Keeping Abreast of Health Care Reforms

The following agencies have implemented recent initiatives or updates. Select a link to learn more about recent developments from the different agencies:

• SIIA Releases Health Care Reform Blueprint
• URAC Announces Three New Pharmacy Accreditation Programs
• Social Security and Medicare Changes for 2008
• CMS Revises Medicare Physician Fee Schedule for 2008
• DOL Issues Final Wellness Program Rules

SIIA Releases Health Care Reform Blueprint for the Uninsured

The Self-Insurance Institute of America, Inc. (SIIA) recently released "A Blueprint for Sensible Health Care Reform" to serve as the foundation for the organization's political-advocacy activities in 2008 and beyond.

The detailed plan reduces the number of uninsured Americans and improves efficiency while maintaining the employer-based health system.

The initiative calls for:

• increased competition among insurance providers
• federal legislation to allow small businesses to pool together and purchase health insurance
• tax incentives for small employers and self-employers to encourage them to provide health coverage
• expansion of Health Savings Accounts (HSAs) and Flexible Savings Accounts (FSAs), particularly for early retirees aged 55 to 64

A link to download a PDF of the blueprint can be found at: www.siia.org/i4a/pages/index.cfm?pageid=3892

URAC Announces Three New Pharmacy Accreditation Programs

In January, URAC announced three new pharmacy-accreditation programs under the organization's Pharmacy Benefit Management Accreditation standards. The latest accreditation programs apply to Specialty Pharmacy, Mail Service Pharmacy and Pharmacy Benefit Management (PBM) for Workers' Compensation and Property and Casualty.

Specialty Pharmacy and Mail Service Pharmacy accreditation standards are geared toward organizations that provide comprehensive and individualized pharmacy care and therapy management for chronically ill patients.

Predictions for 2010 indicate Workers' Compensation Pharmacy costs will represent 25 percent of workers' compensation expenses. To deal with these pharmacy costs, URAC has developed accreditation standards that include the following:

• Core Organizational Quality Standards
• Customer Service, Communications and Disclosures Standards
• Pharmacy Distribution Channel Standards
• Drug Management Standards
• P&T/Preferred Drug List Development Standards

URAC plans to announce the first accredited companies in fall 2008.

For more information, please visit: webapps.urac.org/urac_public_comment/pharmacy.html

Social Security and Medicare Changes for 2008

Here is a summary of key changes in 2008 for Social Security beneficiaries and workers, as well as Medicare enrollees.

Social Security changes include increases in:

• payments to handle a 2.3 percent cost-of-living increase
• taxable wage amount from $97,500 to $102,000
• annual exempt amount under the retirement earnings test for beneficiaries who haven't reached normal retirement age (from $12,960 to $13,560)
• earnings needed to receive one coverage credit (from $1,000 to $1,050)

Medicare enrollees will see an increase in:

• inpatient deductible per "benefit period" from $992 to $1,024
• daily coinsurance for days 61-90 of hospitalization during any benefit period from $248 to $256
• coinsurance for each 60 "lifetime reserve" days from $496 to $512
• coinsurance for days 21 to 100 in a skilled nursing facility (SNF) from $124 to $128
• monthly premium for Medicare Part B from $93.50 to $96.40

Some retirees covered by Medicare will pay higher monthly premiums as part of the Medicare Modernization Act. This includes retirees with incomes of more than $82,000 if single or $164,000 if married and filing a joint return. Of this group, those with incomes higher than $205,000 if single or $410,000 if married and filing jointly will pay the maximum premium of $142.00.

Part B premiums will increase over a three-year transition period, while the Part B annual deductible will increase from $131 to $135 in 2008.

For more information, go to: www.newyorklife.com/cda/0,,16429,00.html

CMS Revises Medicare Physician Fee Schedule for 2008

Proposed changes to the Centers for Medicare & Medicaid Services (CMS) rule in Medicare reimbursement to physicians (the Medicare Physician Fee Schedule, or MPFS) would have reduced payments for services by more than 10 percent.

However, the Medicare, Medicaid and SCHIP Extension Act of 2007 temporarily prevented the reduction. Under the extension act, physicians will see a 0.5 percent fee increase for claims from Jan. 1, 2008 through June 30, 2008. Claims for service from July 1, 2008 on will revert back to the final rule of a 10.1 percent reduction in reimbursement.

The new fee schedule for the first six months of 2008 can be accessed at:
Medicare Physician Fee Schedule Look-Up. (Follow the "Schedule Look-up" links at left.)

DOL Issues Final Wellness Program Rules

The Department of Labor (DOL) released a new Field Assistance Bulletin (FAB) 2008-02 to clarify criteria and exceptions for group health plans. This helps group health plans determine if their health-promotion or disease-prevention programs comply with the Department of Labor's Employee Benefits Security Administration's wellness-program rules. The bulletin includes a "Wellness Program Checklist," along with the five criteria required for a program to meet compliance.

The bulletin also addresses exceptions to the HIPAA nondiscrimination provisions that allow insurance plans to vary individual benefits and premiums.

For more details, go to Field Assistance Bulletin (FAB) 2008-02.