The latest release from the HHS states that,

ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program will reward ACOs that lower health care costs while meeting performance standards on quality of care and putting patients first.  Patient and provider participation in an ACO is purely voluntary.

You or someone you know, may have a serious illness and have more than one doctor and taking more than one medication. If so, you have more than likely witnessed how disorganized your doctor’s office is when it comes to your medical information. No one likes to have to repeat the same information at each visit or watching doctors fumble through unsystematic files. It shows just how much our health care system needs to form accurate coordination of information and better communication between health care providers.

Medicare beneficiaries who have five or more chronic conditions suffer the most – and more than have of the Medicare beneficiaries fall into this category. With such serious conditions as diabetes, heart disease and kidney disease, these beneficiaries are very likely to have multiple physicians. These patients are at risk when doctors have failed to coordinate information in their files – so each physician is not sure what the last doctor did or they may not know which medication or dosage was prescribed. This can inevitably lead to the patient not getting the right care they need and there is an increased risk of being prescribed a medication that should not be taken with a medication prescribed by another doctor. It can also lead to complications that require hospitalization – which could have  easily been prevented. A study was conducted on nearly 12 million Medicare beneficiaries which showed that 1 in 5 patients discharged from the hospital was readmitted within 30 days which means if hospitals and doctors were better organized and coordinated with files and communication ”across care settings” , readmission may have been avoided.

Under the proposal of rules, the ACO teams of doctors, hospitals and other health care providers working together would coordinate and improve care for patients with Original Medicare. The proposal lists the following high quality standards in five key areas that ACOs would have to meet: 

• Patient/Caregiver Experience of Care
• Care Coordination
• Patient Safety
• Preventive Health
• At Risk Population/Frail Elderly Health 

Accountable Care Organizations are designed to help patients feel important and make their visit to the doctor a more enjoyable one. Their health care providers will know what conditions their patients have and documented health history will be updated and coordinated among all health care providers. ACOs will also help to improve relationships between health care providers and facilities which will help in making accurate health care decisions for patients. This will lead to less medical mistakes occurring such as the patient not being at high risk of a wrong diagnosis or being given a prescription in error.

An ACO will be rewarded for providing improved health care and for putting the patient’s health and wellbeing  first and foremost. By working on the coordination of information and the communication among physicians, hospitals and other health care providers, we will be on the right path to helping to lower costs and more importantly, improving the health care that Medicare beneficiaries receive.

To read more on Accountable Care Organizations and improving care for Medicare beneficiaries, check out the fact sheet.

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While missing the window doesn’t mean children can’t be covered at a later date—they can enroll during their birthday month—but their premiums will be higher.

Authored by Assemblyman Mike Feuer, AB 2244 passed in response to the decision by California insurers late last year to stop selling individual policies to children under 19 years of age and was written as a defensive measure against insurance industry attempts to circumvent provisions in the federal health reform law.

Also keep in mind that the opportunity for parents to obtain individual coverage without regard to a child’s health status is here. Pre-existing condition clauses are no longer allowed. Low-income families may have good choices through Medi-Cal or the Healthy Families program. Information is available at 1-877-KIDS NOW.

While the new legislation doesn’t directly affect employer-based group plans, it is a good idea for employed parents to ask if their children under 19 can enroll and at what cost.

The California Department of Insurance has created a web page that explains how to take advantage of this time-limited opportunity. The message is: Act now to save money before the window closes on March 1 and premiums are raised.

Insurance Insider guest blog from Doug Hessel, CalCPA Protectplus Program Director, Ancillary Products at Hover Insurance Services – dhessel@hoverinsurance.com, (800) 805-9480, ext. 4

Disclaimer: Internal Revenue Service Circular 230 Disclosure

Please note that any discussion of or advice regarding United States or State of California tax matters contained herein (including any attachments hereto) does not meet the requirements necessary to be a “covered opinion” as defined in Internal Revenue Service Circular 230, and therefore, is not intended or written to be relied upon or used and cannot be relied upon or used for the purpose of avoiding federal or state tax penalties that may be imposed or for the purpose of promoting, marketing, or recommending any tax-related matters or advice to another party.

The law is designed to encourage individuals to get exams, screenings, and tests that detect health problems in their early stages. And while the law can’t get people to go get the recommended check-ups and tests, it is meant to remove their hesitations over cost by disallowing deductibles, co-payments, or co-insurance for the specified services.

At the time of passage, the legislation left blank the list of services and governing rules. Since then, the departments of Health and Human Services (HHS), Labor and the Treasury have issued regulations and a detailed description of covered services that must now be part of every plan begun after September 23, 2010. Already existing plans, where benefits and costs remain substantially unchanged from previous years, may be grandfathered and exempt.

Under the new rules, a list of routine recommended immunizations for both adults and children was adopted from the Centers for Disease Control and Prevention. The immunization list includes hepatitis A; hepatitis B; herpes zoster; human papillomavirus; influenza; measles, mumps and rubella; meningococcal; pneumococcal; diptheria, pertussis, and tetanus; and varicella.

Health care reform guidelines also include preventive care screenings for depression, alcohol misuse, high blood pressure, colorectal cancer, Type 2 diabetes, HIV, cholesterol, obesity, and syphilis. Adult men who smoke or have smoked can also receive a one-time screening for abdominal aortic aneurysms.

Women are eligible for free screenings for osteoporosis; breast cancer through mammograms; anemia; cervical cancer; hepatitis B; chlamydia and gonorrhea. Women who are pregnant can also receive screenings for Rh incompatibility and urinary tract infections.

In addition to the screenings and tests listed here, still others appear in the HHS guidelines. A complete list that was generated by the U.S. Preventive Services Task Force is available online by clicking here.

When clarifying its rules, the HHS declared that when these services are accessed through out-of-network providers, insurers may apply their usual out-of-network charges. In a related ruling, the agency determined that if a medical appointment is made for care not included in the covered list but covered care is given during the appointment, the co-payment or co-insurance may still be charged for the appointment. However, the insurer can not add an extra charge for the preventive care given during that appointment.

Finally, ProtectPlus subscribers should take note that all the preventive services newly mandated by health care reform were already covered by their plans. Though subject to some cost sharing in the past, these services are now 100% plan paid when obtained through in-network providers.

The “Health Topics” study consisted of 3,000 adults being interviewed between August 9 and September 13, 2010. Following are eight topics that the study used that give us a good idea as to specific health-related searches people are performing online:

– 29% look online for information about food safety or recalls.
– 24% look online for information about drug safety or recalls.
– 19% look online for information about pregnancy and childbirth.
– 17% look online for information about memory loss, dementia, or Alzheimer’s.
– 16% look online for information about medical test results.
– 14% look online for information about how to manage chronic pain.
– 12% look online for information about long-term care for an elderly or disabled person.
– 7% look online for information about end-of-life decisions.

The report also showed that Internet users are searching health symptoms and treatments. Below are six topics the report found Internet users to be searching:

– 66% look online for information about a specific disease or medical problem.
– 56% look online for information about a certain medical treatment or procedure.
– 44% look online for information about doctors or other health professionals.
– 36% look online for information about hospitals or other medical facilities.
– 33% look online for information related to health insurance, including private insurance, Medicare, or Medicaid.
– 22% look online for information about environmental health hazards.

After reading over this report, it is vital that we at CalCPA ProtectPlus, continue to provide our policyholders and other visitors to our website with the information they are looking for – whether that be information regarding a ProtectPlus plan they are enrolled in, the latest information about healthcare reform or a recipe for diabetics. We continue to make it our goal to be a trusted source that people can look to for answers.

Click here to read the full report which includes details such as the data collected in past years on this same topic, demographic groups and use of mobile devices to search health information.

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COBRA Premium Subsidy Helped Fewer Than Expected

The federal subsidy to help laid-off American workers pay for continued health care through the COBRA program helped fewer individuals than expected–in part because COBRA premiums remained unaffordable for many families even with the subsidy, according to a new article by the non-partisan Employee Benefit Research Institute (EBRI).

As part of congressional efforts to blunt the impact of the recent economic recession, the American Recovery and Reinvestment Act of 2009 (ARRA) included a provision for the federal government to pay 65 percent of the premium for individuals who were covered under COBRA and who incurred an involuntary job loss between Sept. 1, 2008, and Dec. 31, 2009.

The subsidy was made available for up to nine months, and was extended by Congress three times, with the last extension occurring in April 2010. This article examines trends in coverage through a former employer to analyze the impact of the COBRA subsidy.

In assessing how the program performed, EBRI notes that there are widely conflicting estimates of how many people benefited from the COBRA subsidy, but generally there has been lower-than-expected take-up of the subsidy. EBRI used the latest data from the U.S. Census Bureau’s Survey of Income and Program Participation (SIPP), a nationally representative survey, as the best available benchmark.

“The COBRA subsidies that became available in April 2009 do appear to have had an impact on the percentage of non-workers with coverage through a former employer,” said Paul Fronstin, director of EBRI’s Health Research and Education Program, and author of the article. “But they appear to have assisted far fewer than the originally estimated 7 million individuals.”

Fronstin said these findings have implications for the impact of the subsidies that will become available in 2014 under provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA), and may mean the number of uninsured may not fall as much as predicted.

The full article is published in the October issue of EBRI Notes, available online at www.ebri.org.

Among the article’s findings:

Costs of COBRA Coverage: The lower-than-expected take-up may be due to the fact that, even after the subsidy, COBRA premiums may not be affordable for many families, especially at a time when they have seen a decline in income. Health insurance premiums averaged $4,824 a year for employee-only coverage and $13,375 for family coverage in 2009. After the subsidy, premiums would be $1,688 for employee-only coverage and $4,681 for family coverage. Furthermore, whereas premiums for current workers’ employment-based coverage are either excluded from taxable income or reduce taxable income, COBRA premiums are generally not tax deductible.

Conflicting Estimates: There is conflicting evidence as to the effect of the subsidies on take-up of COBRA coverage. Hewitt reported in August and December 2009 that COBRA enrollments had doubled, from 19 percent of eligible individuals to nearly 40 percent. In contrast, Ceridian found that COBRA enrollment increased from 12.4 percent to 17.7 percent. And Aon reported that COBRA enrollment increased from 14.1 percent to 15.9 percent, while Deseret Mutual saw enrollment increase from 5.3 percent to 22.5 percent. The Treasury Department reported in May 2010 that between 25 percent and 33 percent of eligible unemployed workers received subsidized COBRA coverage (these estimates are based on a survey conducted in New Jersey).

While these estimates vary as to the impact of the COBRA subsidy, in June 2010, the Treasury Department released its interim report on the program, as required by law. The report concludes that as many as 2 million households benefitted from the COBRA subsidy during 2009 at a cost of over $2 billion.

But the EBRI article notes that it is highly unlikely that 2 million households benefited from the subsidy, since the report is based on employer reporting and may include double counting; if $2 billion was used to subsidize 2 million households it would imply that each household received an average $1,000 subsidy, which is much lower than the expected annual subsidy; and some of the individuals who benefited from the premium may have already elected COBRA at the time that ARRA was passed.

EBRI is a nonpartisan research institute based in Washington, DC, that focuses on health, savings, retirement, and economic security issues. EBRI does not lobby and does not take policy positions. www.ebri.org

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Consider COBRA (but act fast)
If you lose job-based coverage, you only have a short window to make decisions that affect your health insurance options. The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) and state law (Cal-COBRA) give workers and their families the right to continue group health benefits for at least 18 months, but only if they enroll within 60 days of losing their health coverage.

The Federal Government May Partially Offset the Cost
Usually, you’d have to pay your premium share, your former employer’s share, and an administrative charge to keep coverage under COBRA or Cal-COBRA. But if you lost job-based coverage after September 2008, the federal government will pay 65 percent of the cost of COBRA continuation coverage through December 2009.
Get Connected

Local Community Health Centers and Clinics Can Help
If you can’t afford or qualify for coverage, care is available through community health centers and other safety-net providers, which are located in most California communities.
Get Connected to locate a clinic near you.

County-sponsored Programs for Adults
Uninsured single adults who are not eligible for Medi-Cal may qualify for the County Medical Services Program (CMSP) providing health coverage for low-income, indigent adults in 34, primarily rural counties in California.
Get Connected

Hospitals Must Treat Your Emergency
Federal law requires that all hospitals treat and stabilize any patient experiencing a medical emergency, regardless of a patient’s ability to pay.

Coverage for Kids
Parents should consider coverage for their children through public insurance programs such as Medi-Cal and California Children’s Services (CCS).
Get Connected and find out what programs are available.

For Moms and Children
Access for Infants & Mothers (AIM) and Women-Infant-Children (WIC) offer special health care services to women and infants in need.
Get Connected AIM or 800.433.2611

Employer Eligibility
ProtectPlus is available to accounting firms and firms offering general financial services. Solo practitioners (a CPA practicing on his/her own with no other employees) are eligible to apply.

To be eligible and retain such eligibility, more than 50% of all the Employer’s owners (i.e., principals, proprietors, partners, shareholders or other owners) must be CPAs or Associate members of CalCPA in good standing.

If you are a CPA and not a member of CalCPA, see how you can join CalCPA here.

All employers deemed to be part of an affiliated group under Internal Revenue Code Sections 414 (b), (c), or (m) are considered to be a single employer.

Employee Eligibility
Active, regular full-time solo practitioners working at least 20 hours per week are eligible for coverage.

Dependent Eligibility
Eligible dependents include a lawful spouse, domestic partner, and unmarried children, up to age 19, or through age 24 if the child is an unmarried, full-time student carrying nine or more credit hours per semester. Disabled children of eligible employees who, with appropriate medical certification, are eligible for coverage at any age. Children of domestic partners are eligible. Non-student dependent children, ages 19 through 24, are eligible but must be covered at employee rates.

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Comprehensive healthcare, with simple administration.  We know that your time is limited and you have enough to do just keeping your firm running smoothly. The last thing you need standing between you and billable hours is more work shopping for healthcare options and then investing even more time administering a plan. But, there’s an easier way to provide your firm with quality healthcare at affordable rates.

ProtectPlus, makes it simple for small firms to provide comprehensive healthcare to their employees with easy one-stop shopping for plans that include medical, dental, vision, disability and life insurance. And, we make it even easier by providing back office assistance–so administration of your benefits is a breeze.

With ProtectPlus, your CalCPA firm can get exclusive programs and coverage ordinarily available only to larger firms. Our group plans include the best doctors, hospitals and administrators available at competitive rates. Additionally, our staff is responsive and delivers personalized service you won’t get anywhere else.

Since we offer programs only to CalCPA member firms, we understand the unique needs of your business. Our plans are specifically designed just for CPAs, so you’ll find the perfect program for your business.

And if you thought you needed more staff to administer a healthcare plan, think again. So you can stay focused on your core business, ProtectPlus provides back office services that include:

• CalCobra administration and billing
• Employee eligibility assistance
• Help with completing forms
• Billing and collection of premiums
• Answering employee’s questions about plan benefits
• Facilitating claims resolution

Get comprehensive coverage for your firm from the people that know your needs and understand your business. Click here to receive an instant, no-obligation quote now.