Association Health Plans Final Rules Released

On June 19, 2018, the U.S. Department of Labor released the final rule on Association Health Plans (AHPs). The rule seeks to expand health coverage among small employer groups and self-employed individuals. It will make it easier for small business to join together to purchase health insurance without the myriad of regulations individual states and the Affordable Care Act (ACA) imposes on smaller fully insured employers. AHPs are not required to provide the essential health benefits (EHBs) package included in the ACA. The plans have been intended to provide less expensive options for small businesses, regional collectives, and industry groups that may not be able to purchase insurance through the public exchanges.

The rule broadens the definition of an employer under the Employee Retirement Income Security Act of 1974 (ERISA), to allow more groups to form association health plans and bypass rules under the Affordable Care Act. ERISA is the federal law that governs health benefits and retirement plans offered by large employers. Below is a comparison of the original proposed rule and the final rule just released.

association-health-plan-chart
The final rules confirm that self-insured Association Health Plans are considered Multiple Employer Welfare Arrangements (MEWAs) and does not curtail a state’s ability to regulate self-insured AHPs. This means that self-insured AHPs will be subject to MEWA laws in each state where coverage is offered/where members are located. Self-insured AHPs will have to follow the MEWA rules of the state with the most restrictive rule on an issue by issue basis. The final rule did leave an opening for future self-insured AHPs with the following language on page 96 of the 198 page regulation: “a potential future mechanism for preempting State insurance laws that go too far in regulating self-insured AHPs…” But for now, there is not anything in the final regulation designed to help self-insured AHPs thrive.

why-diversified-group

Value Based Pricing Gaining

While plenty of folks talk about value based, or reference based, pricing as though it’s a fad that has come and gone, we’re finding more interest from employers all the time. This may be because many like to brand it as another form of disruption, but regardless of how you brand it, value based pricing is becoming a more important part of our value proposition all the time. It’s becoming more widespread because it enables a self-funded plan to limit costs to an extent that few other measures, if any, can match. This is primarily because by negotiating in advance with hospitals to accept a schedule of fixed payments for certain healthcare services, carrier-sponsored provider networks can be bypassed.

The fact is that while value based pricing may be considered disruptive by many hospitals, it works. It is a transparent approach that can save a lot of money for self-funded health plans and their members. And finding ways to help self-funded employer plans provide high quality, high value healthcare to their members is our most important job.

How America got hooked on a deadly drug

This article was published on June 14, 2018 on BenefitsPro, written by Fred Schulte, Kaiser Health News (Maria Fabrizio for KHN) . Photo Source: BenefitsPro.

opioid-abuse

Purdue Pharma left almost nothing to chance in its whirlwind marketing of its new painkiller OxyContin.

From 1996 to 2002, Purdue pursued nearly every avenue in the drug supply and prescription sales chain — a strategy now cast as reckless and illegal in more than 1,500 federal civil lawsuits from communities in Florida to Wisconsin to California that allege the drug has fueled a national epidemic of addiction.

Kaiser Health News is releasing years of Purdue’s internal budget documents and other records to offer readers a chance to evaluate how the privately held Connecticut company spent hundreds of millions of dollars to launch and promote the drug, a trove of information made publicly available here for the first time.

All of these internal Purdue records were obtained from a Florida attorney general’s office investigation of Purdue’s sales efforts that ended late in 2002.

I have had copies of those records in my basement for years. I was a reporter at the South Florida Sun-Sentinel, which, along with the Orlando Sentinel, won a court battle to force the attorney general to release the company files in 2003. At the time, the Sun-Sentinel was writing extensively about a growing tide of deaths from prescription drugs such as OxyContin.

We drew on the marketing files to write two articles, including one that exposed possible deceptive marketing of the drug. Now, given the disastrous arc of prescription drug abuse over the past decade and the stream of suits being filed — more than a dozen on some days — it seemed time for me to share these seminal documents that reveal the breadth and detail of Purdue’s efforts.

Asked by Kaiser Health News for comment on the OxyContin marketing files and the suits against the company, Purdue Pharma spokesman Robert Josephson issued a statement that reads in part:

“Suggesting activities that last occurred more than 16 years ago, for which the company accepted responsibility, helped contribute to today’s complex and multi-faceted opioid crisis is deeply flawed. The bulk of opioid prescriptions are not, and have never been, for OxyContin, which represents less than 2% of current opioid prescriptions.”

Purdue first marketed OxyContin for cancer pain but planned to expand that use to meet its multimillion-dollar sales goals.

The marketing files show that about 75 percent of more than $400 million in promotional spending occurred after the start of 2000, the year Purdue officials told Congress they learned of growing OxyContin abuse and drug-related deaths from media reports and regulators. These internal Purdue marketing records show the drugmaker financed activities across nearly every quarter of medicine, from awarding grants to health care groups that set standards for opioid use to reminding reluctant pharmacists how they could profit from stocking OxyContin pills on their shelves.

Purdue bought more than $18 million worth of advertising in major medical journals that cheerily touted OxyContin. Some of the ads, federal officials said in 2003, “grossly overstated” the drug’s safety.

The Purdue records show that the company poured more than $8 million into a website and venture called “Partners Against Pain,” which helped connect patients to doctors willing to treat their pain, presumably with OxyContin or other opioids. Continue reading

It’s PCORI Filing Time Again!

IRS ACA Patient Centered Outcomes Research Institute (PCORI) Fees Due July 31st.

For 2018, the annual fee to fund the federal Patient-Centered Outcomes Research Institute (PCORI), paid by employers that sponsor self-insured health plans and by commercial group health insurance providers, will go up by about 10 cents per employee or dependent enrolled in the health plan. The fees are due by July 31. The chart below shows the fees to be paid in 2018, which rose slightly from the fees owed in 2017.

The chart below shows the fees to be paid in 2018, which rose slightly from the fees owed in 2017:

Jan. 1, 2017, through Sept. 30, 2017 $2.26 (up from $2.17) per Covered Life (including spouse & children)
Oct. 1, 2017, through Dec. 31, 2017 (including calendar year plans) $2.39 (up from $2.26) per Covered Life (including spouse & children)

For self-funded plans, the self-insured employer is responsible for submitting the fee and accompanying paperwork to the IRS. PCORI fees are reported on IRS Form 720, Quarterly Federal Excise Tax Return. On page two of Form 720, under Part II, the employer needs to designate the average number of covered lives under its applicable self-insured plan. Although the fee is paid annually, employers should indicate on the Payment Voucher (720-V)—located at the end of Form 720—that the tax period for the fee is the second quarter of the year. Failure to properly designate ‘2nd Quarter’ on the voucher will result in the IRS’s software generating a tardy filing notice.

The PCORI fee will not be assessed for plan years ending after Sept. 30, 2019, which means that for a calendar-year plan, the last year for assessment is the 2018 calendar year.

ATTENTION DIVERSIFIED GROUP CLIENTS:

Clients who have elected to have Diversified Group assist with PCORI fee calculation can expect an email by June 25th that will include a copy of the completed Form 720 along with the PCORI calculation worksheet with supporting documentation. Clients will need to file Form 720 with payment by July 31, 2018.

self-funding-video

 

The Phia Group Recognizes Diversified Group with 2018 Empowered Plan Award

MyHealthGuide Source: The Phia Group, 6/8/2018, http://www.PhiaGroup.com

phia-mvp-awardbadgeFoxboro, MA — The Phia Group, LLC, at its annual MVP (Most Valuable Partners) event, was pleased to recognize this year’s winner of The Phia Group “Trophy of Empowerment.” It is with appreciation that they now publically announce the name of their 2018 Empowered Plan Award winner, Diversified Group.

After analyzing all of their MVPs based on a number of parameters including, but not limited to, collaboration with The Phia Group, a willingness to innovate, as well as application of a forward thinking methodology – reflected through efforts taken to secure the future of our industry – Diversified Group of Marlborough, CT – was a clear winner.

Phia_Group

Phia Group’s 2018 Empowered Plan Award Winner, Diversified Group

The Phia Group’s CEO Adam V. Russo, Esq. remarked, “More than a decade and a half ago, Diversified Group took a chance on us… and since then both of our organizations have grown and thrived, in large part thanks to the friendship and partnership we have in force. We’re grateful for that relationship, as well as the work Diversified Group does on behalf of our entire industry.”

“We are so very honored to have earned this recognition from The Phia Group. Empowering plans is the core value we bring to our customers seeking effective alternatives to the traditional carrier based ASO and fully insured plans – the market is hungry for empowerment! Over the last 15 years, their team of experts have provided prompt and efficient resources; they are dedicated to understanding and adapting, and having them as a reliable partner is a huge asset,” Diversified Group’s President & Principal Partner, Brooks Goodison said. “When we receive recognition from a trusted partner like Phia, completely in line with the promise we make to our clients, it is like receiving a standing ovation!”

About Diversified Group
Like The Phia Group, Diversified Group is comprised of numerous organizations, all working toward a common goal. Comprised of Diversified Group Brokerage, Diversified Administration Corporation, Corporate Managed Health Services, and Corporate Fitness & Health – Diversified Group focuses on customer service and a customized approach to improving health; maximizing benefits and minimizing costs. Through their family of companies, they provide a wide variety of services, ensuring their vast portfolio of offerings addresses all the needs of the entities they aid. This emphasis on variety as well as their customer first mentality – along with a daring focus on innovation and selfless advocacy for the entire industry – are what makes Diversified Group this year’s winner. For more information about Diversified Group, please visit www.dgb-online.com.

About The Phia Group
The Phia Group, LLC, headquartered in Braintree, Massachusetts, is an experienced provider of health care cost containment techniques offering comprehensive claims recovery, plan document and consulting services designed to control health care costs and protect plan assets. By providing industry leading consultation, plan drafting, subrogation and other cost containment solutions, The Phia Group is truly Empowering Plans. Contact Garrick Hunt, Sales Executive, at 781-535-5644, Info@PhiaGroup.com and visit www.PhiaGroup.com.

Drug Overdose Deaths Rising

pill-bottle

According to preliminary government data, U.S. deaths involving fentanyl and other synthetic opioids fueled a 21% jump in annual drug overdose deaths during 2017. The increase from 9,945 opioid deaths in 2016 to 20,145 during 2017 reflected the sharpest one-year increase since the U.S. began experiencing a widespread opioid addiction. CDC data shows that deaths involving heroin and prescription painkillers such as oxycodone, are also increasing.

why-diversified-group