June 2010 | keglerbrown.com

In This Issue

The Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act (“Affordable Care Act”) was enacted on March 23, 2010. The Affordable Care Act requires the establishment of an internet website (“web portal”) through which individuals and small businesses can obtain information on insurance coverage options available to them in a particular state. To establish the web portal, the Department of Health and Human Services (“HHS”) has issued an interim final rule on May 5, 2010 to enact the mandate contained within the PPAC for a web portal. The interim final rule establishes the categories of information that will be collected from insurers/issuers and States for use in the creation of the web portal and establishes the deadlines for the submission of such information. The interim final rule will be effective on May 10, 2010 and comments on the regulations will be received for 30 days after publication in the Federal Register.

The new interim final rule establishes a mandate for data submission by private insurers. Private insurers must now submit relevant information regarding their plans to HHS and the information submitted will be used to populate the new web portal.

The web portal is set to go active in its initial format on July 1, 2010 as required in the Affordable Care Act. Initial information on the web portal is expected to be largely contact information for private insurers, administrative items such as enrollment codes and product names and types. Insurers are being asked to submit information on financial ratings if they currently have such a rating. Date submission for the initial version of the web portal will be due by May 21, 2010.

An update to the web portal will occur on October 1, 2010. Information will be added that will address benefits and pricing of private insurance plans. Data submissions for the October update will be due by September 3, 2010.

As can be seen from the deadlines, the web portal is on a fast track due to deadlines contained within the Affordable Care Act. Any concerns regarding the requested submissions should be directed to HHS and comments should be submitted within the deadline for the comment period. HHS will be working with private insurers on data submission issues throughout May to ensure that the July 1, 2010 deadline will be met. To submit data, parties will need to establish accounts to allow for secure data entry. For further information regarding the creation of the web portal and required information submissions go here.

PPACA Law Takes Effect Soon

Major provisions of the Patient Protection and Affordable Care Act (“PPACA”) do not take affect for several years, but as with the earlier HITECH Act, some provisions of new law take almost immediate effect. Beginning in 2011, Section 2718 of the Public Health Service Act, as established by the PPACA, institutes medical loss ratios (“MLR”) for health insurers. Group providers must spend a minimum of 80% of claims revenue on claims or activities that improve health care quality. Individual providers must spend a minimum of 75%. Currently, the National Association of Insurance Commissioners (“NAIC”) is working on definitions and standardized methodologies for establishing the MLR. The NAIC is likely to issue its guidance in June 2010. The guidance provided by the NAIC must be certified by the Department of Health and Human Services. The MLR will take effect in January 2012.

OHIP Selects Regional Extension Centers

The Ohio Health Information Partnership (“OHIP”), which is the state-designated entity responsible for managing the implementation of health information technology in Ohio, has announced its regional extension center partners. The regional extension centers or (“RECs”) will provide assessments for local doctors in their area and provide help in selecting an electronic health records system. The REC partners are:

Case Western Reserve University
Central Ohio Health Information Exchange
Greater Dayton Area Health Information Network
Hospital Council of Northwest Ohio
Northeast Ohio HealthForce
Ohio University

Kegler Brown Establishes HIT Update Blog

To keep firm clients and friends on the cutting edge of developments and trends in the health information technology arena, Kegler Brown offers a public blog on our website. Because the nature of the HIT environment is ever-changing, make sure to check the blog frequently so you’re up to date on what’s new. View blog archives

Credits

Kegler, Brown, Hill & Ritter's The Pulse is prepared by the Health Care Regulation & Health Information Technology practice group.

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The Pulse is designed to provide general information about the subjects discussed. It is not meant to be all-inclusive or comprehensive. Kegler Brown is not rendering any legal or professional advice by way of this publication.

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