltese islands enjoy warm winters and hot, dry summers. Malta became independent in 1974, ending nearly two centuries of British rule. The nation joined the European Union in 2004. The economy is driven by tourism, industry and services. 9. THAILAND: 82.3 Real Estate: 82 Special Benefits: 57 Cost of Living: 97 Integration: 87 Entertainment & Amenities: 96 Health: 81 Retirement Infrastructure: 77 Climate: 81 Equal in size to Spain, Thailand is the only nation in Southeast Asia not to be colonized by the European colonial powers. Its 65 million citizens live by constitutional monarchy. Temperatures range from 66 to 100 degrees, and the year can be divided into two seasons: hot and cool. Exports account for 60% of the country’s GDP. 8. SPAIN: 82.5 Real Estate: 87 Special Benefits: 57 Cost of Living: 80 Integration: 83 Entertainment & Amenities: 96 Health: 80 Retirement Infrastructure: 93 Climate: 83 Spain, home to 50 million citizens, has three distinct climate zones: Mediterranean, semiarid and oceanic. This diversity offers weather to suit everyone. With nearly 5,000 miles of beaches, the country, ruled by parliamentary monarchy, has plenty of places to kick back and relax. 7. COLOMBIA: 83.0 Real Estate: 94 Special Benefits: 75 Cost of Living: 70 Integration: 90 Entertainment & Amenities: 82 Health: 84 Retirement Infrastructure: 83 Climate: 86 One thing Colombia has in common with the U.S. is that it has coasts on both the Pacific and the Atlantic, the only South American nation that can claim that distinction. Situated near the equator, Colombia has five climate zones inluding steppes, tropical rain forests, savannahs and mountain climate. The country lives under republican rule. 6. URUGUAY: 83.7 Real Estate: 87 Special Benefits: 72 Cost of Living: 69 Integration: 83 Entertainment & Amenities: 94 Health: 91 Retirement Infrastructure: 82 Climate: 86 Located on the east coast of South America, Uruguay is the size of Oklahoma. The country has 120 miles of Atlantic coastline, low plateau and a rolling plain. The constitutional republic has 3.3 million residents and variable weather with cool winters and warm to hot summers depending on location. 5. COSTA RICA: 84.4 Real Estate: 89 Special Benefits: 85 Cost of Living: 87 Integration: 90 Entertainment & Amenities: 94 Health: 86 Retirement Infrastructure: 73 Climate: 71 With a population of 4.6 million in an area slightly bigger than the combined area of New Hampshire and Vermont combined, Costa Rica includes a coast on the Pacific Ocean with good surfing and a coast on the Caribbean Sea with a rain forest. The democratic republic has a rainy season that runs from May to November, which consists of sunny morning and rainy afternoons. Trade winds in January and February make for cooler days. 4. MEXICO: 85.1 Real Estate: 92 Special Benefits: 71 Cost of Living: 82 Integration: 100 Entertainment & Amenities: 100 Health: 84 Retirement Infrastructure: 74 Climate: 78 With a population of 112 million, the United States’ large neighbor to the south (it’s one-fifth as big) offers beaches, big-city life and mountains. And, except on the peaks, you won’t have to worry about dealing with snow. 3. MALAYSIA: 87.6 Real Estate: 89 Special Benefits: 77 Cost of Living: 92 Integration: 90 Entertainment & Amenities: 100 Health: 93 Retirement Infrastructure: 85 Climate: 75 Slightly bigger than New Mexico, Malaysia sits on the Malay peninsula and is home to 26 million people. The nation is heavily forested and a mountain range runs its entire length. Ruled by constitutional monarchy, the citizens enjoy year-round temperatures in the mid-80s during the day and upper 60s at night. 2. PANAMA: 89.0 Real Estate: 83 Special Benefits: 100 Cost of Living: 86 Integration: 93 Entertainment & Amenities: 95 Health: 85 Retirement Infrastructure: 81 Climate: 88 About 3.5 million people call Panama home. The country, about the size of South Carolina, is ruled by constitutional democracy and boasts its namesake canal, the passageway between the Carribbean Sea and the Pacific Ocean. The weather varies by region, but the humidity and temperature are often lower than in Florida. Be aware, the Panamanian winter and summer seasons are reversed from their U.S. counterparts. 1. ECUADOR: 91.9 Real Estate: 99 Special Benefits: 99 Cost of Living: 90 Integration: 90 Entertainment & Amenities: 95 Health: 83 Retirement Infrastructure: 79 Climate: 100 On the Pacific coast of northwest South America, Ecuador is home to 15.2 million people in an area about the size of Nevada. The Andes, with tall volcanic peaks, cross the nation in two ranges. The Galapagos Islands have been a part of Ecuador since 1832. Being directly on the equator means the country has 12 hours of daylight every day of the year. However, temperature can range from temperate at the beaches to cold in the mountains. —— Check out these other Top 10 lists on AdvisorOne: Top 7 Cheap, Easy Foreign Cities to Retire Top 10 Countries for Economic Growth Top 10 Countries With Best Retirement Systems 10 Best Cities for Jobs in Financial Services Related Articles Employees Turn Focus to College Planning in Q2: Financial Finesse Top 20 Companies for Annuity Sales: Q2 Are We Headed to Mandatory Retirement Savings Accounts? How Investment Gurus Are Fixing Fixed-Income Portfolios Fiduciary Fate of Millions of Retirement Accounts Soon to Be Decided More from ThinkAdvisor Contact About Video Subscribe Twitter eNewsletters LinkedIn Facebook Advertise Privacy Desktop Site Back to top

Your eBook bargains for Monday

If you enjoying reading and own a IPad or e reader
You just might enjoy this. Free & Discounted ebooks from popular Authors.http://home.bookbub.com/home/
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To Your Health,
Randy Kelley
Owner-Agent
License#6553301

Kelley Insurance
Home Page
www.123insurME.com
Email: Info

Toll Free. (855) 664-2771
Toll Free Fax. (866) 436-7420
Prayer for Decisions
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God, grant me the serenity to accept the things I cannot change,
The courage to change the things I can, And the wisdom to know the difference.
Amen

The information contained in this email message is confidential under federal law, and is intended only for the use of the individual or Entity named above. If the reader or recipient of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this confidential information is prohibited by federal law. If you have received this communication in error, immediately notify Kelley Insurance at the above number, and return all information that accompanies it to Kelley Insurance to the address given above.

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Center of the Universe

By Bill Johnson

In this inspiring collection of anecdotes, a pastor shares the lessons he’s learned on faith and life — from laugh-out-loud hilarity to honest accounts of struggle, a wonderfully engaging read

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In this hilarious and exhilarating memoir, a comedy writer recalls his early years and friendships with stand-up luminaries including Larry David, Jerry Seinfeld, and Richard Lewis as they struggled for success

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Category: Biographies and Memoirs
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By Irene Tomkinson

After surviviving her own dysfunctional childhood, Irene Tomkinson vows she will not repeat the mistakes of her mother when raising her own children. This insightful and honest memoir is difficult to put down

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After a patient’s disturbing violent outburst, Maggie quits her psychiatrist job and becomes a radio host. When a stalker targets her on air, chemistry with her bodyguard Ethan isn’t enough to protect her in this electric thriller from an award-winning author

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Category: Thrillers
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Desert Places

By Blake Crouch

Andrew Thomas finds a letter telling him that there’s a body buried on his property — and he’s about to be framed for it, unless he follows some very specific directions… “A complex, cleverly constructed novel of motive” (The Globe and Mail)

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The Esposito Series Box Set

By J.M. Griffin

Lavinia Esposito, a.k.a. Vinnie, is a college instructor by day and an amateur sleuth by night. Get the first three mysteries in this fun-filled box set as Vinnie battles stalkers, criminals, and her big Italian family

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By T.L. Haddix

Divorced mother Lauren lowers her barriers when she meets the irresistible, handsome Charlie — but will she be able to embrace their future when a bloody crime stirs up her tragic past?

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From an award-winning author comes a “marvelously engaging” (Kirkus Reviews) and “winning” (Publishers Weekly) novel about Cuddy and Justin, a courageous police duo who must uncover the scandalous secrets of their North Carolina town when a black activist is killed

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One Company In Texas

Beginning August 1 2013 Mutual of Omaha will no longer sell Medigap/Medicare Supplement insurance plans in the State of Texas under the Mutual Of Omaha Brand. Instead all Medigap/Medicare Supplement plans will be offered by Mutual Of Omaha affiliate “Omaha Insurance Company”.

Anyone with a Mutual Of Omaha Medigap/Medicare Supplement plan will still be able to keep in and Mutual Of Omaha will continue servicing and paying your claims. Beginning August 1,2013 agents and brokers will no longer be able to offer for sale the Mutual Of Omaha branded plans.

If you have any questions or know of anyone who has a Mutual Of Omaha Medigap/Medicare Supplement policy with questions just call me at 1.855.664.2771 and I’ll be glad to help by answering any questions you may have.

Final birth control rule issued for faith groups

By Kathryn Mayer | June 28, 2013

The Obama administration issued final rules Friday for the birth control mandate under the Patient Protection and Affordable Care Act, an area of the massive health overhaul that generated some of the greatest opposition.

The mandate — effective Aug. 1, 2012 — requires most employers to cover a range of birth-control methods in their health plans without charging a co-pay or a deductible.

Religious groups have strongly opposed the rule, and dozens of lawsuits against the federal government followed. Meanwhile, the administration — as well as women’s rights advocates — continued to praise the contraception mandate, saying it gives women control over their health care.

Health and Human Services Secretary Kathleen Sebelius said Friday the final rules “strike the appropriate balance” between respecting those religious considerations and increasing access to important preventive services for women.

Related story: White House Backs Down on Birth Control

“The health care law guarantees millions of women access to recommended preventive services at no cost,” Sebelius said in a statement.

“Today’s announcement reinforces our commitment to respect the concerns of houses of worship and other nonprofit religious organizations that object to contraceptive coverage, while helping to ensure that women get the care they need, regardless of where they work.”

The final rules finalize the proposed simpler definition of “religious employer” for purposes of the exemption from the contraceptive coverage requirement in response to concerns raised by some religious organizations.

These employers, primarily churches, may exclude contraceptive coverage from their health plans for their employees and their dependents.

Women at nonprofit, religious-based organizations — such as at certain hospitals and universities — will have the ability to receive contraception through separate health policies at no cost.

The approach taken in the final rules is similar but simpler than that taken in the proposed rules, and addresses many stakeholder concerns, HHS said.

Announced early last year, the original mandate required most employers, including religious-affiliated organizations, to cover a range of birth control methods.

That triggered a fast and intense pushback from Catholics and other religious groups that oppose birth control, and called the mandate an attack on their religious freedom.

In February, the administration proposed a work-around for religious nonprofits that object to providing health insurance that covers birth control, attempting to create a barrier between religious groups and contraception coverage, through insurers or a third party.

But groups such as the U.S. Conference of Catholic Bishops continued to oppose the regulations.

Proponents of the mandate argue that the requirement is a “win” for women, and will help reduce unplanned pregnancies and abortions.

“The magic combination of responsible public and private policies and responsible behavior on the part of men and women can make all the difference in helping reduce unplanned pregnancy and improving the education and employment prospects of women and their families,” Sarah Brown, CEO of The National Campaign to Prevent Teen and Unplanned Pregnancy, said last year.

The Catholic Church has yet to respond to the final rules.

See also:

On the Third Hand: Birth control
Birth Control Mandate Hits Groups That Backed PPACA

15 PPACA provisions that will take effect in 2014

15 PPACA provisions that will take effect in 2014

By Alson Martin | June 3, 2013

The effective date of the Patient Protection and Affordable Care Act (PPACA) is March 23, 2010, although various provisions have their own effective dates from January 1, 2010, (the small business income tax credit) through 2018. The start of 2013 saw the launch of a number of key provisions, among them Medicare tax increases, limits on Health FSA deferrals and the requirement that W-2 reporting note employer and employee payments for certain health care items in 2012.

But 2014 is the year when most core pieces of PPACA will be put into effect, notably the mandates that employers with 50+ employees provide health insurance and that individuals obtain minimum essential health coverage for themselves and their dependents, whether or not they have access to coverage through their employer.

Equally momentous, beginning Jan. 1, 2014, states are required to have opened a state-run health insurance exchange, or to have partnered with the federal government to open an exchange. In theory, within these exchanges, insurance companies will compete for business on a transparent, level playing field, which should reduce costs and give individuals and small businesses the purchasing power enjoyed by big businesses. However, health reform does many things to increase costs by covering those who are now uninsurable and by increasing mandated benefits. Many predict these factors will far outweigh any efficiencies created by the exchanges and that health insurance prices will increase. If exchanges succeed, they will create the first viable alternative to the group markets for the younger than age sixty-five population.

In short, there’s a lot to track over these next six months. Read on for 15 provisions that will become effective on Jan. 1, 2014.

1. Health Insurance Nondiscrimination Requirements

Code Section 105(h) currently taxes the benefits received by highly compensated employees (HCEs) under discriminatory self-funded health plans. PPACA has extended these nondiscrimination rules to insured plans. It is unclear whether this change imposes tax penalties or is a substantive requirement. Employers with discriminatory insured arrangements, however, will need to consider changing them. Grandfathered plans are exempt from this rule.

This new requirement was originally intended to be effective for plan years beginning on or after September 23, 2010. The effective date was postponed in 2010 until IRS publishes a notice, which has not yet been issued. The provision may not be effective in 2014 but it likely will be.

2. State Health Insurance Exchanges

Each state must establish a health insurance exchange (or HHS will do so) for use by the uninsured and small employers with 100 or fewer employees (although states may set the cap at 50 employees). The exchanges will offer fully insured insurance contracts that provide essential health benefits at different levels of coverage (bronze, silver, gold, and platinum). Employees of small employers who offer health insurance coverage through an exchange may pay their employee premiums for such coverage on a pre-tax basis through the employer’s cafeteria plan.

3. State Health Insurance Exchange Tax Subsidies

Individuals who do not have affordable minimum essential coverage from their employer will be eligible for tax credit subsidies for their health insurance purchase on a state exchange if their income is below 400 percent of federal poverty level.

4. Employer Mandate (Pay or Play) Tax Penalties

Employers with fifty or more full-time equivalent (FTE) employees will be required to offer their full-time employees (FTEs) minimum essential health coverage or pay a fine of up to $2,000 per year for each FTE in excess of thirty FTEs if any employee receives a premium tax credit on a state health insurance exchange. If an employer provides minimum essential health coverage to its FTEs, but fails to pay at least 60 percent of its actuarial value or the coverage is considered unaffordable (costs more than 9.5 percent of household income), then the employer must pay a penalty of up to $3,000 per year for each FTE who receives the premium credit on an exchange, but not more than would be owed for the $2,000 per year penalty. An FTE is defined as an employee who is employed for thirty or more hours per week, calculated on a forty-hour work week. This provision also applies to grandfathered plans.

5. Individual Mandate Tax Penalty

Individuals are required to obtain minimum essential health coverage for themselves and their dependents or pay a monthly penalty tax for each month without coverage. The monthly penalty tax is one-twelfth of the greater of the dollar penalty or gross income penalty amounts. The dollar penalty is an amount per individual of:

$95 for 2014 (capped at $285 per family),
$325 for 2015 (capped at $975 per family), and
$695 for 2016 (capped at $2085 per family).
These dollar penalties will be indexed for inflation starting in 2017.

The gross income penalty is a percentage of household income in excess of a specified filing threshold of:

1 percent for 2014,
2 percent for 2015, and
2.5 percent for 2016 and later years.
In no event will the maximum penalty amount exceed the national average premium for bronze-level exchange plans for families of the same size.

Minimum essential coverage includes Medicare, Medicaid, CHIP, TRICARE, individual insurance, grandfathered plans, and eligible employer-sponsored plans. Workers compensation and limited-scope dental or vision benefits are not considered minimum essential health coverage.

6. Automatic Enrollment

Employers with more than 200 employees who maintain one or more health plans must automatically enroll new full-time employees in a health plan. The employer must give affected employees notice of this automatic enrollment procedure and an opportunity to opt out. State wage withholding laws are preempted to the extent that they prevent an employer from instituting this automatic enrollment program. The final effective date was [will be?] established by DOL regulations.

7. Pre-Existing Condition Exclusion Practices Eliminated

Pre-existing condition exclusions no longer will be allowed in group health plans or individual insurance policies, not even the limited exclusions previously allowed under HIPAA. This also applies to grandfathered plans.

8. Ninety-Day Maximum Waiting Period

Group health plans and health insurance issuers may not impose waiting periods of more than ninety days before coverage becomes effective. This also applies to grandfathered plans.

9. Cost-Sharing Limits

Group health plans, including grandfathered plans, may not impose cost-sharing amounts (i.e., copays or deductibles) that are more than the maximum allowed for high-deductible health plans (currently these limits are $5,000 for an individual and $10,000 for a family coverage). After 2014, these amounts will be adjusted for health insurance premium inflation.

10. Annual or Lifetime Limits

Group health plans, including grandfathered plans, may no longer include more than restricted annual or any lifetime dollar limits on essential health benefits for participants. Limits may exist in and after 2014 for non-essential benefits.

11. Wellness Program Health Plan Discount

The maximum premium discount an employer can offer under its health plan for participation in a wellness program is 30 percent. This is an increase from the prior 20 percent maximum premium discount. Regulatory agencies can increase this maximum discount to 50 percent in the future.

12. Coverage for Those in Clinical Trials

Insurers and health plans, unless grandfathered, may not discriminate against an individual for participating in a clinical trial. If a plan covers a qualified individual, it may not deny or impose additional conditions for participation in a clinical trial.

13. Employer Minimum Essential Coverage Reporting

All employers providing minimum essential coverage must file information with the IRS and plan participants.

14. Large Employer Health Information Reporting

Large employers and employers with at least fifty full-time equivalent employees must submit annual health insurance coverage returns to the FTEs and the IRS. The returns must certify whether the employer offers healthcare insurance to its employees and, if so, describe the details regarding plan participation, applicable waiting periods, coverage availability, the lowest cost premium option under the plan in each enrollment category, and other information.
15. Medicaid Expansion

The U.S. Supreme Court in effect ruled that the requirement for states to offer Medicaid benefits to all persons with incomes at or below 133 percent of the federal poverty level is optional with each state. States that participate in the expansion will receive full reimbursement of their additional Medicaid costs from the federal government until 2017. At that time, reimbursement will gradually decline to 90 percent of extra costs in 2020 and thereafter.