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First MBU of 2016 Highlights Health Care Reform


  03:47:00 pm, by MedBen5   , 650 words,  
Categories: News, Health Plan Management, Health Care Reform, Third party administration, MedBen University

First MBU of 2016 Highlights Health Care Reform

MedBen University (MBU) launched its 2016 series of benefits management seminars with a well-attended session that offered an extensive look at the current state of the Affordable Care Act.

Entitled "Navigating the Health Care Reform Storm" and presented by MedBen Vice President of Compliance Caroline Fraker, the session covered a variety of topics, from 2016 plan design considerations to potential employer penalties and fees. Fraker also touched briefly on 1094 and 1095 reporting, a topic with she dealt with in depth at an MBU event last October.

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One of the items discussed in some detail was ACA guidance offered to health care plans though the latest in a series of FAQs released by the U.S. Department of Labor. "These are sort of informal, 'this-is-what-we-really-meant-when-we-wrote-the-law' clarifications," Fraker said.

The 29th FAQ is something of a "pot luck" of health care reform issues. One noteworthy clarification pertains to preventive services: Any ancillary services to the preventive care, such as a follow-up to a mammography, must also be covered at 100%. "And they went even further to say that you can't impose a general exclusion in your plan that would impact a recommended preventive service," Fraker added.

The FAQ also requires that non-grandfathered plans must not only cover screenings for obesity in adults at 100%, but weight management services as well. However, Fraker noted, the guidance does allow for "reasonable medical management techniques," such as prior authorization and ensuring that a proposed treatment matches the diagnosis.

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Another hot-button topic Fraker talked about was the "Cadillac" Tax, which was recently delayed until 2020. President Obama has proposed a change to the tax, using different thresholds to set off the 40% penalty depending on the regions in which the employer does business, rather than a flat rate.

"The idea behind the Cadillac tax to begin with was to require employers to start ratcheting down what they're offering to their employees," Fraker said. "So if I start increasing those thresholds for some employees in some parts of the country, but not other employees in other parts of the country... it flies in the face of the intent of the law."

MedBen President and COO Kurt Harden led off the morning's events with a quick summary of MedBen Analytics, which offers value based payment administration services to health care providers. He also gave an overview of additional service offerings that MedBen will soon introduce (and about which we'll share more on this blog in the coming weeks).

Most of Harden's opening comments pertained to some of the current confusion in the health care market, much of it stemming from the myriad of ACA regulations and rule changes, that has allowed opportunists to create artificial crises in hopes of luring employers away from their current benefit managers. Harden outlined a series of "red flag" situations for clients, including savings "guarantees" and "confidential" opportunities.

"There is no silver bullet for health care costs," Harden cautioned. "The ideas that are out there should be vetted with a variety of sources. You shouldn't just believe what someone says jut because they slap a 'confidential' label on it."

Video from Fraker's presentation will be available on the MedBen YouTube page soon. Once editing of her presentation is completed, we will post highlights on this blog.

And a reminder: MedBen University will soon host two industry-specific events: A Hospital Roundtable on Thursday, March 24, and a Municipality Roundtable on Thursday, April 7, both at the C. Arthur Morrow Conference Center in Newark, Ohio. These special sessions offer employers a unique opportunity to learn how health care spending trends affect their bottom line, and see how their plans compare with others in their industry. Other upcoming MBUs will look at wellness and pharmacy strategies.

MedBen University events are open to current MedBen clients and non-clients alike. To register for one of the roundtables or to be added to the MBU mailing list, please contact MedBen Sales Analyst Sally Wood at (800) 423-3151, Ext. 502 or

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