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LEG REG REVIEW 2010, 22nd Issue August 9

Aug 9

Posted by GPAHUAdmin in Legislative | No Comments

LEG REG REVIEW is a periodic newsletter produced by PHILLIPS ASSOCIATES, a professional lobbying and consultant firm located near the State Capitol.  It contains news on the legislative and regulatory scene in Pennsylvania that may be of interest to the Insurance and Business Communities.  It is a free member benefit for those who are members of the Pennsylvania Association of Health Underwriters (PAHU) or Manufacturers Association of South Central PA (MASCPA).  Subscription information may be obtained by contacting PHILLIPS ASSOCIATES at 717/728-1217 FAX 717/728-1164 or e-mail to xenobun@aol.com.  Please email jtrout2792@aol.com supplying both your name and e-mail address if you wish to be removed from this list.

HHS SEEKS INPUT ON EXCHANGE DESIGN

In the August 3 Federal Register, the Department of Health and Human Services announced that it was seeking public input as to how the Exchanges and “Navigators” created by the Patient Protection Affordable Care Act would operate.  Comments must be received by October 4 at http://www.regulations.gov referencing Docket ID-HHS-OS-2010-0021 Planning and Establishment of State-Level Exchanges Request for Comments in Title 1 of the Patient Protection Affordable Care Act.  Hard copy submissions go to Honorable Kathleen Sibelius, Room 445-G, Hubert Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201.

RISK POOL OPERATIONAL

The PA Insurance Department announced that half the available slots for a PA High Risk Pool were applied for within the first 24 hours of a new program offering.  Dubbed “Fair Care”, the plan uses federal money from the Patient Protection Affordable Care Act to fund 3,500 medically uninsurable adults until 2014.  The plan is not without controversy with the PA Association of Health Underwriters (PAHU) charging that the Governor bypassed the General Assembly which has (or had) the authority to create programs.  HB 2514 and SB 507 were ignored as the Rendell Administration decided that it had the authority to create a new program without the legislature being involved.

PAHU also accused the Administration of ignoring the law regarding producer licensing as the High Risk Pool plan uses direct consumer Internet applications.  Another potential issue is what becomes of medically uninsurable individuals who apply but can’t get in.  They would be put on a waiting list similar to the adultBasic waiting list.  This may spill over into the legislative arena as some legislators such as House Majority leader Todd Eachus (D-Luzerne) seek to force the Blues into another Community Reinvestment Agreement where they dedicate some of their reserves to fund state programs for the uninsured.

INSURANCE BILL SIGNED INTO LAW

An omnibus insurance bill was signed into law by Governor Rendell as Act 51 of 2010.  House Bill 1251 (Costa-D-Allegheny) started out as a long-term care insurance bill but was amended during the legislative process to include a number of other areas.  (Text available at www.legis.state.pa.us) The new law:

  • Spells out how a person covered by a long-term care insurance policy or his/her representative may appeal an insurer’s decision that a benefit trigger is not met.  It says that the insurer must explain in plain language why it feels the benefit trigger was not met; an appeal must be filed in 180 days; an independent review process may come into play if the initial review sides with the insurer; the Insurance Department shall credential these independent review organizations
  • Extends PA’s mini-COBRA (groups 2-19 lives) to fifteen months if the Federal Government reinstitutes a COBRA subsidy such as that provided by ARRA (Stimulus Package)
  • Provides life insurer rules on assets and investments into such things as derivatives

LEGISLATIVE NOTES

  • Former Representative Elinor  (E.Z.) Taylor (R-Chester) passed away in Florida at the age of 89 on July 27. Elected in 1976, she was the former Caucus Secretary for the House GOP .  PERSONAL NOTE: She was a legislator of the old school, trying to broker a health insurance compromise in the contentious days of the Clinton health plan regarding what a minimum benefit package should be.  She was also recognized for her work to enhance the quality of post-high school education in the Commonwealth.
  • Rep. Barbara McIlvane-Smith (D-Chester) had a change of heart in deciding to run for re-election after all.  She had earlier opted not to, citing the inherent difficulties faced by reformers in Harrisburg.
  • Up and coming Democratic Senator Sean Logan (Westmoreland/Allegheny) is vacating his Senate seat for a private sector job August 24.  Rep. Marc Gergely (D-Allegheny) is expected to seek that seat.

BUDGET BRINGS GOOD NEWS, BAD NEWS TO PENNSYLVANIA

The U.S. Senate vote last week providing additional Medicaid money to states is good news for PA since the FY 2010-11 Budget includes this $850 million assumption.  This is good news in that Governor Rendell said that thousands of state workers could be laid off if the money was not forthcoming.  It’s not without a bad side however.  New Federal money to PA will only be $600 million, leaving Rendell with the task of cutting $250 million from the new state budget.  Adding to this fiscal stress  is the $240 million-plus hole in transportation funding because tolling I-80 was rejected by the Federal Government, the $801 million MCARE money used for last year’s budget that the courts said was taken improperly and a looming pension crisis coupled with the fact that Stimulus Package money goes away after this FY.

PHILLIPS ASSOCIATES CE UPDATE

PHILLIPS ASSOCIATES has announced what it calls its ‘Summer Sizzler’ round of continuing education in August and early September.  (Details at 717/732-7255) These four-credit courses include:

-       Health Insurance Public Policy Issues in Towanda August 31 and Lancaster September 2

-       Insurance Privacy Compliance in Towanda August 31 and Lancaster September 2

-       D&O in Warren September 1

-       Workers’ Compensation in Warren September 1

-       Commercial Insurance Flash Points in Wilkes-Barre August 26

-       E&O in Depth in Wilkes-Barre in Wilkes-Barre August 26

INDUSTRY NOTES

  • SPARKS Clinics are now approved in Pennsylvania, Maryland, and Delaware for four CE credits.  Spanning nine locations from September 13-24, SPARKS attracts about 600 agents annually.  The Clinics are sponsored by Mutual Insurance Companies seeking to remind agents that they are a viable choice in meeting consumer insurance needs.  Details: www.sparksclub.com .
  • Pennsylvania agency Johnson Kendall Johnson of Newtown, PA was featured in the August 2010 Rough Notes magazine.
  • NAIC is looking at life insurance retained asset accounts (RAAs) according to a July 27 release from the regulators’ organization (www.naic.org ). While stating that RAAs have generated few complaints, NAIC wants to make sure that consumer disclosures are adequate.  PA legislation may be introduced by Rep. Robert Matzie (D-Allegheny).

FLOOD INSURANCE NEWS

The National Flood Insurance Program (NFIP) announced that October 1 Manual changes are now available (http://www.nfipservice.com/stakeholder/pdf/bulletin/w-10079.txt ).

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LEG REG REVIEW 2010, 16th Issue June 7

Jun 8

Posted by GPAHUAdmin in Legislative | No Comments

LEG REG REVIEW is a periodic newsletter produced by PHILLIPS ASSOCIATES, a professional lobbying and consultant firm located near the State Capitol.  It contains news on the legislative and regulatory scene in Pennsylvania that may be of interest to the Insurance and Business Communities.  It is a free member benefit for those who are members of the Pennsylvania Association of Health Underwriters (PAHU) or Manufacturers Association of South Central PA (MASCPA).  Subscription information may be obtained by contacting PHILLIPS ASSOCIATES at 717/728-1217 FAX 717/728-1164 or e-mail to xenobun@aol.com.  Please email jtrout2792@aol.com supplying both your name and e-mail address if you wish to be removed from this list.

BUDGET TIME IN HARRISBURG
Last week the Governor and leaders of the General Assembly met for the first time to formally begin the negotiations process which will result in the Budget for the fiscal year beginning July 1, 2010.  The outlook for completion of the process by the constitutional requirement of June 30 is unlikely given that:

  • The budget has not been on time for the last seven years.
  • The Governor vowed again to fight for an increase in government spending for education.  Education spending increases have been the theme of Governor Rendell’s tenure in office.
  • Although the PA House passed Gov. Rendell’s Budget proposal on a party-line vote, Senate Republicans pronounced it as dead on arrival, preferring to hold the line of spending at $27.5 billion instead of the $29 billion-plus sought by the Governor.
  • Worse yet, budgetary assumptions included in Rendell’s Budget are flawed given:

-    The $450 million-plus assumed for highways from tolling I-80 was knocked out by the Federal Government denial of  the request
-    $850 million in welfare monies must be approved by the US Congress, something not happening yet
-    $801 million in this fiscal year budget struck down by the courts because of a ruling that MCARE and the MCARE Provider Retention Account money was illegally diverted to the General Fund.

  • Money has to be found for THIS fiscal year.  The budget shortfall (revenues coming in lower than expected) means that at least $1.2 billion must be found between now and June 30 to close the books on this year.  In April, collections were $390 million lower than expected, dismaying because April is supposed to be one of the most productive tax months.  As of April 30, collections to date were $22.8 billion with only two months left to go in this budget cycle.
  • The state must reimburse $15 million to the Federal Government that was overpaid to the PA Department of Public Welfare. Another $6.5 million claim is pending.

Another budgetary development of interest to insurance producers, accountants, realtors and other professional groups is that Governor Rendell backed off from his proposal to impose the state sales tax on additional professional services.

DEPARTMENT SUBMITS RISK POOL PROPOSAL TO HHS
On June 1, the PA Insurance Department submitted a proposal to HHS to run the state’s Risk Pool for uninsured and medically uninsurable adults.  It envisions $160 million spent on just over 5,000 individuals between now and 2014.  It does not reference any role for agents pro or con in the marketing and outreach component except for lumping agents, insurers and legislators as one outreach category.  It does not specify that marketing shall be compliant with Act 147, the Producer Licensing Law.  The Pennsylvania Association of Health Underwriters (PAHU) is considering the filing of a complaint to the Attorney General and is reminding the General Assembly that authorizing legislation (SB 507 and HB 2514) appears to be side-stepped by the Rendell Administration.

CONKLIN IS LT. GOVERNOR NOMINEE
Rep. Scott Conklin (D-Centre) is the official running mate for Democratic Governor candidate Dan Onorato.  He had led in the primary by just a few thousand votes but his opponent waived off a recount because the numbers, although close, were insurmountable.

FEDERAL DATES AND DEADLINES

  • The National Flood Insurance Program (NFIP) has for the forth time since October failed to be re-authorized by the US Congress.  This means that no more flood insurance policies may be issued but claims for existing policies will continue to be paid.  According to NFIP’s May 28 Memorandum, “New policies for which the application was completed on or before May 31 and application and premium were received within ten days of the application date, will be issued for coverage and will become effective on the requested effective date, in accordance with applicable waiting period rules.”
  • May 31 was the deadline for applying for the 65% Federal COBRA subsidy (applying to PA mini-COBRA as well).  Congress did not authorize an extension of the subsidy past that date although doing so was on the congressional agenda.  The House passed HR 4213 without the COBRA extension for fear of losing votes on the larger bill.
  • On June 10, some seniors will begin receiving tax-exempt checks for $250.00 from the Federal Government as part of the Patient Protection and Affordable Care Act’s effort to close the so-called ‘Donut Hole’. According to the Centers for Medicare and Medicaid Services (CMS) June 2, just seniors entering the Donut Hole will receive the checks, not all seniors.  No paperwork or application forms are required but HHS cautioned seniors to beware of suspected fraud or scams and to call 1(800)633-4227 if such is suspected.

UPCOMING INSURANCE MEETINGS
Both House and Senate plan insurance meetings this coming week.

The House Insurance Committee will hold a June 8 informational hearing on self-referrals (HB 2521 and HB 2522) featuring presenters from the PA Ambulatory Surgery Association, the PA Medical Society, Thomas Jefferson University Hospital and others.  The committee also meets on June 8 to consider:
-    HB 2522 (DeLuca-D-Allegheny) re improper referrals by health providers where there is a financial conflict of interest
-    HB 2521 (DeLuca) provides for more billing transparency and defines unprofessional conduct for health care providers that order but do not supervise or perform a component of anatomic pathology who fail to disclose certain information on its bills
-    HB 2106 (Taylor-D-Montgomery) creates the PA Health Information Exchange (not to be confused with the Exchanges coming in 2014 as part of the new health care law) to promote electronic data exchanges between health care providers.

The Senate Banking & Insurance Committee also meets June 8 on five bills: SB 1181 regarding immunity from liability; SB 1222 prohibiting insurers from charging fees for non-covered insurance services (amendment limiting to dental services); SB 1334 provides for service contracts as being distinct from the business of insurance; HB 838 regarding PA’s dependents to age 30 law; and HB 1251 providing for appealing an insurer’s determination when the benefit trigger is not met, for prompt payment of clean claims (amendment extending mini-COBRA to 15 months from the current nine)

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