Consociate Health > News > Category: Healthcare Industry News

Hospitals To Publish Retail Prices Under A New Proposed Rule

September 4, 2019

In July, the Centers for Medicare and Medicaid (CMS) proposed rules that would require all Medicare-participating hospitals to post their negotiated prices for standard health care services.

The proposed rule is intended to increase pricing transparency and help consumers understand the charges they may incur before receiving care.

These are just proposed rules at the moment, which means no changes will be made effective until the rules are finalized. The agency is currently asking for comments on the proposed rule. The deadline for submitting comments is Sept. 27, 2019.

We will continue to monitor and keep you updated on these developments.

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Open Enrollment: What’s Changing in 2020?

To prepare for open enrollment, group health plan sponsors should be aware of the legal changes affecting the design and administration of their plans for plan years beginning on or after Jan. 1, 2020. Employers should review their plan documents to confirm that they include these required changes.

In addition, any changes to a health plan’s benefits for the 2020 plan year should be communicated to plan participants through an updated summary plan description (SPD) or a summary of material modifications (SMM).

Health plan sponsors should also confirm that their open enrollment materials contain certain required participant notices, when applicable—for example, the summary of benefits and coverage (SBC). There are also some participant notices that must be provided annually or upon initial enrollment.

Important Notices

  • Annual CHIP notice
  • Medicare Part D creditable coverage notice
  • Notice of grandfathered status (if applicable)
  • Annual notice regarding coverage requirements for mastectomy-related benefits (WHCRA notice)

Don’t wait any longer to review your plans. Contact Consociate Health for a full list of 2020 plan changes and requirements.

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Final Rule Expands Options For HRAs

August 5, 2019

Health officials issued a final rule that expands the usability of health reimbursement arrangements (HRAs).

Effective in 2020, the final rule establishes two new types of HRAs:

Individual Coverage HRA: Allows employers to offer an HRA to be used to reimburse the cost of individual market premiums on a tax-preferred basis, subject to certain conditions, as an alternative to traditional group health plan coverage.

Excepted Benefits HRA: Allows employers that offer traditional group coverage to provide an HRA of up to $1,800 per year (as adjusted) to reimburse certain qualified medical expenses.

Talk to us to learn more about the specifics of these new plan designs.

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Executive Order On Health Costs To Affect Employer Health Plans

President Donald Trump recently signed an executive order aimed at improving price and quality transparency in health care. The order is intended to increase availability of health care price and quality information and protect patients from surprise medical bills.

What’s in the Order?

Specifically, the order is aimed at:

  • Eliminating unnecessary barriers to price and quality transparency
  • Increasing the availability of meaningful price and quality information for patients
  • Enhancing patients’ control over their own health care resources, including through tax-preferred medical accounts
  • Protecting patients from surprise medical bills

Employer Impact

Within 120 days, the order directs the Treasury to issue guidance to expand access to high-deductible health plans.

Additionally, the order directs the Treasury to propose regulations within 180 days to:

  • Treat expenses related to certain types of arrangements—potentially including direct primary care arrangements and health care sharing ministries—as eligible medical expenses
  • Increase the amount of funds that can carry over without penalty at the end of the year for flexible spending accounts

To learn more about how this order might affect you, speak with us today.

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2020 HSA/HDHP Limits Announced

July 19, 2019

The IRS recently announced that limits for health savings account (HSA) contributions will increase for 2019. The high deductible health plan (HDHP) maximum out-of-pocket limits will also increase for 2020. The HSA contribution limits will increase effective Jan. 1, 2020, while the HDHP limits will increase effective for plan years beginning on or after Jan. 1, 2020.

These limits vary based on whether an individual has self-only or family coverage under an HDHP.

Because the cost-sharing limits for HDHPs will change for 2020, employers that sponsor these plans may need to make plan design changes for plan years beginning in 2020.

Also, if an employer communicates the HSA contribution limits to employees as part of the enrollment process, these enrollment materials should be updated to reflect the increased limits that apply for 2020.

New Limits
The following chart shows the HSA and HDHP limits for 2020 as compared to 2019. It also includes the catch-up contribution limit that applies to HSA-eligible individuals who are age 55 or older, which is not adjusted for inflation and stays the same from year to year.

2020 HSA Contribution Limit
• Family – $7,100 (up $100)
• Self-only – $3,550 (up $50)

2020 HSA Catch-up Contributions
• Age 55+ – $1,000 (no change)

2020 HDHP Minimum Deductible
• Family – $2,800 (up $100)
• Self-only – $1,400 (up $50)

2020 HDHP Maximum Out-of-pocket Expense Limit
(Deductibles, copayments and other amounts, but not premiums)
• Family – $13,800 (up $300)
• Self-only – $6,900 (up $150)

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Moves Toward Better Health Care Price Transparency

July 8, 2019

Beginning in May 2018, the Trump administration began searching for ways to curb out-of-control prescription drug costs—referring to the initiative as American Patients First. This effort is finally seeing some traction, with the administration issuing regulations aimed at improving health care pricing transparency in May 2019.

Drug Pricing Transparency 
Drug companies will now be “required to disclose to patients the list price for prescription drugs in TV ads,” according to the Department of Health and Human Services (HHS).

More specifically, the rule requires prescriptions covered by Medicare or Medicaid that cost $35 or more per month for a typical course of therapy to be disclosed. Drugs under that threshold are unaffected.

HHS points out that the 10 most commonly advertised drugs range in price from several hundred to several thousands of dollars for a typical month of treatment.

This rule will take effect July 9, 2019. Employers should prepare for increased employee questions regarding drug costs.

President Trump’s Plan to Combat Surprise Medical Billing 
On May 9, 2019, President Donald Trump delivered a speech criticizing the practice of surprise medical billing. He announced a general plan of attack and hinted at a few specifics for curbing the trend. Here are the four main regulatory aspects called out by the president, suggesting that they might be tackled first:

  1. In emergency situations, patients shouldn’t have to “bear the burden” of out-of-network costs.
  2. Balanced billing should be prohibited for emergency care.
  3. For scheduled non-emergency care, patients should receive an “honest” bill up front—including an itemized list of out-of-pocket expenses the patient must cover.
  4. Patients should not receive a surprise bill from out-of-network providers they did not choose themselves.

Lower Health Care Costs Act 
Just a few weeks after the president’s speech on combatting surprise medical billing, the Senate Health Committee proposed a bipartisan bill called the Lower Health Care Costs Act.

The Lower Health Care Costs Act has five main components, including:

  1. Addressing surprise medical bills
  2. Lowering the cost of prescription drugs
  3. Improving transparency
  4. Improving public health
  5. Improving the exchange of health information

The Senate Health Committee Chairman Sen. Lamar Alexander said that “Republicans and Democrats in the United States Senate have announced this proposal of nearly three dozen specific bipartisan provisions that will reduce the cost of what Americans pay for health care. These are common sense steps we can take, and every single one of them has the objective of reducing the health care costs that you pay for out of your own pocket.”

The proposed legislation also includes a provision that would require benefits brokers to disclose their fees and any incentives they may receive from insurers. This provision would create a new level of transparency between employers and their benefits brokers, as many employers aren’t aware of the inner workings of health plan agreements or renewals.

What’s Next? 
The Lower Health Care Costs Act is just proposed legislation at the moment, meaning that there are no compliance obligations to meet. However, Sen. Lamar Alexander, bill co-sponsor, hopes that the bill will be on the Senate floor for a vote by July of this year.

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Consociate Health Expands Community Focused Healthcare Model in the Midwest

April 19, 2019

New Chief Business Development Officer Ziad Rubaie brings proven track record in building strategic partnerships to drive results for clients

DECATUR, IL – Illinois-based Third-Party Administrator (TPA) Consociate Health has developed a reputation for building strategic partnerships that deliver innovative solutions to its clients in today’s complex healthcare landscape. Today, the company announced an aggressive team expansion to deliver healthcare administrative services and high-performance network development throughout the US.

Existing partnerships with nearly 20 healthcare systems have allowed Consociate to perfect its community centric model using data integration strategies and data driven decision support resources. That success and the need for more patient-centered service from TPAs industry-wide, led to a decision to expand.

Spearheading these efforts will be Ziad Rubaie, a respected sales and marketing leader in the Healthcare industry with more than 24 years of experience leveraging an impressive network of healthcare consultants to build strategic partnerships.  Ziad comes to Consociate after a 9-year successful tenure at CastiaRx, formerly known as LDI, where he established and delivered nationwide pharmacy solutions that exceeded industry results. He also developed unique value propositions that positively impacted PBM services and overall business development opportunities.

Ziad, also, served as Executive Vice President of Sales and Marketing for Essex Dental & Vision Benefits, a subsidiary of Delta Dental of Missouri. During his tenure, he oversaw a greater than 318 percent growth in revenue for Essex.  Rubaie started his healthcare career in 1995 with many roles including Assistant Vice President of Sales Healthscope Benefits.

“Consociate is always looking for talent that advances our culture of innovation and growth and we continue to recruit leadership that have track records of delivering proven solutions.  Ziad’s expertise in bringing together strategic healthcare partnerships that drive solutions for clients and their members is highly respected in the industry and we are excited to welcome him to our team,” said Consociate President Darren Reynolds.

For more than 40 years Consociate Health has partnered with employers of all sizes to deliver employee benefit program consulting and administrative services. As a Third-Party Administrator (TPA), Consociate has built a reputation for exceptional accuracy, customer service and a focus on helping employers with innovative cost containment solutions.

Through data analytics, Consociate provides its clients with personalized analysis of their plans to ensure they have quality data and are using that data to make educated decisions.

Essential data analytics allow Consociate Health to integrate claims, eligibility, financial and other healthcare data into a consolidated system database; analyze member health and then identify cost drivers; monitor health plan utilization; and forecast employer healthcare costs which allows them to develop a strategy to manage and control healthcare costs for employers and members.

Earlier this month, Consociate was recognized on a national stage for excellence in data accuracy, using key analytics to transform the customer experience. The Illinois based company received the Commitment to World-Class Data award at the 4th Annual Benefit Focus Celebrate Community Awards, recognizing companies that have transformed the benefits experience for their employees and consumers, empowering them to make the best decision for their personal needs.

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IRS Announces HSA Limits for 2019

May 17, 2018

On May 10, 2018, the IRS released Revenue Procedure 2018-30 to announce the inflation-adjusted limits for health savings accounts (HSAs) and high deductible health plans (HDHPs) for 2019. These limits include:

  • The maximum HSA contribution limit;
  • The minimum deductible amount for HDHPs; and
  • The maximum out-of-pocket expense limit for HDHPs.

These limits vary based on whether an individual has self-only or family coverage under an HDHP.

The IRS limits for HSA contributions will increase for 2019. The HDHP maximum out-of-pocket limits will also increase for 2019. The HSA contribution limits will increase effective Jan. 1, 2019, while the HDHP limits will increase effective for plan years beginning on or after Jan. 1, 2019.

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IRS Updates Employer Guide for 2018 Tax Changes to Fringe Benefits

The IRS recently released the 2018 version of Publication 15-B—Employer’s Tax Guide to Fringe Benefits, which contains information for employers on the tax treatment of fringe benefits. The 2018 version is significant because it incorporates the changes made by the new tax law—the Tax Cuts and Jobs Act—to the following fringe benefits:

  • Qualified transportation plans
  • Moving expense reimbursements
  • Employer-provided meals
  • Employee achievement awards

Employers that offer fringe benefits should review the 2018 version of Publication 15-B and work with their tax advisors to implement the tax changes.

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IRS Announces Second Change to HSA Family Contribution Limit

Earlier this year, a tax law change for 2018 reduced the health savings account (HSA) contribution limit for individuals with family high deductible health plan (HDHP) coverage from $6,900 to $6,850. On April 26, 2018, the IRS announced that, for 2018, taxpayers with family HDHP coverage may treat $6,900 as the annual contribution limit to their HSAs.

Why was the limit changed again?

After the IRS reduced the HSA limit for individuals with family HDHP coverage, it received feedback from various stakeholders, including employers, that the change would be disruptive and costly to implement. For example, some individuals with family HDHP coverage made the full $6,900 HSA contribution before the limit was reduced, and many other individuals made annual salary reduction elections for HSA contributions through their employers’ cafeteria plans based on the $6,900 limit.

In response to these concerns and others, the IRS issued Revenue Procedure 2018-27, which allows taxpayers with family HDHP coverage to use the original $6,900 HSA contribution limit for 2018.

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