Blue Moon Benefits Group

Hospital Treatment Costs to Become Transparent?

blue_moon_benefits — Fri, 10 May 2013 13:21:48 +0000

This has been a long time coming. Making the cost for treatments transparent makes a lot of sense. Here is the article… http://www.charlotteobserver.com/2013/05/09/4032678/senate-passes-bill-to-make-hospitals.html

Healthcare Reform Informational Video

blue_moon_benefits — Wed, 08 May 2013 14:58:15 +0000

Below is an informative video produced by BCBSNC that helps shed some light on the Affordable Care Act (ACA) and what to expect later this year…

Small Employer SHOP Exchange Delayed

blue_moon_benefits — Tue, 02 Apr 2013 13:19:33 +0000

A major part of the proposed SHOP exchange for small employers has been delayed until 2015. Although the new SHOP exchange will still begin on January 1st, a major part of it (employee choice) will not begin until January 1, 2015. This decision is due to “operational challenges” that prevent the program from being ready on time for the original launch date of January 1, 2014. See article here…SHOP Exchange Delayed

Medicare Advantage Plans Get Payment Boost for 2014

blue_moon_benefits — Tue, 02 Apr 2013 12:49:21 +0000

This is great news for the Medicare Advantage program and for those seniors that currently have a BCBSNC Medicare Advantage plan. CMS reversed course Monday and said it now anticipates boosting rather than cutting payments to insurers who offer Medicare Advantage plans. What was going to be a 2.2% cut in reimbursement rates is now going to be a 3.3% increase in reimbursement rates. See article here…Medicare Advantage Plans Get Reimbursement Payment Boost

Healthcare Reform Guide

blue_moon_benefits — Thu, 14 Mar 2013 18:07:20 +0000

Questions about what the new Healthcare Reform law may mean for you? As you’ve probably heard, there are changes happening these day to healthcare and how how insurance will work. Blue Cross and Blue Shield of North Carolina® has an easy to use interactive guide that is sure to help. Whether you are an individual or run a business, this guide will help answer your questions. Click here… Ask Blue Reform

Medicare Premiums To Rise By $5 A Month In 2013

blue_moon_benefits — Mon, 19 Nov 2012 12:56:44 +0000

from NAHU News…
The AP (11/16, Alonso-Zaldivar) reported Medicare premiums “are going up $5 a month in 2013, the government said Friday. It’s less than expected, but still enough to eat up about one-fourth of a typical retiree’s cost-of-living raise next year. Medicare chief Marilyn Tavenner said the new ‘Part B’ premium for outpatient care will be $104.90 a month. In most cases, it’s deducted directly from a beneficiary’s monthly Social Security check. Currently the premium is $99.90 a month.”
Modern Healthcare (11/16, Zigmond, Subscription Publication) reported, “The Medicare Rights Center, an advocacy group, issued a statement that said Friday’s announcement should remind lawmakers during deficit-reduction negotiations that seniors and persons with disabilities already pay a lot for healthcare.” The Wall Street Journal (11/19, Radnofsky, Subscription Publication) and CQ (11/19, Subscription Publication) also reported the story.

US Supreme Court Upholds Affordable Care Act

blue_moon_benefits — Fri, 29 Jun 2012 11:33:58 +0000

Here is a detailed analysis of today’s Supreme Court ruling, courtesy of our retained counsel for NAHU, Ernst & Young:
US Supreme Court Upholds Affordable Care Act
The US Supreme Court today (June 28, 2012) upheld the Affordable Care Act (ACA), ruling that the law’s individual mandate is a constitutional exercise of Congress’s power to impose taxes. With the Court’s decision, compliance efforts likely will move ahead at full speed with major provisions of the ACA becoming effective in 2013 and 2014.
In a 5-4 decision, Chief Justice Roberts, joined by Justices Ginsberg, Breyer, Sotomayor and Kagan, concluded, “The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax. Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.”
In the Court’s analysis of the ACA’s Medicaid provisions, it held that it would be unconstitutional for the federal government to withhold all Medicaid funding in order to force states to comply with the Medicaid expansion. Chief Justice Roberts wrote, “Nothing … precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.”
The Court ruled that the Anti-Injunction Act, which limits lawsuits challenging a tax before it is assessed, does not apply because Congress specifically provided that the penalty payment enforcing the individual mandate would not be treated as a “tax.” Notwithstanding acceptance of Congress’s penalty label for purposes of application of the Anti-Injunction Act, the Court ruled that for purposes of determining whether the individual mandate is constitutional, the penalty payment falls within Congress’s general power to tax and, therefore, is upheld.
The decision arises from cases brought by the state of Florida (and joined by 25 other states), the National Federation of Independent Business, and several individuals challenging the constitutionality of the individual mandate and the Medicaid expansion. The cases were later consolidated.
In their dissent, Justices Kennedy, Scalia, Thomas and Alito wrote that the law should have been struck down in its entirety.
With the exception of the limitation on the federal government’s authority to withhold Medicaid funding, all provisions of the ACA stand and compliance efforts likely will move ahead at full speed. In preparation for the major coverage expansion to occur under the ACA in 2014, the Administration is expected to release a host of regulations dealing with the definition of minimum essential coverage, employer coverage and reporting requirements, and an array of new taxes and fees. Clients should be aware of provisions of the law set to take effect in 2013 and 2014, including those listed in the table below.
Provisions of the Affordable Care Act That Take Effect in 2012, 2013 and 2014
2012 • Medicare hospital value-based purchasing program
• Increase in physician quality reporting requirements in Medicare
• Additional Medicare pilot programs on alternative payment methodologies, e.g., accountable care organizations
• Increased requirements for hospitals to maintain not-for-profit status
• Fees from insured (including self-insured) plans transferred to the Patient-Centered Outcomes Research Trust Fund
2013• Increase Medicare payroll tax by 0.9% on high-income earners
• Impose a 3.8% tax on net investment income of high-income individuals
• $500,000 cap on health insurers’ deduction for executive compensation
• Eliminate employer deduction for Medicare Part D subsidy
• FSA limitations
• Excise tax on medical device manufacturers and importers
• Medical expense deduction floor increases to 10%
• Nationwide bundled payment pilot begins in Medicare
• Increased Medicaid reimbursement for primary care
• Medicare physician comparison data available to the public
• Reductions in Medicare payments for select hospital readmissions
• Expanded coverage of preventive services by Medicaid
2014• Employer mandate and individual mandate
• Employer and insurer reporting requirements
• New health insurance market reforms take effect
• State health insurance Exchanges established
• Premium tax credits and cost-sharing subsidies available to certain individuals in Exchange insurance products
• Medicaid expansion to new populations (100% federal match to states for newly-eligible populations through 2016)
• Annual fee on health insurers
• Medicare/Medicaid DSH payment cuts begin
• Independent Payment Advisory Board (IPAB) issues first report to Congress if Medicare spending exceeds growth target
Post-2014
• Excise tax on high-cost employer-sponsored coverage (2018)
Political reactions The Court’s ruling will not end the political debate over health care, which will remain a central issue in the 2012 elections and beyond. The law stands as the centerpiece of the domestic record of President Obama, who today said, “Whatever the politics, today’s decision was a victory for people all over this country whose lives will be more secure because of this law and the Supreme Court’s decision to uphold it.” The President added, “With today’s announcement it is time for us to move forward to implement and, where necessary, to improve this law.”
In comments in response to the ruling, presumed Republican presidential nominee Gov. Mitt Romney said, “What the Supreme Court did not do on its last day in session, I will do in my first day in office. I will act to repeal Obamacare.”
Following the release of the decision, House Majority Leader Eric Cantor (R-VA) announced that the House on July 11 will hold a vote on legislation to repeal the ACA in its entirety. The measure likely will pass the Republican-controlled House, but it is unlikely to advance in the Democratic-controlled Senate.
Repeal of the ACA has been a primary focus of congressional Republicans and remains a central objective of many Republicans’ campaigns in the November elections. Efforts to repeal all or part of the law will remain difficult unless Republicans maintain control of the House, win the presidency, and win at least a majority in the Senate in the November 2012 elections.
Republicans to date have not coalesced around a proposal to replace the ACA. Further efforts to control rising health care costs, including reforms to federal health entitlement programs and health-related tax expenditures, will be at the center of budget and deficit-reduction debates that are expected to dominate Washington after the November elections.
Background on the law
The Affordable Care Act was enacted in March 2010; it comprises the Patient Protection and Affordable Care Act of 2010 (which President Obama signed on March 23, 2010) and the Health Care and Education Reconciliation Act of 2010 (which the President signed on March 30, 2010).
The primary goals of the ACA are to: (i) expand coverage to an estimated 32 million Americans without health insurance; (ii) reform the delivery system to improve quality and drive efficiency; and (iii) lower the overall costs of providing health care.
To accomplish the goal of expanding coverage, the ACA mandates that all Americans maintain a minimum level of health coverage (the so-called individual mandate) or face a tax penalty. The law expands Medicaid coverage and provides federal premium tax credits and cost-sharing subsidies to assist low and moderate income individuals without affordable employer-sponsored insurance in obtaining health insurance through state-based insurance Exchanges. The ACA mandates, for the first time, that employers with 50 or more full-time employees provide certain minimum benefits or pay penalty fees.
The law also implemented insurance market reforms, including a ban on exclusions for pre-existing conditions, premium rate restrictions, extension of dependent coverage through age 26, and mandatory coverage of preventive services.
A mix of Medicare and Medicaid reimbursement cuts; provisions to reduce fraud, waste, and abuse in those public programs; other delivery system reforms; and a series of tax increases on individuals, corporations and the health industry are used to offset the cost of the law.
For more information
A video highlighting key elements of the Supreme Court’s decision will be available on www.ey.com.
An Ernst & Young Thought Center webcast discussing the ruling’s implications for individuals, employers, and health care providers has been scheduled for July 17. Follow this link to register.
Any U.S. tax advice contained in the body of this e-mail was not intended or written to be used, and cannot be used, by the recipient for the purpose of avoiding penalties that may be imposed under the Internal Revenue Code or applicable state or local tax law provisions.

Healthcare Reform Law’s Fate Uncertain…

blue_moon_benefits — Wed, 28 Mar 2012 12:09:44 +0000

Healthcare Law’s Fate Uncertain After Sharp Questioning From Supreme Court Justices.Media reports and analyses last night and this morning portray the Supreme Court as leaning towards ruling against the constitutionality of the Affordable Care Act. Yesterday’s hearing generated widespread coverage on both TV and print. However, only the CBS Evening News, among the three network newscasts, led with the court hearing.
According to Brian Williams, on NBC Nightly News (3/27, story 2, 3:05), “A lot of the experts have been predicting that the law would probably stand, but after today, all bets are off.” On the CBS Evening News (3/27, lead story, 4:40, Pelley) Jan Crawford said, “The healthcare law is considered President Obama’s signature achievement, but…it appeared a majority of the Justices were ready to describe the individual mandate another way — unconstitutional.”
According to the Washington Post (3/28, Fahrenthold, Aizenman), “By the end of Tuesday’s long-awaited oral arguments, the individual mandate…seemed to be in trouble.” Adam Liptak, in a front-page article for the New York Times (3/28, A1, Subscription Publication), also says “the available evidence indicated that the heart of the Affordable Care Act is in peril.” Liptak continues, “If the indications from Tuesday’s arguments are correct…the ruling may undo parts or all of the overhaul of the health insurance system, deal Mr. Obama a political blow in the midst of the presidential election season, and revise the constitutional relationship between the federal government and the states.”
Justice Kennedy gets the lion’s share of the attention, and “skeptical” is, by far, the adjective most often used to describe the tone of his questioning. A Los Angeles Times (3/28, Savage, Levey) headline reading “Skeptical Kennedy Signals Trouble For Obama’s Healthcare Law” is a concise summation of the day’s analysis.
In an analysis touted on the Drudge Report Tuesday, The Hill (3/27, Strauss) reported New Yorker legal analyst Jeffrey Toobin, on CNN (3/27, 12:07 PM EST), described the hearing as a “trainwreck for the Obama administration,” and Kennedy as “enormously skeptical.” Toobin added, “This law looks like it’s going to be struck down. … All of the predictions, including mine, that the justices would not have a problem with this law were wrong.” Toobin also claimed Solicitor General Donald Verrilli “did a simply awful job,” characterizing Verrilli as “nervous,” and “not well spoken.”
On NBC Nightly News (3/27, story 2, 3:05, Williams), NBC’s justice correspondent Pete Williams reported, “It does seem the majority of the justices are skeptical that Congress has the power to pass such a sweeping law.”
David Leonhardt, in an analysis for the New York Times (3/28, Subscription Publication), says, “Many legal scholars, including some conservatives, have been predicting that the Supreme Court will uphold” the ACA, but “after Tuesday’s arguments, when several justices asked skeptical questions about the heart of the law, a political lens seemed relevant, too. … Skeptical questions from the bench are often an indicator of how justices will ultimately vote — and many court experts expressed surprise at the apparent agreement among the conservatives, including” Kennedy.
Bill O’Reilly, in his opening monologue for Fox News’ The O’Reilly Factor (3/27), said “most of the justices” were “openly skeptical about the power needed to impose Obamacare.” O’Reilly added that “the consensus is” Verrilli “did not make a strong argument.”
Roll Call (3/28, Dennis, Drucker, Subscription Publication) quotes Senate minority leader Mitch McConnell as saying, “It was noteworthy that the four more liberal members of the court were mainly peppering the plaintiffs and the other five were mainly peppering the government, leading us to hope this awful law will be overturned.” Sen. Ron Johnson added, “I was encouraged that they were asking the right questions.”
Fox News’ Special Report (3/27, lead story, Bream) reported Kennedy “unleashed an unexpectedly candid assessment of the individual mandate today that has supporters terrified the Affordable Care Act could be toast.”
The Wall Street Journal (3/28, Kendall, Subscription Publication), in an article titled, “Kennedy Leaves Both Sides Hopeful,” says some liberal analysts are still hopeful that Kennedy will side with the Administration.
NBC’s Pete Williams, on CNBC’s The Kudlow Report (3/27), said, “It’s quite clear the four conservatives…believe this law is unconstitutional, and it’s equally clear that the four liberal members of the court…would vote to uphold it. … But tonight I think the future of the healthcare law is very much in doubt.” Williams, on MSNBC’s Hardball (3/27, Matthews), added, “It wasn’t a great day for the administration. … It’s quite clear they didn’t pick up any of the conservatives,” which means “the question comes down to” Kennedy, and “for most of the questioning…he showed great skepticism.”
The CBS Evening News (3/27, lead story, 4:40, Pelley) reported that the Administration “says the mandate will make sure that everyone has health care, while keeping insurance affordable, but opponents say it is a dangerous new power for the government, forcing citizens to buy a product.” CBS’s Jan Crawford added, “The conservative Justices and Kennedy, a moderate, expressed concerns the law gave Congress broad new powers to dictate behavior,” while “all four of the Court’s liberal Justices defended the law.”
McClatchy (3/28, Doyle, Lightman) reports that the justices “cast serious doubts on the Obama administration’s signature health care law Tuesday, emboldening the Republicans who now are eagerly campaigning to kill it.” According to McClatchy, Solicitor General Verrilli “stressed…that the 40 million uninsured Americans posed what he called ‘an economic problem’ that Congress is empowered to fix.” McClatchy adds, “In a potentially sobering sign for the Obama administration, even [Kennedy] the justice most commonly considered to be a swing vote made pointed observations about the insurance-buying mandate.”
The Washington Post (3/28, Barnes, Aizenman) says Kennedy “suggested” that the Affordable Care Act “invoked a power ‘beyond what our cases allow’ the Congress to wield in regulating interstate commerce.” Paul Clement, “the former George W. Bush administration solicitor general representing 26 states challenging the law, picked up on that theme, saying the government was defending an ‘unprecedented’ act by Congress with no limiting principle.”
The Los Angeles Times (3/28, Savage, Levey) notes Kennedy “described it as ‘unprecedented’ for the federal government to impose an ‘affirmative duty’ on people to buy a product.” According to the Times, “In his closing argument, Verrilli urged the justices to defer to the choices made ‘by the democratically accountable branches of government,’” but “the court, which has five Republican appointees, did not sound as though it was inclined to do so.”
Mike Sacks, in the Huffington Post (3/28), reports, “From the very start, things did not go well for the government’s argument that” the mandate is “constitutional.” Sacks says Verrilli “began his argument not with his usual calm and clear delivery, but rather with a case of coughs that seemed to take him off his game. And just as he was starting to recover his composure,” Kennedy “asked, ‘Can you create commerce in order to regulate it?’” which “adopted the framing of the case put forward by those challenging the mandate.”
The Wall Street Journal (3/28, Bravin, Subscription Publication) notes Justice Scalia said the Administration’s argument was akin to saying: “Everybody has to buy food sooner or later, so you define the market as food, therefore, everybody is in the market. Therefore, you can make people buy broccoli.”
USA Today (3/28, Wolf, Heath) says the “conservative justices suggested they might be willing to send lawmakers back to the drawing board just months before a presidential election. … Inside the courtroom…the most significant law signed by Obama came under sharp attack by justices appointed by his Republican predecessors. Outside, hundreds of demonstrators packed onto the sidewalk in front of the marble courthouse, shouting over each other.”
According to Politico (3/27, Brown, Gerstein, Haberkorn), “Before the arguments, many court watchers said they expected the law would be upheld, and a few even predicted that as many as eight justices would back the constitutionality of the mandate.” But “after the session, court watchers said a 5-4 decision along partisan lines striking down the mandate was a distinct possibility — harkening back to other politically divisive, sharply divided rulings from the court, such as Bush v. Gore in 2000.”
Sam Baker, in a post for The Hill (3/27), wrote, “The sense of a possible election-year defeat in the courtroom for the president’s signature domestic achievement was unmistakable.”
However, on NBC Nightly News (3/27, story 3, 1:30, Williams), legal correspondent Savannah Guthrie said, “Oral arguments are not always an indicator of where the court will come out,” and noted that in “the DC circuit, very conservative judges grilled the government’s lawyers,” but, “ultimately those conservative judges were in the majority upholding the healthcare law.”
The Washington Times (3/28, Cunningham) reports, “The justices also posed rigorous questions to…Clement and Michael Carvin, attorneys for the National Federation of Independent Businesses and 26 states, probing for answers to why they say the government can’t require Americans to buy coverage ahead of time to pay for their own health care. … ‘When you are born, and you don’t have insurance, and you will in fact get sick, and you will in fact impose costs, have you perhaps involuntarily — perhaps simply because you are a human being — entered this particular market?’ Justice Stephen Breyer asked Mr. Carvin.”
Also reporting on the hearing are the AP (3/28, Sherman), Roll Call (3/28, Dennis, Drucker, Subscription Publication), the National Journal (3/28, Khan, Friedman, Subscription Publication), CQ (3/28, Norman, Subscription Publication), NPR (3/28, Totenberg) “Shots” blog, the Huffington Post (3/28, Young), Forbes (3/28, Fisher), the Detroit Free Press (3/28, Spangler), HealthDay (3/28, Esposito), Medscape (3/28), MedPage Today (3/28), WebMD (3/28, Lowes), and Modern Healthcare (3/28, Subscription Publication).

New Ryan Plan Reignites Political Debate Over Spending, Medicare…

blue_moon_benefits — Wed, 21 Mar 2012 12:55:02 +0000

New Ryan Plan Reignites Political Debate Over Spending, Medicare.
House Republicans offered a budget plan yesterday which they said would reduce federal spending by over $5 trillion over the next ten years. The plan is getting a great deal of coverage in today’s newspapers – though it was not mentioned on the network newscasts last night. Most of the coverage portrays the plan as an election-year tactic by Republicans to draw contrasts between themselves and Democrats on fiscal issues. Many stories also report on the fierce criticism of the plan from the White House and congressional Democrats who say the proposal would bring an end to Medicare and punish the poor and the middle-class while protecting the wealthiest Americans.
Fox News’ Special Report (3/20, lead story, Baier) reported Rep. Paul Ryan, “the Republicans’ point man on money matters…unveiled his latest plan to try to make the federal books a little less unbalanced.” Ryan “proposed a sweeping reform of everything from taxes to Medicare today as part of the new Republican budget plan. And he began with a GOP favorite.” Ryan: “First, we propose that we repeal the President’s disastrous healthcare law.”
Also on Fox News’ Special Report (3/20, Baier), Ed Henry reported that the White House is “again charging, as they did last year, that the Ryan budget would end Medicare as we know it, even though it’s gone through some changes. Last year, it was a full privatization of Medicare, this year it’s just a partial privatization. Despite that tweak, White House officials like [NEC director] Gene Sperling today, basically said, ‘this will wipe out traditional Medicare.’” Sperling: “Death spiral is the term that is used in insurance for exactly for this process where adverse selection pulls out people and leaves those in the pool facing higher and higher costs.”
The New York Times (3/21, Weisman, Subscription Publication) reports that the proposal reflects Republicans’ “vision of a smaller government, a flatter tax code and a free-market Medicare system.” The Times says Republicans are “banking that fears over surging federal deficits will trump longstanding voter allegiances to popular government programs.” The plan would “reshape Medicare into a system of private insurance plans, shrink programs for the poor and turn them over to state governments, and try to simplify the tax code for individuals and businesses.” It also calls “reducing spending below the cap agreed to in last year’s debt limit deal, raising the prospect of a tense fiscal clash just a month before the election.”
The Washington Times (3/21, Cunningham) reports that the proposal is “the third such GOP plan in the past month to try to change Medicare, and it runs smack into the White House and congressional Democrats, who say the GOP is tangling with an issue that will cost them votes in November.” While Ryan “revised key elements of his Medicare plan from last year,” he “still proposes having the federal program compete with private plans and giving seniors a voucher to choose the plan they like.” The Times notes that while all sides agree that Medicare needs changes, “Republicans and Democrats are struggling to find any common ground over how to make it sustainable.”
The Washington Post (3/21, Helderman, Montgomery) calls the plan a “bold but risky election-year marker,” that congressional Republicans “plan to use the document to demonstrate their willingness to tackle the nation’s difficult fiscal problems head-on.” The Post adds that the plan, which would cut federal spending by $5.3 trillion over the next decade, “provided new fodder for Democrats, who argued that Republicans would slash the social safety net while protecting the rich.” House Budget Committee chairman Paul Ryan “says he will stage a vote on the plan in the House Budget Committee on Wednesday, and that he has the necessary support to move it to the House floor.”
USA Today (3/21, Davis) reports that Ryan said the plan is “philosophically rooted in reducing Americans’ reliance on the federal government.” He “acknowledged and dismissed the political risks of voting on a non-binding proposal for sweeping changes to popular programs in an election year,” saying, “If we simply operate based on political fear, nothing is ever going to get done.”

2013 BCBSNC Prescription Claim Form

blue_moon_benefits — Thu, 01 Dec 2011 02:51:19 +0000

2013 BCBSNC Prescription Claim Form