Health Decisions Webinar: ACA Preventive Services
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Presenter: Si Nahra, Ph.D., President November 26, 2013 ACA Preventive Services: Ignore at Your Own Risk
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ACA requirements for self-funded plans continue. One of the newer additions to this growing list of requirements is the elimination of cost-sharing for certain preventive services. This webinar explores what the new preventive rules encompass and mean. We also explain how the new preventive health benefits can provide an excellent indicator of what to expect as further requirements become effective. Has your plan done anything to prepare for this change? If you are relying on the plan administrator for this, do you know what they changed? Failure to meet these requirements poses tax liabilities, potential for negative employee relations, and a missed opportunity for positively impacting health use. This webinar explains why. For a copy of the full webinar recording, please contact Health Decisions at http://www.healthdecisions.com/contact-us.
Transcript of Health Decisions Webinar: ACA Preventive Services
Presenter:
Si Nahra, Ph.D., PresidentNovember 26, 2013
ACA Preventive Services:Ignore at Your Own Risk
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About Health Decisions, Inc.
Pioneering Specialists inPioneering Specialists in
Group Health CareGroup Health Care
Post-Payment AdministrationPost-Payment Administration
For Over 25 YearsFor Over 25 Years
RespectRespect for Existing Procedures for Existing Procedures
EmphasisEmphasis on Customization on Customization
FocusFocus on Solutions on Solutions
Customer Philosophy
ACA Preventive Services Copyright Health Decisions, Inc. 11/26/13
ACA Preventive Care
Covering Preventive Health Care
is Now the Law.
Starting in 2014, all non-grandfathered plans must comply with new Preventive Services
coverage regulations.
NOT DELAYED!ACA Preventive Services Copyright
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ACA Preventive Care:What is it?
Three-Part Definition
1. Description: www.healthcare.gov
For in-network providers, a list of services have no co-pay or coinsurance even if deductibles are not yet satisfied.•Part 1: Adults•Part 2: Women•Part 3: Children
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ACA Preventive Care:What is it?
Three-Part Definition
2. Codes Billed:
•372 distinct procedure codes
•More than Medicare, AMA, and most private plans I know.
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ACA Preventive Care:What is it?
Three-Part Definition3. Conditions (gender, age, frequency, diagnoses)
•USPSTF A and B Recommendations: http://www.ama-assn.org/resources/doc/cpt/aca-uspstf-a-and-b-recs.pdf
•HRSA: http://www.hrsa.gov/womensguidelines/
•Bright Futures: http://brightfutures.aap.org/pdfs/Coding%20PR%20F0809.pdf
•Advisory Committee for Immunization Practices: http://www.cdc.gov/vaccines/hcp/acip-recs/index.html
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ACA Preventive Care:Common Reactions
• Wasn’t that all delayed?• What is it?• Political diatribes.• I assume the administrator has this handled.• Our plan already includes this.
All mean the same thing.
Let’s ignore it.ACA Preventive Services Copyright
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ACA Preventive Care:Ignore at Your Own Risk
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All Preventive Care Paid 100%
Excess Preventive Care Cost Sharing
Saves Enrollee
Costs Enrollee
Costs Plan•Now $50-$100 per enrollee•Increased demand•Provider discretion
Costs Plan•Excise tax $100/day per person•Employee refund requests•Class Action lawsuit
ACA Preventive Care:Monitor
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All Preventive Care Paid 100%
Excess Preventive Care Cost Sharing
MONITOR
Provider and Enrollee Misuse.
Enrollee refunds and reconciliations.
ACA Preventive Care:Monitor
• Preventive Service Cost Sharing Compliance is an excellent indicator of what to expect with new ACA Out-of-Pocket maximum limits.
• If Preventive Services compliance is hard to address, Out-of-Pocket maximums will be worse.
But, that’s another webinar.ACA Preventive Services Copyright
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Past Webinars Available
Recordings of past webinars are available upon request, including:
• September 2013 – Secret Provider Agreements
• August 2013 – What Happens After Open Enrollment (And Before Obamacare)?
• July 2013 – The Claims You Should Be Auditing, but Aren’t
• June 2013 – Obamacare Compliance – How it Helps Self-funded Plans
• Mid-June 2013 – Employer Mandate Calculations Explained
• May 2013 – Pay or Play: A Bigger Challenge for TPAs than for Plans
• April 2013 - The Most Overlooked Part of Health Reform: Enrollee Communications
• March 2013 – Why Cost Sharing is not Working
• February 2013 – Loss of Fiduciary Control
• January 2013 – Top 10 Do’s and Don'ts of Data Warehousing
• December 2012 – Union Trusts: Health Reforms Most Overlooked Winner?
• November 2012 – Year-end Renewal and Bidding: Opportunities for Control and Savings
For more information, please visit www.healthdecisions.com
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For More Information
Contact
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ACA Preventive Services Copyright Health Decisions, Inc. 11/26/13
