Once again, I was invited to serve as a panelist on a webinar. The focus this time:  CEO/Executive Perspectives on the State of the Healthcare Industry.  We discussed a variety of topics, including healthcare reform, consumer driven healthcare, and affordability.

For today’s blog I will confine my comments to one of the questions posed during the webinar: “If there is a change to the make-up of the federal government next November, what regulatory changes would you like to see put into effect for 2013 and beyond?” Isn’t that a loaded question?! Right now, the Republicans control the House, while the Senate and the White House are controlled by the Democrats. So, for any kind of radical change, wouldn’t the Republicans have to take control of all three? And with enough seats to make it filibuster safe? Even with a new Congress, it seems more than obvious that it will be well into 2013 before something could occur.

I don’t read crystal balls, nor does anyone at TASC, where we operate on the concept that most provisions of the Patient Protection & Affordable Care Act (PPACA), if not all, will prevail in one form or another. I expect tweaks. Tweaks are not new in our industry; they are inevitable and have been going on as long as I’ve been in this business. I don’t foresee any tweaks that will materially shift the current regulations.

The moderator pushed the issue a little further, and asked “Suppose the make-up of federal government does change significantly after the next election; what would TASC like to see happen?”  That’s an interesting and complicated proposition. In that circumstance, TASC would like to see the following:

• Clarity regarding the upcoming cap on health Flexible Spending Accounts (FSAs). TASC’s position is that the cap goes into effect for Plan Years starting in February of 2013 or after.
• A permanent exemption on the annual limit requirement affecting Health Reimbursement Arrangements (HRAs).
• An ultimate plan for the W-2 requirement. We would like to see companies with fewer than 250 employees exempted from the requirement, along with some consistency in the requirement for those with more than 250 employees.
• Removal of the mandate that restricts over-the-counter medications from inclusion in FSAs and HRAs.  This removal would result in a better value proposition for consumers, and would remove a lot of confusion in the market.
• I admit that it’s not likely to happen anytime soon (or that it will garner much attention whatsoever before 2013).  Nevertheless, it would be advantageous to many if the employee-funded portion of an FSA were stripped from the 2018 Cadillac tax calculation.

During the webinar we were also asked to discuss these questions: What does the future hold for private and public exchanges? What do you see as the most important areas of focus for healthcare technology and service organizations which cater to the consumer driven healthcare market?  What is your outlook on the future for healthcare accounts and healthcare payments? 

If you want to hear our answers, you can listen to the entire one-hour webinar by following this link:

https://fisglobalinfo.webex.com/fisglobalinfo/lsr.php?AT=pb&SP=EC&rID=5178607&rKey=7780d08e92548bc3

As I wrote in my last blog, I recently sat on a panel of healthcare experts to discuss the impact of recent legislation and regulation. The legislative phase of healthcare reform may be over for now, but the implementation phase shows no sign of letting up. Meanwhile, astute employers are constantly evaluating and revaluating what healthcare reform means to them and how they will be impacted. Previously, I looked at the impact of this legislation on employee benefits accounts. In this post I focus on the new documentation and notice requirements created by the Patient Protection & Affordable Care Act of 2010 (PPACA) and other related regulatory actions.

Now mandated by the new regulations is the requirement—imposed on various benefits Plans—that certain notices be distributed to employees directly or disclosed to them in written Summary Plan Descriptions (SPDs).  Compliance is even more challenging and confusing because some notices must be distributed only once, and some must be distributed annually. Because the Public Health Service Act (PHSA) amended the Health Insurance Portability and Accountability Act (HIPAA), failure to comply can be quite costly for an employer/Plan Sponsor. For example, failure to comply with these reforms—much like failure to comply with HIPAA portability rules under ERISA—is punishable with a $100/day penalty per employee (for every employee who is affected by the violation)  until said violation is corrected. In addition, such noncompliance also requires self-reporting, and even after the violation is corrected any failure to self-report may result in additional fines/penalties.

Beginning in 2012, all healthcare plans and insurers must create and distribute a document summarizing benefits to plan enrollees and policyholders. To be separate from the SPD, this document must include the following:

• Definitions of standard medical and insurance terms.
• A summary of the coverage provided, including any cost-sharing provisions.
• A description of any exceptions to or limitations on coverage, and the renewability and continuation of the plan/policy coverage terms.
• Examples of common benefits scenarios to illustrate coverage.
• A statement clarifying whether the plan or policy provides minimum essential coverage.
• Contact information for consumer convenience.
• The Act prescribes specific formatting requirements for this summary document.

Who is responsible for ensuring that documentation and notice requirements are met? Per the regulations, health insurers of fully insured plans are responsible for providing notification. But the requirement doesn’t stop there…  As also spelled out in the regulations:  it is the ultimate responsibility of the Employer Plan Sponsor to ensure Participants receive Notices. Yes, that’s right, ultimate responsibility again falls on the employer.

Of course, this comes down to just one question: Where do employers go for assistance? They can look to their broker or agent. They can seek legal counsel. They can resolve to stay on top of this issue—and to avoid the inevitable pitfalls—all by themselves. The healthcare scene is constantly developing and transitioning, and I certainly wouldn’t advise any of those options. Instead, of course, I’d suggest they put their trust in TASC, an administrator which is already all over this! As always, stay tuned for future updates.

Recently, I was on a panel with other healthcare experts brought together to discuss the impact of recent legislation and regulation, including the Patient Protection & Affordable Care Act of 2010 (PPACA). Moderated by Barbara Zabawa of Whyte, Hirschboeck, Dudek S.C., other panelists included Laura Brown from the Office of the Commissioner of Insurance, Pete Frittitta of R&R Insurance Services, Inc., and Randy Pinnow of Kolb+ Co. The panel discussion was part of a day long workshop on Human Resources (HR) issues.

One part of the discussion focused on the impact this legislation continues to have on benefits accounts. For example, over-the-counter drugs not prescribed by a doctor are already excluded from reimbursement through a Flexible Spending Account (FSA), Health Savings Account (HSA), or Health Reimbursement Arrangement (HRA). This exclusion continues to challenge employees who may no longer purchase these necessities tax free.

Coming soon are limits for medical FSA contributions. Effective January 1, 2013, employees will be able to contribute no more than $2,500 to a medical FSA in a Plan Year. Of course, a husband and wife with access to separate FSAs can each max out their Plan and increase their family’s limit to $5,000.

Coming in 2018, an excise tax will be imposed on high-cost insurance plans. This will affect plans with aggregate expenses that exceed $10,200 for individual coverage and $27,500 for family coverage. There are lingering questions regarding this provision…  Will the portion an employee runs through an FSA count toward that total?  Stay tuned for more.

Of particular concern to HR personnel are the administrative actions that need to be taken to comply with the new rules. Again, for example, TASC quickly updated our Plan Documents to accommodate the federally mandated extension of healthcare coverage to dependent children through age 26. Further, while delayed twice already, the new W-2 reporting requirement is now scheduled to take effect in 2014. The formula for determining the amount to report is complicated and employers are well advised to leave this calculation to administrators like TASC.

Of course there are opportunities for gains as well. One that comes to mind is the Small Business Tax Credit. To get the credit, a business must have fewer than 25 full-time workers or the equivalent (for example, two half-time employees equals one full-time employee), must pay an average annual wage of less than $50,000, and must cover at least half the cost of health insurance premiums for their workers. Through 2013, the tax credit covers up to 35% of the amount a qualifying business spends on its health insurance premiums. In 2014, the top tax credit bumps up to 50%. The credit is available for up to six years. Employers should consider how this credit plays against the traditional deduction (Section 162) and choose the most advantageous route for their circumstance.

In the future we will see grants to help small businesses provide wellness programs to their employees. Eligible employers will be those without a workplace wellness program who employ fewer than 100 individuals who work 25 hours or more per week. Other than that, the details of this program have not been worked out. TASC will step in to help facilitate the grant competition process for our participating employers.

Clearly, many of these new provisions are still very much in play. TASC continues to watch these developments to determine the best course of action for our customers.  In my next blog, I will look at the new notice and documentation requirements.

Although you may not be seeing it in the papers or on the internet every day, and although the economy and jobs have replaced it as the hot topic among candidates, the healthcare reform bill is still very relevant to our industry. Provisions of the bill-known as the Patient Protection and Affordable Care Act (PPACA)—continue to come into law and modifications and clarifications of the bill continue to be released. Court cases regarding portions of the bill remain very much in play.

For example, here are some recent PPACA-related updates that we are following:

• The deadline has passed for submitting a waiver request to the annual HRA Plan limits. This provision prohibits health plans from imposing annual “caps” on the reimbursement of essential health benefits. The deadline to submit a waiver request ended on September 22, which means applications are no longer being considered.
• Another provision we are watching is CLASS, the Community Living Assistance Services and Supports program.  According to various sources, the Obama administration is putting a financially troubled part of the 2010 healthcare reform law on hold, leaving in doubt whether the benefit for disabled Americans will ever be implemented.
• The Department of Health and Human Services recently rolled out the initial regulations regarding the establishment of State Health Insurance Exchanges under PPACA. Exchanges are state-based competitive health insurance marketplaces through which individuals and small businesses (with fewer than 100 employees) can purchase private health insurance. 
• The Obama administration chose not to ask a federal appeals court for further review of a ruling striking down the centerpiece of the president’s sweeping healthcare overhaul—the mandate that individuals must purchase health insurance if they have none. The decision makes it more likely that the U.S. Supreme Court will hear the case during the court’s current term.

Needless to say, there continues to be a lot of movement with these regulations – and a lot to review, research, and analyze. For that reason, we made the move earlier this year to create a new position on our TASC corporate roster. Designed specifically to help us keep up with the ever-changing governmental landscape, our new Legislative Analyst position is held by Jason Westphal. Jason spends his days reviewing, analyzing, and interpreting Internal Revenue Service rulings and clarifications, governmental and healthcare related blogs, industry opinions, and upcoming trends. His efforts are another example of how TASC makes the investment to ensure we’re offering the most up-to-date and innovative services possible, how TASC strives to leave no stone unturned when it comes to protecting the compliance of our services.

We have made it easy to follow the efforts of our new Legislative Analyst.  Just visit TASC’s Capital Connection website (www.tasccapitalconnection.com). The Capital Connection will keep you updated on all the latest legislative action that affects our Plans. As is our custom, TASC is ready to adapt and capitalize on any change that affects our industry. You can count on it.

I don’t think it’s immodest to say that here at TASC we have won our fair share of awards.  The Better Business Bureau, Benefits Selling Magazine, and Ernst & Young’s Entrepreneur of the Year program have all bestowed awards on TASC.  While each honor is certainly gratifying, a recent award we received is especially so.  I am pleased to announce our newest achievement and recognition as Dane County’s Best in Business.

What makes this award so special?  It’s the fact that it was selected by an independent panel of community business leaders who are right in our hometown.  To be recognized by those who know you best is a pretty strong statement and one we take very seriously.

Since 1987, the Best in Business Award has been presented to outstanding Dane County businesses to showcase their business achievements as well as their commitment to customers, employees, and the community.  Specific awards criteria are used, including growth, the recipient’s standing among its competitors, its adaptation to changing markets, response to customer needs, and commitment to the community, and the company’s workplace environment.

I speak on behalf of TASC’s management, Board of Advisors, and team of employees when I say we are extremely proud to be recognized and honored in this manner.  We strive to provide the best quality and service to our customers, to foster a creative and fun work environment for our employees, and to be a productive and charitable member of our community.  It’s sure rewarding to have been recognized for the very attributes we attempt to achieve!

High marks for TASC

It shouldn’t come as too much of a surprise that other business leaders appreciate what we have going here at TASC.  For years we have been hearing the same message from our business customers.  In our latest Participant Satisfaction Survey, FlexSystem received a high approval rating—with 93% of the respondents saying they are Very Satisfied or Satisfied with TASC.  And in a mid-year Client Pulse Study, AgriPlanNOW and BizPlanNOW also received a high approval rating—with 86% of the respondents saying they are Very Satisfied or Satisfied.  Such fine customer approval ratings beat winning awards any day!

And why are our customers so satisfied with TASC?  They tell us it’s because TASC listens and TASC responds.  In striving to maintain this high esteem we have created our new Voices Carry program; it’s in place to help us better listen to our customers so we may respond more swiftly than ever.  With customer feedback as our guide, we are able to continuously improve our services to better meet the evolving needs of those we serve—improving their overall experiences with TASC. With a program like Voices Carry, who knows?  There may even be more awards in our future!