Amendments to excepted benefits. Final rules.

This document contains final regulations that amend the regulations regarding excepted benefits under the Employee Retirement Income Security Act of 1974, the Internal Revenue Code (the Code), and the Public Health Service Act. Excepted benefits are generally exempt from the health reform requirements that were added to those laws by the Health Insurance Portability and Accountability Act and the Patient Protection and Affordable Care Act. In addition, eligibility for excepted benefits does not preclude an individual from eligibility for a premium tax credit under section 36B of the Code if an individual chooses to enroll in coverage under a Qualified Health Plan through an Affordable Insurance Exchange. These regulations finalize some but not all of the proposed rules with minor modifications; additional guidance on limited wraparound coverage is forthcoming.

Ninety-day waiting period limitation and technical amendments to certain health coverage requirements under the Affordable Care Act. Final rule.

These final regulations implement the 90-day waiting period limitation under section 2708 of the Public Health Service Act, as added by the Patient Protection and Affordable Care Act (Affordable Care Act), as amended, and incorporated into the Employee Retirement Income Security Act of 1974 and the Internal Revenue Code. These regulations also finalize amendments to existing regulations to conform to Affordable Care Act provisions. Specifically, these rules amend regulations implementing existing provisions such as some of the portability provisions added by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) because those provisions of the HIPAA regulations have become superseded or require amendment as a result of the market reform protections added by the Affordable Care Act.

Patient Protection and Affordable Care Act; program integrity: Exchange, SHOP, and eligibility appeals. Final rule.

This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, this final rule outlines Exchange standards with respect to eligibility appeals, agents and brokers, privacy and security, issuer direct enrollment, and the handling of consumer cases. It also sets forth standards with respect to a State's operation of the Exchange and Small Business Health Options Program (SHOP). It generally is finalizing previously proposed policies without change.

OIG demands transparency for physicians and staff in 2010: welcome to the modern era of compliance.

A compliance plan is a physician practice's defense against legal and ethical misconduct. A compliance plan that sits on a shelf provides no protection from government watchdogs. You have to have a practice culture that demonstrates the importance of a commitment to compliance with the law. Your practice must encourage every effort to combat fraud and abuse. Your employees must know that you are committed to doing the right thing. Everyone in the practice must live up to the procedures and policies in your plan on a daily basis. Implementing a compliance program not only makes you aware of the processes in your office but gives you feedback on what you staff members doing and how competent and knowledgeable they are. It is a "win win" situation for all involved.

Designing Wellness programs with HIPAA in mind.

Voluntary wellness programs have been shown to effect positive outcomes and can benefit both individuals and employer group health insurance plans. Such programs often offer individuals a specific reward--cash incentives, rebates, discounts, or modified co-payments--if they participate in the program and meet certain health "targets" or standards (e.g., obtaining a cholesterol count of less than 200).

Clinical Experiences: Navigating the Intricacies of Student Placement Requirements.

Clinical apprenticeships, also called clinical experiences, are integral to most allied health (AH) student professional education. Clinical experiences begin the process of enculturating students into a healthcare profession where higher cognitive mastery of learned skills is supported through social interaction and scaffolding with an AH professional. In AH programs, clinical experiences for students are a necessity for programmatic accreditation; however, clinical sites have developed a range of requirements for students, which lead to a myriad of issues. These requirements may include drug screens, criminal background checks, and HIPAA training prior to a student beginning their clinical experience. Because of differing interpretation of policy, there is variability of requirements imposed on students before beginning these clinical experiences. This variability can create a financial burden on the student, who likely pays out-of-pocket for criminal background checks, vaccines, or drug screens. It also creates an administrative burden for clinical coordinators, who must know what each of the hundreds of clinical sites require, and they must follow up with each site to determine if these requirements have changed. Some strategies exist that may help clinical coordinators to manage clinical site requirements for student placement.

Regulatory and tax issues for worksite wellness programs.

Worksite wellness programs continue to grow and find expression in employer organizations of all types. As these programs mature and are offered to larger and larger numbers of employees in more worksites increased opportunity exists for regulatory problems. Applicable legislation and major federal regulatory issues affecting worksite wellness programs are explored and categorized. Final rules regarding Title I non-discrimination provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) are described and implications for employers are identified. Due to the increasing importance of incentive rewards in programming, the tax implications of various types of program expenditures are also described. Finally, suggestions for legislative amendments and regulatory changes that would enhance wellness program effects are described.

Joint custody: bipartisan interest expands scope of tax-credit proposals.

The Bush administration's proposal to use tax credits to cover the uninsured has not attracted enough bipartisan support to make headway in a divided Congress. Democratic objections have centered on the administration's insistence that the credits be used primarily in the individual market. But bipartisan exploration of alternative credit designs has continued on Capitol Hill. Democratic proposals to include health coverage for laid-off workers in debate over the post-September 11 economic stimulus package and more recently in the Trade Adjustment Assistance Act have resulted in increased awareness that tax credits might be used for employer groups as well as in the nongroup market.

Health insurance reform: standard unique employer indentifier. Final rule.

This final rule establishes a standard for a unique employer identifier and requirements concerning its use by health plans, health care clearinghouses, and health care providers. The health plans, health care clearinghouses, and health care providers must use the identifier, among other uses, in connection with certain electronic transactions. The use of this identifier will improve the Medicare and Medicaid programs, and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the system and enabling the efficient electronic transmission of certain health information. It will implement some of the requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996.

Amendments to Summary Plan Description regulations. Pension and Welfare Benefits Administration, Labor. Final rule.

This document contains a final rule amending the regulations governing the content of the Summary Plan Description (SPD) required to be furnished to employee benefit plan participants and beneficiaries under the Employee Retirement Income Security Act of 1974, as amended (ERISA). These amendments implement information disclosure recommendations of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, as set forth in their November 20, 1997, report, "Consumer Bill of Rights and Responsibilities." Specifically, the amendments clarify benefit, medical provider, and other information required to be disclosed in, or as part of, the SPD of a group health plan and repeal the limited exemption with respect to SPDs of welfare plans providing benefits through qualified health maintenance organizations (HMOs). In addition, this document contains several amendments updating and clarifying provisions relating to the content of SPDs that affect both pension and welfare benefit plans. This document also adopts in final form certain regulations that were effective on an interim basis implementing amendments to ERISA enacted as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This final rule will affect employee pension and welfare benefit plans, including group health plans, as well as administrators, fiduciaries, participants and beneficiaries of such plans.

Reporting by multiple employer welfare arrangements and certain other entities that offer or provide coverage for medical care to the employees of two or more employers. Final rule.

This document contains a final rule governing certain reporting requirements under Title I of the Employee Retirement Income Security Act of 1974 (ERISA) for multiple employer welfare arrangements (MEWAs) and certain other entities that offer or provide coverage for medical care to the employees of two or more employers. The final rule generally requires the administrator of a MEWA, and certain other entities, to file a form with the Secretary of Labor for the purpose of determining whether the requirements of certain recent health care laws are being met.

Final regulations for health coverage portability for group health plans and group health insurance issuers under HIPAA Titles I & IV. Final regulation.

This document contains final regulations governing portability requirements for group health plans and issuers of health insurance coverage offered in connection with a group health plan. The rules contained in this document implement changes made to the Internal Revenue Code, the Employee Retirement Income Security Act, and the Public Health Service Act enacted as part of the Health Insurance Portability and Accountability Act of 1996.

Combining mandatory health insurance and medical savings accounts.

The American tradition of freedom of choice is mirrored exceptionally well in the health care industry. The consequences of this system are the highest health care costs in the world and 38.7 million uninsured. Implementation of mandatory, high-deductible health insurance in conjunction with a medical savings account for every resident could have several benefits, and it may engender bipartisan support.

Roadmap to HIPAA: keeping occupational health nurses on track.

So what does HIPAA require most covered entities to do? At this point, the Privacy Rule compliance date has already passed for all covered entities except small health plans. Most of the requirements under the Privacy Rule dictate the development of appropriate policies and procedures, a notice of privacy practices and other forms, implementation of measures to secure the privacy of PHI, contracting with Business Associates, and training of all involved. For covered entities, testing of the electronic standard transactions to exchange data between participating parties should have begun by April 16, 2003. Although full implementation of the electronic transactions should have taken place by October 16, 2003, the government has allowed covered entities that are still actively working toward compliance to operate under contingency plans. It remains unclear when the use of such plans will be disallowed. After standards are published for claim attachments and first report of injury, these electronic standard transactions will be incorporated by the designated compliance date. Appropriate use of national identifiers will be implemented after final rules and standards are published. For the occupational health nurse who is not a covered entity, the most critical implementation factor is a HIPAA compliant authorization form so the occupational health nurse can continue to obtain necessary PHI. This is essential when attempting to obtain medical information, even for workers' compensation or disability case management. Although these plans are not considered health plans under HIPAA and, therefore, would not require the designation of covered entity, the occupational health nurse frequently needs to obtain PHI to manage these cases. Most providers in the health care community will be covered entities under HIPAA and will not be able to release PHI without a signed HIPAA compliant authorization form. In addition, providers will want a HIPAA compliant authorization form signed when requesting health information from the occupational health nurse. The HIPAA's privacy regulations are considered "the floor" or minimum standard for the protection of PHI. As such, it is likely that these privacy regulations will become the "industry standard" to which all health care professionals will be held. Even though the occupational health nurse may not be a covered entity, implementing appropriate HIPAA procedures is recommended. Knowing that most of HIPAA's privacy rule contains requirements already in place and in practice for most occupational health nurses can take some of the worry out of this complex regulation. Additionally, the nurse interacts with the health care system in a variety of roles. As a health care consumer, occupational health nurses can assert their own patient rights when interacting with covered entities. As the trusted advisor and consultant to many employees, the occupational health nurse can play a vital role in educating employees about HIPAA and assisting employees with navigating an ever-complex health care system. As a health care professional, the occupational health nurse continues to protect and safeguard all PHI while respecting employees' rights and delivering quality care. Staying knowledgeable and up-to-date on the HIPAA regulations as they continue to evolve and change allows occupational health nurses to stay on the right course while mapping their way toward regulatory compliance (see Sidebar for recommended resources).