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CCH® BENEFITS — 06/17/10

Health Reform 2010, Quality Of Care, Individual And Group Markets

from Spencer’s Benefits Reports: For the next few weeks, Spencer’s Benefits Reports will highlight specific provisions in the new health reform law which affect employer-sponsored plans. Sec. 1001(5) of the Affordable Care Act concerns the quality of care in individual and group markets.

The Department of Health And Human Services (HHS) has two years after the date of enactment of the Affordable Care Act to develop the following:

1. Quality reporting requirements for group health plans and insurers offering individual or group coverage,
2. Regulations that provide criteria for health provider reimbursement structure. Then within 180 days of publication of regulations, the Government Accountability Office must submit a report to the Congress reviewing the impact of the requirements on the quality and cost of care.

The requirements are to be developed in consultation with experts in health care quality and other stakeholders for group health plans and issuers offering group or individual coverage. The quality of care reporting requirements apply to plan or coverage benefits as well as “health care provider reimbursement structures” that add the following enhancements:

• improve health outcomes through the implementation of activities such as quality reporting, effective case management, care coordination, chronic disease management, and medication and care compliance initiatives (including the use of the “medical homes model”;
• implement activities to prevent hospital readmissions through a comprehensive program for hospital discharge that includes patient-centered education and counseling, comprehensive discharge planning, and post discharge reinforcement by an appropriate health care professional;
• implement activities to improve patient safety and reduce medical errors through the appropriate use of best clinical practices, evidence based medicine, and health information technology under the plan or coverage; and
• implement wellness and health promotion activities.

Annual Report

On an annual basis, group health plans and insurers offering group or individual coverage shall provide to plan participants and to HHS a report detailing whether the coverage under the plan satisfies the reporting requirements listed above. The report must be made available to enrollees during each open enrollment period, and HHS must make the reports available to the public on an Internet site.

HHS may develop and impose penalties for noncompliance and also may provide exceptions for plans and insurers that “substantially” meet the goals of the reporting requirements.

Regulations presumably will define what it means for a plan or insurer to substantially meet the goals of the reporting requirements.

Wellness And Prevention Programs

Wellness and health promotion activities may be operated by a health care provider, a wellness and prevention plan manager, or a health, wellness or prevention services organization that conducts health risk assessments or offers ongoing face-to-face, telephone, or Web-based interventions for program participants. The following features may be included in the organization’s efforts:

(1) smoking cessation;
(2) weight management;
(3) stress management;
(4) physical fitness;
(5) nutrition;
(6) heart disease prevention;
(7) healthy lifestyle support;
(8) diabetes prevention.

Protection Of Second Amendment Gun Rights

Wellness and prevention programs provided by group health plans and insurers may not require the disclosure of information relating to (1) the presence or storage of a lawfully-possessed firearm or ammunition on the individual’s property or in his or her residence and (2) the lawful use, possession, or storage of a firearm or ammunition (Act Sec. 1001(5) of the Affordable Care Act, as amended by Act Sec. 10101(e), adding Public Health Service Act Sec. 2717(c)). HHS is prohibited from authorizing the collection or maintaining records of such information pertaining to firearms.

CCH Law, Explanation And Analysis Of Health Reform Act Available

CCH’s Law, Explanation And Analysis of the Patient Protection and Affordable Care Act of 2010 provides the most comprehensive and practical guidance available to professionals needing to make sense of this historic legislation. Included in the online version is the complete text of the law, integrating both the Affordable Care Act and the Health and Education Reconciliation Act. A hard-copy version of the book is available for $149.

For more information or to order the hard-copy version of the book, please call (800) 248-3248 or click http://hr.cch.com/Products/ProductID-7127.asp. Discounts are available for multiple copies.

For more information on this and related topics, consult the CCH Pension Plan Guide, CCH Employee Benefits Management, and Spencer's Benefits Reports.

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