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Friday, May 8, 2009

Laudable Carrier Tricks

[Welcome Industry Radar readers!]
Sometimes, carriers surprise us by "doing the right thing" without being asked. Case in point: Just received an email from Anthem Blue Cross/Blue Shield outlining their response to the Swine Flu kerfluffle:
· Making changes to our formulary to ensure members with pharmacy benefits are covered for Tamiflu® or Relenza® without the need for prior authorization.
· Complying with state and federal regulatory guidelines for care, including those that override benefit language.
· Providing educational information to our employer groups and members about swine flu.
Of these, the most critical is the change on rx benefit: this saves the client an office visit co-pay, and (more importantly) gets the med to the patient much more quickly.
Kudos!

Do You Know the Way to T-A-A?

FoIB Rick B tips us to a little known, but well-established, Federal program that's been around since the early 60's. The Trade Adjustment Assistance program began in 1962 as part of a major labor law overhaul. It was originally intended to help workers whose jobs were shipped overseas by helping them obtain new jobs at pay similar to their previous employment. It's since been expanded to offer additional benefits.
Unlike "regular" unemployment compensation coverage, TAA funds are accessed by groups of laid-off folks: a group of newly unemployed workers file with the Department of Labor, if that group is approved each person in it can then apply for the services and benefits that he or she needs.The criteria seems to be based on proving that these workers' jobs have been sent outside the country (or they've suffered a significant reduction in hours and income as a result of outsourcing). Rick believes that this program is a major reason why Michigan and Ohio (with relatively high unemployment rates) still sport a lower than average percentage of uninsureds. Part of that reason is that the taxpayer picks up 65% of one's group insurance premium (deja vu all over again) for up to two years, and the new COBRA/ARRA program expanded that rate to 80%.
Interestingly, this newly expanded subsidy comes via a mechanism called the Health Coverage Tax Credit, which is now available to eligible employees retroactively: the newly expanded program provides eligible employees "with retroactive payments to help cover up-front costs of obtaining health coverage prior to the start of HCTC." It also applies, to some extent, to individual states' "mini-COBRA" programs.
Of course, if someone else is picking up 80% of your tab, it's a lot easier to afford to stay on the plan. Rick posits that the TAA was essentially a starting point for COBRA/ARRA: after all, why start from scratch? That makes a lot of sense, since it's an already established program easily adapted to other, similar efforts.

Thursday, May 7, 2009

Rx Cyberjacking [UPDATED AND BUMPED: 5/7/09]

[UPDATED - Please scroll down]
[Welcome Industry Radar readers!]
On the one hand, EMR (electronic medical records) promises convenience and efficiency. Having one's records easily accessible by one's provider saves both parties time, and can help avoid potentially dangerous medication interaction problems.
On the other hand, one's data is only as convenient and safe as the holder of that data makes it. In Virginia, for example, the state has set up a website for licensed pharmacists to track potential prescription drug abuse. Unfortunately, the firewall protecting this sensitive information wasn't as effective as they might have believed: hackers broke into the system, deleting "records on more than 8 million patients and replaced the site's homepage with a ransom note demanding $10 million for the return of the records."
The news item is based on a Wikileaks entry that claims to include a copy of the ransom note. It's hard to verify that, since it's just text, not a picture of the note itself. Naturally skeptical, I clicked on over to the Virginia Department of Health's website, hoping to find either confirmation or denial. Unfortunately, this is what I found at the top of the relevant page:
Ooops.
While this kind of news makes interesting, and perhaps important, blog fodder, I can't in good conscience comment as if this is fact. We'll continue to follow this, updating and expanding on this post.
[Hat Tip: Holly Robinson]
5/6/09: New information is coming online about this bizarre situation. According to Fox News:
The Prescription Monitoring Program discussed in the original post is still offline, which is causing even more speculation, but which may be indicative of a simple server crash. According to the news story, though, a spokescritter with the Virginia Department of Health claims that the "Prescription Monitoring Program Web site is now secure," although there's nothing to corroborate (or refute) her statement.
Since we have only the hacker's word that the data was breached, I'd prefer not to speculate, but we'll keep our readers posted.
Gee, that must be comforting to those allegedly affected by recent events.

Exciting Science News

Although the primary focus at IB is, of course, insurance (and, to a lesser extent, health issues in general), we sometimes feature non-insurance-related items. FoIB Rick B tips us to this latest news from the world of science, which may have applications and ramifications far beyond the laboratory:
Lawrence Livermore Laboratories has discovered the heaviest element yet known to science. The new element, Governmentium (symbol=Gv), has one neutron, 25 assistant neutrons, 88 deputy neutrons, and 198 assistant deputy neutrons, giving it an atomic mass of 312.
These 312 particles are held together by forces called morons, which are surrounded by vast quantities of lepton-like particles called peons. Since Governmentium has no electrons, it is inert. However, it can be detected, because it impedes every reaction with which it comes into contact.
A tiny amount of Governmentium can cause a reaction that would normally take less than a second, to take from 4 days to 4 years to complete. Governmentium has a normal half-life of 2 to 6 years. It does not decay, but instead undergoes a reorganization in which a portion of the assistant neutrons and deputy neutrons exchange places.
In fact, Governmentium's mass will actually increase over time, since each reorganization will cause more morons to become neutrons, forming isodopes. This characteristic of moron promotion leads some scientists to believe that Governmentium is formed whenever morons reach a critical concentration.
This hypothetical quantity is referred to as critical morass. When catalyzed with money, Governmentium becomes Administratium (symbol=Ad), an element that radiates just as much energy as Governmentium, since it has half as many peons but twice as many morons.

Wednesday, May 6, 2009

Cavalcade of Risk #77, (literally) Hot off the Presses

Most excellent tax-blogger Joe Kristan braved a fiery inferno to bring us this week's Cavalcade of Risk. It's an excellent journey 'round the risk-related blogosphere.
Do stop by.

Ohio DOI vs The Feds?

In an online forum to which both Bob and I contribute, there's an on-going discussion regarding my post from last month reporting on Ohio's implementation of the new COBRA/ARRA regs. In brief, the new Ohio rules state that "(s)mall employers will not be obligated to pay any portion of the premium. The former employee will pay 35% of the premium and the insurance company will claim the credit from the IRS for the 65% of the premium not paid by the former employee."
All well and good, but for one (ahem) minor detail: as Bob points out, "it does not appear to say how that credit will be achieved. Nor does it indicate the IRS will go along with this scheme."
It's that last bit that's the real poser: how can state insurance law trump federal tax law?
While it's very nice that the Ohio Department of Insurance is willing to give the insurer a break, what makes the DOI think it can offer a federal tax break? This morning, I posed that question to the folks at the Ohio DOI, and was delighted to learn that this has the "blessing" of the IRS:
So it appears that the state is simply reiterating what the Feds have already specified. Good news, right?

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