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Her competencies include a wide range of clinical and administrative skills and she is culturally competent. She has grown the company significantly, in part, due to the excellence of the supports offered. She diligently pursues her methodology to incorporate continuous improvement within the organization. As the leader for The Arc of Stanly County, and an advocate for people with disabilities for more than 40 years, Peggy has presented often at conferences and technical workshops, particularly on emerging practices that are used at Monarch. Peggy was appointed to the N.
She is also a board member of the N. In addition to her career, Peggy is married to Bob, mother to seven adult children and the couple has 10 grandchildren. They are currently foster parents to older teens and have opened their hearts and homes to more than children including adolescents with disabilities and teenagers in crisis as therapeutic foster parents.
A servant leader, Peggy is involved within her community and church. We all know the problem: While not a panacea, many believe artificial intelligence, virtual health, digital patient engagement, data interoperability and realigned economic incentives will lead to better access, patient experience and outcomes. But it all sounds like science fiction.
Can you deliver better behavioral health today leveraging current technologies? Are better efficiencies and financial outcomes already happening? Speakers articulate why better patient experience, access, and outcome as well as provider and payer financial benefit is accruing now. BOH host Matthew Hanis facilitates this carefully planned discussion and with real-time audience feedback.
This experiential session, including buffet lunch, will be recorded and later published to the BOH audience of 19, senior healthcare executives. A business of healthcare national expert, Matthew Hanis works with healthcare providers and the innovators serving them. Each discussion includes a healthcare executive and innovator concentrating on the same problem. You can access, at no charge, these and other published interviews at www. The BOH audience of 19, senior executives come from across healthcare.
Hanis frequently speaks on healthcare trends and innovation. He has commercialized businesses serving health systems, physician practices, state hospital associations, commercial insurance carriers, Medicaid agencies, and the US Department of Health and Human Services. He resides in Charlotte, NC with his wife and children.
Marlowe has worked with nonprofit organizations and local governments as a consultant and educator, and is keenly aware of the philosophical and change-management issues that occur with the integration of new technology. He shapes many of the partnerships that help Foothold serve its client agencies. Marlowe was previously a partner in the Flores Greenberg Consulting Group, where he directed projects for organizations such as Cisco Systems, Inc.
Richard Louis, III
Marlowe graduated from Vassar College with honors. He holds a BA in Sociology, and completed coursework in Philosophy. Jim Stefansic serves as President and Chief Executive Officer of Raiven Healthcare, a rapidly growing provider of healthcare artificial intelligence and data analytics solutions. An accomplished healthcare entrepreneur, Dr. Stefansic has years of experience launching and growing numerous healthcare technology businesses. His experience includes serving as the Director of Commercialization at Launch Tennessee, where he led the statewide SBIR program and assisted numerous technology businesses in their growth and development.
He was also a Research Professor at Vanderbilt University Medical Center, where he utilized functional magnetic resonance imaging techniques in image-guided neurosurgery, and was critical in the initiation of this technology within the Vanderbilt Vision Research Center. He has authored or co-authored more than a dozen peer reviewed scientific articles. Stefansic was named the Distinguished Alumnus of the Year in and currently serves as an Adjunct Instructor of Business.
Over the past 2 decades, Staci has worked in agency, in-patient, residential, school, and outpatient settings. Calling upon her experience and expertise, Staci endeavored to create a counseling practice that is designed to make quality mental health care as accessible, comprehensive, and affordable as possible. Staci partnered with her business-minded husband and now operates a successful outpatient practice that provides counseling, psychiatry, psychological testing and nutritional services for children, adolescents, adults, couples and families.
Staci continues to be passionate about direct care as a clinician and continues to see adolescents, adults and couples. Through her clinical work, she has been keenly aware of a dynamic shift in the mental health field in response to our growing dependency on technology. Staci founded the The Digital Education Project in response to the growing challenges that she saw families facing in the digital age. The goal at the Digital Education Project is to offer an educational program for children and parents, providing science-based information, current research, and simple strategies to promote healthy digital use.
Staci is a Licensed Clinician Social Worker. She resides in Newtown Square, PA with her husband and 3 children. As Chief Operations and Innovation Officer, Peggy is responsible for clinical strategy, innovation and operations, as well as network operations. Additionally, she provides clinical oversight of the Employee Assistance Program EAP , health plan account management teams. Since she joined the company in , New Directions has tripled the number of people it serves through health plans and employers. The shift to value-based contracting. Shared risk for patient outcomes. A major focus on interoperability and coordinated care.
The challenges and benefits of data optimization. The emergence of population health management. Increasing market consolidation and new competitive threats. This session will provide insights and practical take-aways for crafting a successful plan in a time of rapid change. Scott Green is senior vice president of the behavioral health business unit. He works closely with the clinical, development and product teams to ensure Netsmart solutions and services align to client and market needs.
Doing so allows clients across the human services industry to participate and thrive in emerging models of care. In addition to driving strategy for behavioral health, substance use, intellectual or developmental disabilities IDD and child welfare, Scott manages the teams charged to develop interoperability, population health, consumer engagement and analytics strategies. He also develops partnerships that bring new clinical content to clients. Prior to joining Netsmart, Scott held various roles with Pfizer Pharmaceuticals, including government relations, marketing and sales, and integrated delivery systems IDN team.
Scott makes everydaymatter by "striving to deliver value to clients from the investment they make in technology. Terry Fox is a sixth-generation resident of Gettysburg, Pennsylvania, and a battlefield guide emeritus with Gettysburg National Military Park. He taught American History in the public schools for 33 years, serving as department head and as a member of the Carnegie Foundation for teaching American History. Since his retirement he has taught as an adjunct professor at Gettysburg College and at the Johns Hopkins University School of Education.
He has presented leadership seminars for U. Air Force chief master sergeants as well as employees of the U. He earned his undergraduate and graduate degrees from Shippensburg College. Ethical leadership is a commitment to doing what is right. In the world of non-profit health and human services, this can present many challenges. How do leaders balance the pressure for near-term results with the long-term public good?
What is the role of leaders in policy and political issues? How do you weigh your bottom line against your responsibilities as a moral leader? Holoviak is a retired professor of Management at Penn State Mont Alto where he taught senior level business courses. Prior to this he was the long tenure Dean of the John L. Grove College of Business at Shippensburg University. In retirement he has authored two fiction spy adventure novels; The Cuban Connection: A Stephen masters Adventure, and Iberia Calling: He has four children, four grand children, loves to bike, golf and enjoys travel.
When you set out to identify future leaders to move your organization forward, do you know what to look for? Better yet, if you do not have an HR budget to spend on talent management, do you at least have a basic system and structure in place with the proper tools to evaluate talent?
Once you have identified your future leaders, do you have a plan in place to for them to gain new leadership skills? Leadership recruitment and retention have become two of the most challenging issues facing health and human service organizations today. In this timely session, we will discuss:. Tine Hansen-Turton is the President and Chief Executive Officer of Woods Services, a leading advocacy and service organization for people with exceptional challenges, disabilities and complex needs.
Hansen-Turton served as CEO of the National Nurse-led Care Consortium, a non-profit organization supporting the growth and development of over nurse-managed and school health clinics. Hansen-Turton still serves as the founding Executive Administrator for the Convenient Care Association CCA , the national trade association of over private-sector retail clinic industry, serving 25 million people with basic health care services across the country.
Hansen-Turton also teaches public and social innovations, leading nonprofits, health policy and the social innovations lab at University of Pennsylvania Fels Institute of Government and School of Nursing. This presentation will focus on the benefits of adding Mindfulness Training in concert with other traditional modalities that address Post Traumatic Stress Disorder in Veterans. The use of Mindfulness Techniques, such as meditation, can significantly lower levels of stress and anxiety which reduces anger and creates a sense of calm that can break dysfunctional patterns of behavior that accompany PTSD.
The program will evolve sequentially with exercises to increase awareness of the impermanence of sensations, images, feelings, and thoughts. Exercises to overcome obstacles to practice are employed and exercises that help the practitioner to recognize and experience the unfiltered somatic sensations that may be habitually ignored or overridden are practiced. This connection to physical sensations provides a window into our understanding of trauma and unresolved trauma with an exercise designed to provide a safe channel to release unresolved trauma along with practice in recognizing a flashback to a traumatic event and applying traumatic first aid.
The presentation will also include several brief demonstrations and group exercises to actively involve the participants. Mike has authored several published articles on the subjects of technology and training.
Transitional Reinsurance Program
Mike spends his time reading and writing; painting, drawing, and sculpting; gardening; shooting photos; traveling and hiking. He has raised two children and resides in Chambersburg with his wife, Elizabeth. Come prepared to discuss the challenges facing your organization and hear from your fellow attendees about their strategies for sustainability. Wendy Allen, author of Lincoln Into Art: The First Thirty Years , is known internationally for her extraordinary paintings of Abraham Lincoln, which have exhibited alongside works by Rauschenberg, Dali, and Rockwell.
Wendy Allen was born in Pittsburgh in In she left to pursue painting full-time. He soon became the focus of her artwork. Her work has also been featured at the Historical Society of Washington, D. Join us for this special executive networking reception in the historic Gettysburg Hotel. Take this time to debrief, share your experiences, and make plans to further develop your professional network with our faculty and your fellow attendees. To provide the proper context for this session, a handout including a brief introduction to Generals Lee and Longstreet and the Battle of Gettysburg will be made available to attendees.
We will retrace the steps of General Robert E. Lee and General James Longstreet as they made the decisions that would ultimately determine not only the outcome of the Battle of Gettysburg, but possibly the ultimate outcome of the Civil War. Lee found himself at odds with his trusted commander, General James Longstreet. The assault required the Confederate troops to march nearly a mile over an open field and to climb over several fences under open fire from the Union line.
This disastrous end to the battle resulted in a fifty percent casualty rate among the Confederate troops, and is seen as not only the decisive end to the Battle of Gettysburg, but also the turning point in the Civil War. For most executive teams, this high turnover rate is a familiar problem and for anyone working in the industry, it isn't a surprise.
DSPs perform stressful, critical functions, in often less than ideal conditions, for a wage similar to the food service industry.
- Kaiser Health Tracking Poll: April 2013.
- The Blockage - Rethinking Organizational Principles for the 21st Century.
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With shrinking budgets and tight margins, simply raising wages is not always a practicable solution for staff retention—instead, organizations need to think more broadly about benefits, culture, advancement opportunities, and work environment. This session will explore the challenges of recruitment and retention of DSPs, discuss how to build an environment that is supportive of staff and offers opportunities for growth, and hear new strategies for retention with executives who are currently managing a direct care workforce.
In the current environment of changing consumer expectations and new financial models, one essential skill that all executives need to master is the ability to evaluate and modify current services — and to develop new services to meet the challenges and opportunities in the market. In this exciting session, we will review everything you need to know about developing a new service line and hear from an executive who has been there. We will review how to analyze current service lines and determine strategic options for diversification, a structured approach for selecting new services for your organization and ensuring they are financially sustainable, and a target costing model for launching new services.
Leadership roles are becoming increasingly complex with organizations forming strategic alliances, outsourcing services, operating within flatter non-hierarchical management structures, and employing a diverse multi-generational workforce. Meta-leadership provides a framework for navigating complex situations by pulling together collective knowledge, expertise, and resources to accomplish what may otherwise be unattainable.
In this session, we'll discuss the key principles of meta-leadership and learn about one organization, the Cohen Veteran's Network, that has been able to build collaborations throughout the health care market to provide mental health care to veterans and their families. Hassan oversees the establishment of 25 mental health clinics nationwide.
In addition, he leads efforts to advance the field through funded research initiatives and training programs to improve care within the network and beyond. Hassan is a veteran of the United States Army enlisted and Air Force officer with 30 years of experience in military behavioral health, serving as a military social work officer, leader, clinician, and academic. He served during Operation Iraqi Freedom in on the first-ever Air Force combat stress control and prevention team embedded with the Army. He also led the largest military substance abuse and family advocacy programs in the Pacific.
These programs were recognized as benchmark programs and training sites for all other Pacific bases. He has strong relationships with the most senior levels of leadership in the U. Department of Defense, U. Department of Veterans Affairs, and Washington, D. Robert Bob Vero has worked in behavioral healthcare for nearly four decades. His clinical experience includes both private and community-based practice with special focus on substance abuse prevention, marriage and family therapy, and critical incident stress management services.
Vero has held adjunct faculty positions in both Omaha and Nashville and served as a volunteer Board member for several middle Tennessee not-for-profits including Cumberland University, where he is currently a member of the Board of Trustees, and the Tennessee Association of Mental Health Organizations TAMHO for which he is President-elect. Laurie Keenan McGarvey is a well known practitioner in the fields of communication and organizational behavior.
She also founded The McGarvey Group in order that she work with individuals and organizations to become the best version of themselves. However, economies of scale and organizational size are an integral part of strategy for health and human service organizations. The question — how to develop a merger and acquisition implementation plan that makes your organizational strategy successful? Now I understand why CMS waited until the mid-term elections ended to approve and allow the health insurance rates to be released, there would have been higher voter turnout for sure.
To see it in print and comparing costs for my family is quite a shock to the system. Fortunately we are a healthy family of four living in middle Tennessee. Of course the new EHB plans and the "affordable care act" don't distinguish between healthy or unhealthy individual any longer. What are my options? Not sure yet but group insurance now looks like a much better option with the ability to pre-tax premiums. Truth is I expect these new rates to still be competitive and for many their best "Affordable" health care option. These are very interesting times in the health insurance business.
We have guidebooks that show what we consider the best individual and group insurance options in Tennessee comparing benefits and rates. Would you like a copy? Give us a call or send an email dmoore thebenefitbrokers. Accountable care organizations are showing up across the country but have been relatively unseen in Tennessee until the recent announcement of this new partnership. Mission Point has built their business with the ACO model which rely on a "patient centered home" where healthcare is coordinated between doctors and facilities. It only makes sense to share information and work together but many in the healthcare continue to work independently and EMRs do not transfer easily.
The new network M will only be available to large employers with 1, or more employees. They will of course have access to the Mission Point network as well as Blue Cross's largest network P. Thomas and Vanderbilt's Monroe Carrell Jr. That of course would be a wonderful thing as bending the healthcare cost curve down has proven difficult and ACO's could finally be the solution everyone has been looking for.
Need help with your insurance? Benefit Brokers has been helping employers build and manage group insurance programs for more than 20 years. Find out today how we make our clients live easier and more affordable. Soon we will will hopefully know how much it costs when our child needs to see a Pediatrician for an ear ache and a prescription to treat it.
Imagine your doctor telling you to schedule and MRI for an injury and actually making that decision based on are report card of customer satisfaction, wait times and cost. It will change the way we purchase healthcare and actually create competition in the marketplace. Education is another key aspect of how Change Healthcare is bending the cost curve down. We try to make such terms as deductibles, co-insurance, non-formulary and limitations understandable but at the end of the day most don't really understand until they have claims and start seeing these items on their EOB.
Insurance is frustrating and expensive. It's exciting to see what is becoming available and some promising tools to help consumers in one of the most expensive areas of their lives. My hope is insurance carriers will get on the bandwagon and use these transparency tools to let consumers vote with their pocketbooks rather than go blindly into another medical procedure. Benefit Brokers, LLC and it's staff have been helping employers and their employees design and implement creative benefit plans that work and are affordable for more than 20 years.
If you have questions or need help call today, I attended a broker event this week to learn more about the Private Health Insurance Exchange Cigna will be offering to groups with more than 50 employees in They have contracted with B-Swift to do the administration and provide back office support. The insurance industry is predicting growth in private exchanges to be incredible in the coming years.
Many compare this to the k revolution when companies switched from pension plans to a more defined contribution model. Many in the industry are talking about defined contribution in healthcare and all the money that will save employers, the reality is that companies already pay premiums that way. A company that pays all or part of the employee premium for medical insurance pays a "defined contribution" for his staff. A private exchange does not change that, the big difference is the ability to offer more benefit choices, use online enrollment and hopefully streamline the process.
There are challenges as this is a new technology and platform in the small and mid-sized group market. One of the biggest things to consider is the plan design and pricing build out that has to be done before the first employees can be enrolled. Many times it takes a month or more to set up the system and groups tend to make decisions on insurance options at the last minute.
Cost is another factor and many employees are not computer savvy and will still need to have help. I do think this model will streamline and simplify benefits in the future. California has CalChoice a private exchange with more than 10, businesses participating. It offers different carriers and many products to choose from giving employees true choice.
It's just a matter of time before we have options like this in Tennessee. At Benefit Brokers, LLC we try to stay abreast of the new technology, tax strategies and options for our clients. Do you have questions or need help with your group insurance plan? Give us a call, we have helped many companies just like yours over the past 20 years. Open Enrollment is the time when you can apply for a new Marketplace plan, keep your current plan, or pick a new one.
Enroll by the 15th if you want new coverage that begins on January 1, If your plan is changing or you want to change plans, enroll by the 15th to avoid a lapse in coverage. Coverage ends for plans. Coverage for plans can start as soon as January 1st. This is the last day you can apply for coverage before the end of Open Enrollment. To buy Marketplace insurance outside of Open Enrollment, you must qualify for a Special Enrollment Period due to a qualifying life event like marriage, birth or adoption of a child, or loss of other health coverage.
You are to determine if your policies prescription benefits are as good or better than Medicare's Part D coverage. We help thousands of people with their health insurance plans and always get the question about costs.
Prescriptions are just one factor but the costs can be staggering and in most cases the insured does not fully understand the true cost of many prescriptions. When you have a co-pay for your prescription you really don't care what the cost is as long as you feel better. Ever wonder why so many prescriptions are advertised on the nightly news? Direct to consumer advertising works and when you ask your doctor for a specific drug, he generally does not know the cost and may not have time to fully explain your options.
Most of the drugs you see advertising are extremely expensive and advertising works. While this is not a full blow study, I did take claims data from some of our clients to see what the cost is for some better know prescriptions, here are some examples;,. Most don't realize that each pharmacy has a different contract with the insurer and prices can vary widely even with stores across the street from each other.
With real time pricing tools virtually non-existent it's difficult to compare costs between pharmacies. It never hurts call or shop around and in most cases generics can and will save you money. The new policies are a little different than what you currently have. We are happy to help and have put together an Individual Health Insurance Guidebook to help you find the right policy at the right price. President Ronald Reagan made an old Russian proverb -- trust but verify -- one of his mottos.
Unfortunately, even though the Department of Health and Human Services HHS promised last Fall to make it their motto too when it came to exchange-based subsidies, this week the House Energy and Commerce Subcommittee on Health revealed their promise to be a fairly empty one so far. Even though former HHS Secretary Kathleen Sebelius testified before Congress last Fall multiple times that the HHS subsidy verification process was ready and working, and certified its viability this past January, the House Committee has identified at least four million unverified subsidy cases.
At the beginning of this month, the U. Findings of the report include:. Most inconsistencies are related to citizenship and income, the first and most basic qualification criteria. Without the ability to resolve inconsistencies in an applicant's data, the marketplace cannot determine if the applicant is eligible for enrollment. This should be step one in the enrollment process, but there is no confidence that this is being done properly.
Both federal and state-based marketplace websites continue to have problems, resulting in applicants not being able to enroll online. These problems generated a backlog of paper applications for several states. The Federal Data Hub created additional problems for states who attempted to appropriately process applications.
Federal data sources accessed through the Hub were frequently inaccurate, thus creating more inconsistencies. One state marketplace reported that the Data Hub identified a set of infants and children as incarcerated, according to federal data sources. However, CMS placed part of the blame for these failures on consumers who are inexperienced with the enrollment process.
During this week's House hearing, Republicans asserted their concern for people who could least afford to pay back subsidies and noted that many cases of incorrect determination are likely not the result of fraud, but rather consumer misinformation and honest mistakes. Democrats retorted that health reform is working for millions of people and called Republicans to work with them to make changes to the law that will actually improve verification, rather than merely holding hearings outlining problems. Unlike enforcement of the individual mandate, where IRS authority and collection methods are limited, the Treasury Department has full authority to reclaim subsidy dollars from consumers who took premium tax credit dollars for which they were not eligible.
NAHU has been raising the subsidy verification issue with the Administration, members of Congress and the media for months. One area we have particularly highlighted is employer coverage verification, which has been poor at best. When members of Congress asked during the hearing if any employer had been notified about an employee requesting a subsidy, the witnesses were unaware of any cases where employer verification had truly occurred.
Government witnesses also admitted that the verification system is still not fully operational. It is uncertain if the verification system will be ready in time for enrollment scheduled to begin in November. That's what they call it but for many the new health plans are anything but affordable. As you know we work primarily in the group health insurance marketplace and many are seeing big increases there as well. That's not to say everyone is getting hurt by the new plans, many are seeing better benefits at lower costs.
While lower income Tennesseans are seeing the greatest benefit from the new Essential Benefit Plans EHBs , many who had pre-existing conditions or were on expensive COBRA policies have been able to get better coverage for substantially lower costs. We have many group clients who have seen lower costs as well. This is due to how insurance policies are rated with healthy people getting the lowest rates and those with higher risks or medical conditions paying much higher costs.
The new plans are "community rated" with guarantee issue. That means there is one set cost for a health insurance policy and each person that age pays the same cost regardless of their health status. Healthy people pay more, unhealthy pay less. The carriers get the same amount of premium dollars in the end, it's who is paying what that has changed. September 1st is where we are seeing our first healthy groups who did an "early renewal" get their EHB pricing. Carriers are allowing companies to keep their current plans for another year with a "grand mothered" program.
Better have a good broker on your side to show you all the options and help you design the right plan for your situation. We are happy to help, call us The Institute will be responsible for setting national research priorities and establishing an agenda to carry out such research. In addition to specified appropriations and transfers from the Medicare Trust Fund, the Affordable Care Act also imposes a fee on fully-insured health insurance policies individual and group and self-funded health plans that together will fund the PCORTF.
This article is provided for general use. Employers and other plan sponsors with specific questions about the PCORI fee are urged to contact their legal counsel or tax professional. For fully-insured group plans and individual policies, BlueCross is responsible and liable for calculating, reporting and paying the fee to the IRS. For self-funded plans - including Health Reimbursement Arrangements HRAs - the plan sponsor is responsible and liable for calculating, reporting and paying the fee.
The final rule provides guidance to determine the plan sponsor and methods for calculating the number of members on which the fee is based. Please refer to the IRS website for other information about reporting and paying the fee, especially if you have to file Form for other purposes. As mentioned above, BlueCross is responsible for paying the fee for our insured business. However, the plan sponsor of the HRA plan will also be responsible for paying a fee on the self-funded portion of the plan. However, an HRA that may be used to pay deductibles and copays under the applicable self-insured health plan is not subject to a separate fee and the fee will apply only to the applicable self-insured health plan if both the HRA and the applicable self-insured health plan have the same plan sponsor and the same plan year.
While BlueCross cannot report or pay the PCORI fee on behalf of self-funded plans, we are providing a variety of resources that may assist plan sponsors. BlueCross provides information to self-funded plans for Form reporting, including the number of participants at the beginning and end of the year for plans that we administer.
In addition, BlueCross has reports available through Interactive Reporting on BlueAccess that may be of assistance if the plan sponsor determines it to be appropriate. Two reports are available:. The current reporting date is the default. If you are looking for the most recent information, select Run. This will return all member demographics for the group. Run the report for the month you need. Print or download the results for your records. Run the report for the period that you wish to see. The results will be separated for each month within the time period specified.
You can print or download the results for your records. These tools can be found on BlueAccess. These reports provide information about all subscribers or members enrolled under a group number based on the information in our database at the time the report is compiled.
This information is provided for general use. If you are an employer or self-funded plan sponsor and have specific questions regarding the calculation, reporting, or payment of the PCORI Fee, please consult with your attorney or tax professional. They are collectively known as the Affordable Care Act. Long term disability insurance is the most under rated benefit offered by employers but in my opinion, it's second in importance to health insurance. Most think life insurance is critical to a financial plan but the truth is, you are much more likely to become disabled than you are to die.
What happens to your family and lifestyle when your income stops for an extended period of time? This is where LTD insurance comes in. Do you realize it is going to run out of money by ? Since , the Council for Disability Awareness CDA has conducted an exclusive annual review of long term disability claims among the U. The report identifies continuing or emerging trends for the purposes of education, evaluation and use by interested audiences.
Nineteen CDA member companies, representing more than 75 percent of the commercial disability insurance marketplace, contributed disability claim data for this year's study, making this edition of the review the largest and most comprehensive to date. The federal government has been releasing hospital charges across the country showing the differing costs for the same medical procedures.
Not only is this article interesting there is an interactive map that shows all the hospitals based on a zip code and how the rates differ. See what your favorite hospital charges compared with the others in your area. Tennessee business owners have long seen double digit increases in their group medical insurance premiums while Medicare continually freezes or reduces reimbursements.
It seems even Medicare can't slow down the inflation and medical trend challenge as charges are increasing for most of the common procedures. This is offset by fewer people being admitted which is what allows the federal government the right to say Medicare costs are stable. Employers who thought they had found a way to shift the cost and responsibility of providing health insurance to the government are learning that door has been closed for good. At least if they want to give employees "tax free money" to pay the premiums.
We thought HRAs and FSAs would provide a great tool to help employees purchase less expensive individual policies when the ACA was first being rolled out, it's clear now this is not an option. Christopher E Condeluci, a former tax and benefits counsel to the Senate Finance committee says "if employers want to help employees buy insurance eon their own, it can give them higher pay, in the form of taxable wages.
But in such cases, he said, the employer and employee would owe payroll taxes on those wages, and the change could be viewed by workers as reducing a valuable benefit. The Obama administration released a page regulator update on Friday May 16th providing clarity around a number of different issues. It appears the White House has authorized as much as 5. Many of course think this is a political issue to try and keep rate increases at a minimum level until the next round of elections in the fall. The Washington Post is reporting this morning that more than 1 million people may be receiving too much or too little premium subsidies and they are having to verify the information by hand.
The newest problem reveals that the IRS has found hundreds of thousands who listed incomes significantly from the income the IRS has on file. The problem is the next step is consumers are asked to upload or mail in payroll documentation as proof of income. While only a fraction have done so, the federal computer is unable to match the documentation because the capability has not yet been built. That leaves piles of unprocessed "proof" sitting in a federal contractors desk in Kentucky while the government continues to pay undocumented subsidies.
The white house agrees this is a problem that needs to be resolved "as soon as possible". But it seems there is a more pressing issue they must first address. It seems there are another roughly 1 million cases where people enrolled - or tried to enroll - in health plans and ran into questions about their citizenship status. Throughout the signup period the HealthCare. I am 52 years old, very healthy, exersize regularly, don't smoke, have no family history or heart or other medical problems, take no medicines and eat a pretty good diet.
Sound like a great health risk, that's what I think. The problem is I have a good friend who can say the same thing and is actually in better shape than I am who just had a very bad heart attack. He is ok, he made it to hospital just in time but this would have been fatal if he had been further from the hospital. I did a long bike ride with him just a few weeks before. Needless to say, I began to question how healthy I really am.
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There is a fast, easy and inexpensive test that will look inside your heart and blood vessels to see if there is any artery buildup or plaque. I don't have my results yet but feel better for being proactive about this. Getting an annual physical is very important, this inexpensive test seems equally important. Remember, if you need help with your health insurance or employee benefits in Nashville Tn, we are here to help. On Thursday, May 1, the Center for Medicaid and Medicare Services CMS released the most comprehensive analysis to-date of health coverage enrollments made through the new health insurance marketplaces between October 1, , and March 31, The data also includes enrollments made via special election periods through April 19, Here are some key takeaways:.
The report also shed some light on the question of how many of the 8 million were previously uninsured and how many of them were just switching to new exchange-based individual coverage. The report extrapolated data to predict about 5. This number is based on data showing that just 13 percent of new enrollees told the federal exchange that they had coverage at the time of the application. One key piece of data not contained in the report — how many people enrolled in private qualified health plans have paid their first premiums.
Obviously, this is the final step to truly being covered. Industry trends suggest that 85 percent will pay and 15 percent will not, and that an additional number will drop their coverage or simply will stop paying premiums at some point during the coverage year. How many new exchange enrollees will ultimately drop-off of their coverage plans is right now an unknown, but a recent study shows that only about half of individual market purchasers pre-health reform remained in their individual policy for a year or more.
Will this new 8 million people behave similarly? Only time will tell! Beyond that, many of the reports focus on the late surge in enrollment, with more than five million individuals signing up since February. Populating the less positive assessments, though, were two key points: Blue Cross Blue Shield of Tn announced several months ago that they would no longer pay for the higher cost of "out of network" care charged by providers not in their PPO networks.
Medicaid medicare
For years we informed those with the S Network that they could visit the nearest facility in a true emergency and it would be treated as if they were "in network" from BCBST. We are finding that this is no longer true. Under this new payment strategy, BCBST is paying "out of network" facilities what they would have paid an "in network" facility for the same procedures.
The problem is, facilities can charge any amount they want for each service as they don't have negotiated rates. This change is putting hard working employees who have what they deemed good health insurance in the cross hairs of a corporate battle between BlueCross BlueShield of Tennessee and HCA TriStar. So far there are only losers who are the insureds that are now facing huge bills with what appears nowhere to turn for help.
We have been helping several of our groups employees in this situation by working through the system and BlueCross dispute channels but we are running in brick walls. Who is the bad guy in this situation? It seems the system but one would think these two powerhouses could take off the gloves and work together to help these unfortunate few who are now left with thousands of dollars in medical bills for following the rules.
Many Tennesseans and others around the country who did not sign up for insurance during open enrollment will be in for a rude awakening if they want or need coverage for the rest of the year. Because of the guarantee issue and no pre-existing condtions limitations carriers needed the protection of not allowing someone to buy insurance only when they need it. There has to be protection for the carriers and I personally think this is a good thing. Another option would be to offer coverage with pre-x if you don't buy the policy during open enrollment.
You can, of course buy coverage if you have a qualifying event marriage, divorce, birth or adoption, loss of group coverage, etc. It's very important to understand how these rules work and we are happy to help, feel free to call us at Until now, customers could walk into an insurance office or go online to buy standard health care coverage any time of year. With limited exceptions, insurers are refusing to sell to individuals after the enrollment period for HealthCare.
They will lock out the young and healthy as well as the sick or injured. Those who want to switch plans also are affected. The next wide-open chance to enroll comes in November for coverage in You should be able to buy anything anytime you want. Those who act now may still be able to get in, depending on where they live. Rules vary from state to state. But insurers consider it too risky now that the law prohibits them from rejecting people in poor health.
Bobiak, whose NICA Benefits company helps people buy insurance in New Jersey, Ohio and Pennsylvania, said he learned only a couple of weeks ago that insurers were cutting off new policies. The Obama administration, insurance companies and nonprofit groups scrambled to spread the word, often with messages that focused on the cost savings available to many people through the government marketplaces.
Albright had no further comment. Some do still offer temporary plans, lasting from a month to a year. Nate Purpura, spokesman for eHealthInsurance. For people trying to get an off-marketplace plan through an open enrollment extension, some insurers are selling them through April 15, and others through the end of the month. Purpura said eHealth will offer such plans in at least some areas of these states: Kaiser Permanente will offer extensions that mirror the state or federal marketplace in the area where a plan is sold, Stenrud said.
The federal marketplace extension for online enrollment is April But Oregon, for example, is giving marketplace buyers until April Across our beautiful state nearly 78, have signed up in February for a health insurance policy under the federal health insurance exchange. Nationwide over four million have signed up since the October 1st open enrollment began.
In Tennessee 56 of those who signed up were women. In January, 60, Tennesseans had signed up. That means if you have a loss of coverage due to: Cancelling an individual policy you don't like does NOT qualify for a loss of coverage. Additionally, if you have not signed up for a policy by March 31st, you will be subject to the tax penalty. If you have questions about this or need help with your insurance plans give us a call today. The Obama administration on Wednesday released a broad set of regulatory changes to the health law that would give some consumers additional time to stay in plans that do not comply with all its coverage requirements and all consumers more time to enroll in coverage come The rules changes, released jointly by the Department of Health and Human Services and the Treasury Department, were published now to provide certainty and clarity for consumers, employers and insurers, officials said.
Both lawmakers are facing tough re-election campaigns this fall. Republicans criticized the decision to allow people to remain longer in plans that do not comply with the health law. Those policyholders need to sign up for new coverage — often at higher rates — to offset the costs of enrollees who are older or sicker, he said. Brian Haile, senior vice president for health policy at tax service Jackson Hewitt, said adding a month to what was previously planned for the open enrollment period next year is a good idea.
There are many reports and rumors of increased health insurance costs due to "ObamaCare". This one is a little different because it's actually provided by The Centers for Medicare and Medicaid. They predict costs will increase for two out of three small and medium sized businesses in As a professional who works with small and medium sized companies. I agree with this study and the coming shock that will affect many employers and employees.
One thing we are not seeing mentioned is how high the costs are for people over age While I have not seen anyone writing about it, age discrimination becomes real factor when you have that type of premium disparity. There are of course many things that change with the new "essential health benefit" plan designs. This is giving employers another reason to consider dropping their group coverage and just sending employees to buy their own coverage in the individual market. To read the full article and see the CMS report click here. The health insurance marketplace was supposed to be the solution to Tennessee and Americas uninsured population.
After four months of open enrollment it does not appear they are actually that interested in getting health insurance regardless of the low price tag.
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We here at Benefit Brokers, LLC have been doing our part to help enroll individuals in both subsidized and non-subsidized plans outside of the Marketplace. We have had several employers drop their group coverage sending employees out to find their own policies. There have been some employees who benefited due to their age and low income but many employees have not been happy with the results they are seeing. Most companies don't subsidize dependents and group policies cost for children generally charge the same regardless of the number of kids. For those with just one child, they can save a substantial amount of money and choose the type of coverage they want.
Needless to say, there is much work to be done prior to the March 31st deadline to enroll and receive subsidies. If you have questions feel free to call us at Since the law is aimed at only 15 percent of the adult population in the U. On top of that, the administration has made numerous changes in the rules and deadlines, adding to consumer confusion.
Read the full story here. This delay is implemented to give smaller employers more time to adjust, and for businesses to reconsider cutting employees' hours. Firms wanting to use this new "phase in" period, however, must certify that they haven't shrunk employee numbers to qualify as a medium-sized business. Employers can use a six-month measurement period with a twelve-month stability period for Employers with plans that do not start on January 1, do not have to comply until the start of their plan year if they meet certain conditions.
Generally, management carve-out plans that do not currently offer coverage to most all employees will have to comply on January 1, If a plan doesn't offer dependent coverage in , then the plan will have until to arrange for coverage. Also, stepchildren and foster children do not have to be included in the definition of dependent. Plans are not required to offer coverage to spouses.
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Determining large employer status: Employers can use six consecutive months of , instead of twelve months, to determine whether they have full-time equivalent employees for These clarifications address volunteers, educational employees, seasonal employees, students under work programs and adjunct faculty. A full-time employee is defined by law as one who works 30 or more hours per week. The final regulations provide for two methods to determine full-time employee status.
The first is the look-back measurement period described in the earlier proposed regulations. The second is the monthly measurement period. The final regulations clarify this alternate method that allows employers to use hours of service for each calendar month to determine the status.
Do you have questions about how this will impact your company and employees? Give us a call, we are happy to review your current benefit strategy and make recommendations to help you reach your goals. Just a brief reminder in case you have forgotten a few of the reasons our health insurance costs are going up this year. Being a group insurance specialist, we help a lot of companies and their employees design and manage their insurance programs. Smaller companies with 50 or less employees are all forced to have an Essential Health Benefits EHB plan which has many requirements and fixed pricing based on a persons age.
Those groups with over 50 employees are still underwritten and rates can vary widely based on many factors. These over 50 companies are the groups we see getting big increases so far in While the fees and taxes are computed at 3. It's very painful and in a lot of cases the options are very limited to try and keep the increase at a moderate level. This fee will be imposed on employers for the next three years and will go toward helping the state-based insurance exchanges pay for large claims. Patient Centered Outcomes Research Institute fee: This charge will go to pay for a new agency tasked with giving patients a better understanding of the prevention, treatment and care options available, and the science that supports those options.
The fee then increases with inflation in health care spending for the next five years. This annual fee is aimed at helping pay for the implementation of ACA. It will be about 2. Beyond that, it will rise with the growth in premiums. Insurers are expected to pass this fee through to employers. This tax is prompting companies to shift more medical expenses onto employees, which not only brings down the price of the premiums, but also pushes employees and their spouses to consider other options available to them. Also adding to employer costs is the ObamaCare requirement that Americans obtain insurance or face a penalty starting in this year.
That will prompt many employees who had opted out of their company's coverage to sign up. Aside from new ObamaCare fees and taxes, the growth of health care costs has been at record low levels for several years.