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Logo Federal Health Care Reform Update 1Q11 Medical Office WEBINAR March 30, 2011 Kathy C. Nixon, CMA (AAMA), CPC Provider Network Manager (Virginia) Provider.

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Presentation on theme: "Logo Federal Health Care Reform Update 1Q11 Medical Office WEBINAR March 30, 2011 Kathy C. Nixon, CMA (AAMA), CPC Provider Network Manager (Virginia) Provider."— Presentation transcript:

1 Logo Federal Health Care Reform Update 1Q11 Medical Office WEBINAR March 30, 2011 Kathy C. Nixon, CMA (AAMA), CPC Provider Network Manager (Virginia) Provider Engagement & Contracting

2 Logo Thank You! WELCOME ! Please... Mute your phone and keep it muted Do not place this call on HOLD at any time Hold all questions; we will ask you to submit your comments/questions via e-mail for response afterwards Close out your web connection and hang up your phone if you must leave this program

3 Logo Thank You! Disclaimer The information contained in this WEBINAR was current at the time it was published or uploaded. Due to the evolving nature of this subject matter, this information may be subject to change. Anthem will continue to communicate updates on an ongoing basis via our provider newsletters and web portals. Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliated HMO, HealthKeepers, Inc., are independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

4 Federal Health Care Reform Update | Revised Jan. 10, 2011 4 Logo Note: This presentation is not intended to advise you on how to comply with PPACA or its related regulations. This presentation is not intended to offer legal advice. For specific questions, please consult with your counsel or benefits advisor. Today’s Agenda (March 30, 2011) ▪What is Health Care Reform? ▪Our Approach to Implementation ▪Key Provisions for 2010-12 and Beyond Group / Individual / Medicare ▪Spotlight on Preventive Care ▪How to Stay Informed

5 Federal Health Care Reform Update | Revised Jan. 10, 2011 5 Logo Note: This presentation is not intended to advise you on how to comply with PPACA or its related regulations. This presentation is not intended to offer legal advice. For specific questions, please consult with your counsel or benefits advisor. ACRONYMS related to Health Care Reform ▪ACIPAdvisory Committee on Immunization Practices ▪CDCCenters for Disease Control & Prevention ▪CLASSCommunity Living Assistance Services & Supports Act ▪FSAFlexible Spending Account ▪HCRHealth Care Reform ▪HHSU.S. Department of Health & Human Services ▪HRSAHealth Resources & Services Administration ▪PPACAPatient Protection & Affordable Care Act ▪USPSTFUnited States Preventive Services Task Force

6 Federal Health Care Reform Update | Revised Jan. 10, 2011 6 Logo What is Health Care Reform? HHS Issues Interim Final Regulations Implementation Begins HHS Finalizes Regulations The Patient Protection & Affordable Care Act or “PPACA,” which was signed into law by President Obama on March 23, 2010 How is it being Implemented?

7 Federal Health Care Reform Update | Revised Jan. 10, 2011 7 Logo Our Approach to Implementation PUT OUR CUSTOMERS AND MEMBERS FIRST ▪Our mission: Improve the lives of the people we serve and the health of our communities ▪Our implementation strategy: Adjust policies and procedures with the best information available at the time Implement appropriately and consistently across business units Communicate aggressively

8 Federal Health Care Reform Update | Revised Jan. 10, 2011 8 Logo Rate review Rescission requirements Early retiree reinsurance Tax credits for small employers Dependents to age 26 No pre-ex exclusions for children No lifetime limits Restrictions on annual limits Coverage of recommended preventive services* Patient protections (PCP selection, OB-GYN access, ER services)* Consumer appeal process* No benefit differences by employee salary* Reporting cost of health coverage on employees‘ W-2s Minimum medical loss ratios Grants for small employer wellness programs Prescription required for OTC drug reimbursement Increased tax on nonqualified HSA disbursements CLASS program developed (enrollment date TBD) Uniform coverage summaries Standard terms and conditions FSA contributions limited to $2,500/year Tax exclusion for Medicare Part D retiree drug subsidy payments eliminated Quality initiative reporting Employer mandate (with auto- enrollment) Expands small group to 1-100 Insurance exchanges for small group New product framework for small group Free choice vouchers Increased small business tax credit No annual limits Essential Health Benefits mandates *Required for non-grandfathered, but plans may choose to implement for grandfathered Key Provisions: GROUP Health Plans

9 Federal Health Care Reform Update | Revised Jan. 10, 2011 9 Logo Rate review Rescission requirements Dependents to age 26 No lifetime limits Restrictions on annual limits* No pre-ex exclusions for children* Coverage of recommended preventive services* Patient protections (PCP selection, OB-GYN access, ER services)* Consumer appeal process* Minimum medical loss ratios Prescription required for OTC drug reimbursement Increased tax on nonqualified HSA disbursements Uniform coverage summaries Standard terms and conditions Quality initiative reporting Individual mandate Insurance exchanges New product framework Premium subsidies and tax credits for low-income individuals No annual limits Individual health plans “guaranteed issue” No health status rating Essential Health Benefits mandates Key Provisions: INDIVIDUAL Market *Required for nongrandfathered, but plans may choose to implement for grandfathered

10 Federal Health Care Reform Update | Revised Jan. 10, 2011 10 Logo $250 rebate to offset the Medicare Part D “donut hole” Reductions to Medicare Advantage program payments, which may result in reduced benefits and/or increased member cost-sharing No more cost-sharing for preventive services Discounts on prescriptions in the Medicare Part D “donut hole” Subsidies for brand- name prescriptions filled in the Medicare Part D “donut hole” Medicare provider payment changes Pilot programs such as bundled payments for an episode of care Medicare Advantage plan minimum medical loss ratios Key Provisions: MEDICARE

11 Federal Health Care Reform Update | Revised Jan. 10, 2011 11 Logo Plans Not Impacted by HCR In general, these plans are exempted from health care reform: ▪Retiree-only plans with no active employees ▪Short-term health insurance plans ▪Most dental and vision plans (unless built into a basic health plan) ▪Long-term care insurance ▪Medigap (Medicare Supplemental) ▪EAP (Employee Assistance programs)

12 Federal Health Care Reform Update | Revised Jan. 10, 2011 12 Logo Update on 2010 Provisions Grandfathering Allows groups to keep the health plan they had when HCR was passed if they make no changes after March 23, 2010 EXAMPLE: Plans will lose their grandfathered status if they decrease benefits or increase member cost share (deductible or co-insurance), or copays if over a certain amount We are reviewing our plans to determine which plans we consider grandfathered and are notifying them as required by law Newly insured plans sold after March 23, 2010, are NOT grandfathered Federal law doesn’t require us to continue offering a product just because it’s a grandfathered plan; however some states restrict a payer’s ability to close out books of business

13 Federal Health Care Reform Update | Revised Jan. 10, 2011 13 Logo Update on 2010 Provisions (continued) Dependent Coverage to Age 26 No Lifetime Dollar Limits on Essential Health Benefits Restricted Annual Dollar Limits on Essential Health Benefits Implemented early for many plans Business decision to include vision and dental, as well as pharmacy Parents can enroll dependents at their next open enrollment after September 23, 2010, (for group) or during a one-time enrollment period (for Individual) Implemented for all grandfathered and non-grandfathered group and Individual plans starting September 23, 2010 Those who previously reached their lifetime maximum may re-enroll Business decision to not administer restricted annual limits on essential health benefits We’re providing data for employers who want to apply for a waiver

14 Federal Health Care Reform Update | Revised Jan. 10, 2011 14 Logo Update on 2010 Provisions (continued) Essential Health Benefit Categories per HHS Ambulance Ambulatory surgical services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services, including behavioral health treatment NOTE: PPACA includes provisions that eliminate lifetime $ limits and restrict annual $ limits for essential health benefits; Effective upon renewal on or after September 23, 2010, this applies to medical and pharmacy benefits only. Regulations to fully define essential health benefits have not yet been issued, and good faith compliance is required until we receive detailed regulations from HHS. Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services Chronic disease management Pediatric services, including oral and vision care

15 Federal Health Care Reform Update | Revised Jan. 10, 2011 15 Logo Update on 2010 Provisions (continued) Preventive Care Patient Protections We’ve reviewed the USPSTF/HRSA/ACIP recommendations to determine services we are required to cover We’ve updated non-grandfathered plans to cover preventive services with no member cost sharing Some grandfathered plans may voluntarily implement this provision; we chose to include this coverage in some grandfathered plans Give consumers more flexibility in choosing a primary care doctor and accessing OB-GYN services Insurers must cover out-of-network emergency medical care received in an ER; copays and coinsurance for these services cannot exceed those required for in-network emergency care We chose to include these provisions in all plan offerings, even though they aren’t required for grandfathered plans

16 Federal Health Care Reform Update | Revised Jan. 10, 2011 16 Logo Preventive Care Who, What, When, Where ? Anthem (VA) already had a Preventive Services list, which was expanded to include the HCR compliant preventive services effective September 17, 2010 Grandfathered plans are not required to implement the new HCR Preventive Care provision if they retain the preventive coverage they already have Non-grandfathered plans are required to include it with no member cost- sharing; however, the change from cost-share to no cost-share does not occur until the renewal date for existing policies --- this is not “One Size Fits All” Verification of eligibility and benefits for every patient is key to determining correct member cost share; use of Point of Care is even more critical to provider practices

17 Federal Health Care Reform Update | Revised Jan. 10, 2011 17 Logo POINT of CARE Benefit Screen Point of Care EXAMPLE: HMO “Jane Doe” Benefit Screen NOTE: PCP OV Copay $25 PCP OV (Preventive) is $0

18 Federal Health Care Reform Update | Revised Jan. 10, 2011 18 Logo POINT of CARE Benefit Screen Point of Care EXAMPLE (continued) Select PREVENTIVE from dropdown box and VIEW; NOTE: $0 copay and 0% coinsurance for all Preventive Services

19 Federal Health Care Reform Update | Revised Jan. 10, 2011 19 Logo Navigating Anthem’s Provider Portal ▪Provider information regarding HCR is featured in our Network Update bi-monthly provider newsletters ▪HCR articles specific to providers are also being posted to a dedicated HCR section of our website ▪The following are screen prints taken from the Virginia open provider portal of www.anthem.comwww.anthem.com Codes for Preventive Services Where to Find Updates on-line

20 Federal Health Care Reform Update | Revised Jan. 10, 2011 20 Logo www.anthem.com

21 Federal Health Care Reform Update | Revised Jan. 10, 2011 21 Logo Virginia; then Enter

22 Federal Health Care Reform Update | Revised Jan. 10, 2011 22 Logo HORIZONTAL Navigation VERTICAL Navigation

23 Federal Health Care Reform Update | Revised Jan. 10, 2011 23 Logo Provider Home; Preventive Codes

24 Federal Health Care Reform Update | Revised Jan. 10, 2011 24 Logo HCR- VA Preventive Care Code List

25 Federal Health Care Reform Update | Revised Jan. 10, 2011 25 Logo Notice TABS at bottom of screen for ease in finding code(s) by category

26 Federal Health Care Reform Update | Revised Jan. 10, 2011 26 Logo

27 Federal Health Care Reform Update | Revised Jan. 10, 2011 27 Logo

28 Federal Health Care Reform Update | Revised Jan. 10, 2011 28 Logo Provider- The “DIAG Codes” tab is currently the last tab of this listing; however, we plan to add a “Modifiers” tab at our next revision to include “PT” and “33”

29 Federal Health Care Reform Update | Revised Jan. 10, 2011 29 Logo HEALTH CARE REFORM Provider-centric information being Posted “prn” by corporate Provider Communications – Please check here periodically For the latest addition to this “library”.

30 Federal Health Care Reform Update | Revised Jan. 10, 2011 30 Logo

31 Federal Health Care Reform Update | Revised Jan. 10, 2011 31 Logo NEW! HCR Article for March

32 Federal Health Care Reform Update | Revised Jan. 10, 2011 32 Logo NEW WAY TO RECEIVE ANTHEM NEWS! Requires you to register on-line to receive “prn” time-sensitive e-mails of importance for providers.

33 Federal Health Care Reform Update | Revised Jan. 10, 2011 33 Logo NEW! Please Sign-Up TODAY!

34 Federal Health Care Reform Update | Revised Jan. 10, 2011 34 Logo Thank You! CONCLUSION This concludes our WEBINAR program for the 1 st quarter of 2011. We hope you found the information helpful and that your time today was well spent. If you wish to comment about your experience today and/or if you have questions specifically regarding today’s topic, please submit an e-mail with “Anthem 3/30/11 Webinar: HCR” in the subject line to: kathy.nixon@anthem.com kathy.nixon@anthem.com (Remember to include your detailed contact information.) Thank You! Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliated HMO, HealthKeepers, Inc., are independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.


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