Health policy news for business leaders
October 2014
Volume 10, Number 9
News from Albany
NY State of Health open enrollment begins Nov. 15
Databank
New report: Low vaccination rates, higher incidence of some preventable diseases in
upstate NY
Controversial database intended to promote transparency
News from Washington
Employers face reporting challenge
Study finds ACA not increasing part-time work
News from Albany
NY State of Health open enrollment begins Nov. 15
As New Yorkers review coverage options for 2015, they need to determine what
plan will best meet their needs. The products in the state marketplace vary by
price, benefits and provider networks. Shoppers may go directly to the NY State
of Health website, work with a navigator or marketplace facilitated enroller or
directly contact a prospective insurer.
The NY State of Health will provide links to each participating insurer. Shoppers
can see if their providers are in a plan’s network. The state will continue to use
the provider look-up tool, available to registered consumers. The tool will be
slightly modified to make it easier for consumers to distinguish among different
qualified health plans and plan levels.
The NY State of Health has announced the list of insurers that will offer health
plans to individuals and small business owners on the state marketplace in 2015.
When enrollment opens Nov. 15, consumers will be able to choose from the
same number of insurers on the individual marketplace and two new offerings in
the small business marketplace, or SHOP. Among their choices will be some new
companies and some will no longer be offered. Seven insurers will expand into
additional counties in the individual marketplace.
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For a map of 2015 Health Plans Offered in NY State of Health:
http://info.nystateofhealth.ny.gov/PlansMap
For a report on 2014 Open Enrollment County Level Enrollment Data:
http://info.nystateofhealth.ny.gov/2014OpenEnrollmentCountyData
To find providers in a health plan’s provider network, choose a plan and search
for doctors: http://info.nystateofhealth.ny.gov/resource/health-plan-providernetworks
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Databank
New report: Low vaccination rates, higher incidence of some
preventable diseases in upstate NY
Upstate New York residents are more likely to contract certain vaccinepreventable illnesses and develop the flu at twice the rate of other state
residents, according to a new Excellus BlueCross BlueShield fact sheet.
“The Facts About Vaccine-Preventable Diseases in Upstate New York,” highlights
low upstate New York vaccination rates for influenza, pertussis, pneumonia and
childhood diseases and provides the facts challenging common vaccine
misconceptions.
The report shows that the childhood immunization rate among upstate New York
children 19 months to 35 months (54.5 percent) is lower than the state rate
(65.1 percent) and national rate (68.5 percent). Reported rates include the
recommended doses of DTaP, polio, MMR, Hib, hepatitis B, varicella and
pneumococcal conjugate vaccines.
Only one in three upstate New York adults age 18 to 64 receives an annual flu
shot.
Key findings include:
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The rate of influenza in upstate New York (225.7 per 100,000) was nearly
double the statewide rate (113.2 per 100,000) in 2012.
In 2011, 32.6 percent of upstate New York adults age 18 to 64 reported
having a seasonal flu shot within the previous year. Among adults age 65 and
older, 61.7 percent reported receiving the vaccine. Adults age 18 to 24 had
the lowest vaccination rate (18.8 percent).
Upstate New York adults had a low rate of pneumococcal lifetime vaccination
(30.9 percent). More than 10 percent reported not knowing if they had
received a pneumococcal vaccination.
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For “The Facts About Vaccine-Preventable Diseases in Upstate New York,” look under
Behaviors and Health Conditions:
https://www.excellusbcbs.com/wps/portal/xl/our/hpr/factsurveyreport
For a printable booklet to record a child’s personal record of important medical
information: “Health and Immunization Record”
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Controversial database intended to promote transparency
Shedding light on payments from medical device and drug companies to doctors
and hospitals is the goal of the new federal Open Payments database mandated
by the Affordable Care Act. Released to mixed reviews, the database tracks $3.5
billion paid to more than 500,000 physicians and nearly 1,360 teaching hospitals
during the last five months of 2013.
“Open Payments does not identify which financial relationships are beneficial and
which could cause conflicts of interest,” said Shantanu Agrawal, deputy
administrator and director of the Center for Program Integrity at the Centers for
Medicare and Medicaid Services, “It simply makes the data available to the
public. So while these data could discourage payments and other transfers of
value that might have an inappropriate influence on research, education, and
clinical decision-making, they could also help identify relationships that lead to
the development of beneficial new technologies.”
Due to concerns with accuracy, one-third of the records are not attributed to
specific doctors, a value of $2.2 billion in payments. The American Medical
Association warns that “Publishing inaccurate data can lead to misinterpretations,
harm reputations and cause patients to question their trust in their physicians. It
can also unfairly impact physicians' ability to attain or keep research grants and
other employment opportunities that require disclosure.”
Favoring transparency Lisa Swirsky, senior policy analyst for Consumers Union
said that, “Making this information available will illuminate and hopefully root out
potential conflicts of interest between doctors and the drug and device makers.”
Although she recognizes problems with the release Swirsky said, “It is important
to keep things in perspective. Data quality improves over time when stakeholders
and the public have a chance to review it and address issues.”
“Transparency shouldn't stop doctors from receiving a payment if they want to,”
says longtime champion, Sen. Charles E. Grassley, R-Iowa, “It should empower
consumers to learn whether their doctors take payments and if so, why, and
whether that matters to them.” With then Sen/ Herb Kohl, a Democrat from
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Wisconsin, Grassley first introduced the Sunshine Act in 2007, which later passed
as part of the 2010 Affordable Care Act.
For the Consumer’s Union report, “CU: Open Payments site will help shine
spotlight on potential conflicts of interest between doctors and drug, device
makers”: https://consumersunion.org/news/cu-open-payments-site-will-helpshine-spotlight-on-potential-conflicts-of-interest-between-doctors-and-drugdevice-makers/
For the American Medical Association press release on the database:
http://www.ama-assn.org/ama/pub/news/news/2014/2014-09-30-statementsunshine-act-data-release.page?#
For the government’s Open Payment website:
http://www.cms.gov/openpayments/index.html
For a guide to the Open Payments website:
http://www.cms.gov/OpenPayments/Downloads/Fact-Sheet-Sept-30-2014Published-Data.pdf
For the Centers for Medicare & Medicaid Services physician fact sheet, “Open
Payments (Physician Payments Sunshine Act)”:
http://www.cms.gov/Regulations-and-Guidance/Legislation/National-PhysicianPayment-Transparency-Program/Downloads/Physician-fact-sheet.pdf
For the Centers for Medicare & Medicaid Services User Guide for Industry. “Open
Payments Creating Public Transparency into Industry-Physician Financial
Relationships”:
http://www.cms.gov/Regulations-and-Guidance/Legislation/National-PhysicianPayment-Transparency-Program/Downloads/Open-Payments-User-Guide%5BAugust-2013%5D.pdf
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News from Washington
Employers face reporting challenge
In 2015, employers will be responsible for capturing and documenting monthly
health insurance coverage for their employees and employees’ dependents. The
Affordable Care Act mandates employer and individual coverage beginning in
2015. Failure to do so could result in payment of a federal penalty.
To submit the necessary information, most employers with an average of 50 fulltime employees (or combined with part-timers, an employee total that equals at
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least 50) will have to restructure their record-keeping and reporting systems. The
required information for employees and their dependents include:
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Employees and dependents Social Security numbers, date of birth, address,
covered months
Source of the policy (Small Business Health Options Program or SHOP,
employer-sponsored, government-sponsored, individual market insurance,
multiemployer plan or miscellaneous minimum essential coverage)
Months covered in an employer health plan
Health insurance provider
For self-insured group health plans: offer of minimal essential coverage,
employee share of lowest cost monthly premium
Safe harbors under which an employer is not subject to the shared
responsibility payment
The Internal Revenue Service posted draft forms and instructions for businesses
and individuals to use to verify health coverage to meet the ACA mandates.
For Internal Revenue Service Questions and Answers:
Questions and Answers on Employer Shared Responsibility Provisions Under the
Affordable Care Act (reviewed or updated May 13, 2014)
http://www.irs.gov/uac/Newsroom/Questions-and-Answers-on-Employer-SharedResponsibility-Provisions-Under-the-Affordable-Care-Act
Questions and Answers on Information Reporting by Health Coverage Providers
(Section 6055) (reviewed or updated Sept. 22, 2014)
http://www.irs.gov/uac/Questions-and-Answers-on-Information-Reporting-byHealth-Coverage-Providers-Section-6055
For Internal Revenue Service tax forms:
Transmittal of Health Coverage Information Returns – Draft form 1094-B (posted
July 24, 2014) http://www.irs.gov/pub/irs-dft/f1094b--dft.pdf
Transmittal of Employer-Provided Health Insurance Offer and Coverage
Information Return – Draft form 1094-C (posted Sept. 22, 2014)
http://www.irs.gov/pub/irs-dft/f1094c--dft.pdf
Health Insurance Marketplace Statement for individuals – Draft form 1095-A
(posted Oct. 1, 2014) http://www.irs.gov/pub/irs-dft/f1095a--dft.pdf
Health Coverage – Draft form 1095-B for individuals (posted July 24, 2014)
http://www.irs.gov/pub/irs-dft/f1095b--dft.pdf
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Employer-Provided Health Insurance Offer and Coverage – Draft Form 1095-C
(posted Oct. 1, 2014) http://www.irs.gov/pub/irs-dft/f1095c--dft.pdf
For Internal Revenue Service instructions:
Instructions for Forms 1094-B and 1095-B (posted Aug. 28, 2014):
http://www.irs.gov/pub/irs-dft/i109495b--dft.pdf
Instructions for Forms 1094-C and 1095-C (posted Aug. 28, 2014):
http://www.irs.gov/pub/irs-dft/i109495c--dft.pdf
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Study finds ACA not increasing part-time work
The Affordable Care Act hasn’t led to an increase in part-time work at the
expense of full-time employment, at least so far, according to a report
conducted by the Urban Institute and funded by the Robert Wood Johnson
Foundation. The researchers found transitions between full- and part-time work
to be in line with historic patterns, and more likely to be a result of the slow
economic recovery after the recession.
The authors cautioned, “Although we find little evidence consistent with
anticipatory effects of the ACA’s employer mandate on part-time work to date,
our analysis does not rule out the possibility of effects in the future if the
mandate goes into effect in 2015 as scheduled and as other ACA provisions are
more fully implemented.”
The Urban Institute looked at recent trends to determine if the ACA:
 Replaced full-time workers with part-time workers or reduced part-time
worker’s hours, and
 Increased voluntary part-time employment by reducing the need for
employer-based coverage.
For the full report: http://www.urban.org/UploadedPDF/413217-Little-Evidenceof-the-ACA-Increasing-Part-Time-Work-So-Far.pdf
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Capitol Briefings is a free online publication of Excellus BCBS, a nonprofit health insurer based in
Rochester, N.Y.
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