Wednesday, June 17, 2009

PIA Opposes Kennedy Proposal to Create Health Insurance "Navigators"

/PRNewswire/ -- A proposal to award grants to public and private entities to conduct public education, distribute information and assist with health insurance enrollment is ill-advised, according to the National Association of Professional Insurance Agents (PIA).

The proposal is part of the Affordable Health Choices Act introduced by Sen. Edward M. Kennedy (D-Mass.), chairman of the Senate Committee on Health, Education, Labor & Pensions.

Section 3105 of the Kennedy bill says American Health Benefit Gateways would be created in every state, serving as a health insurance exchange. A "Navigators" program would award grants to public and private entities to "conduct public education; distribute fair and impartial information regarding health plans; [and] assist with enrollment and provide information that is culturally and linguistically appropriate for the population." The bill stipulates that both health insurance issuers and current independent insurance agents would be prohibited from participating in the Navigators program.

"This proposal would give federal grants to groups with no background or expertise in health insurance the responsibility to advise businesses and individuals regarding their health insurance decisions," said PIA National President Kenneth R. Auerbach, Esq. "In addition, it would specifically exclude licensed health insurance agents or brokers from participating, which makes no sense at all."

"Consumers already turn to their local professional insurance agents to help them navigate the current maze of health insurance choices," Auerbach said. "There's no need to recreate that system. The Kennedy proposal would use taxpayers' dollars to set up what are, in essence, federal insurance agencies for health insurance in every state, with the proviso that those with health insurance experience would be barred from being involved."

Auerbach expressed concern that entities receiving grants to act as health insurance "Navigators" could be community groups, labor unions, or other organizations with no experience in health insurance and that might be biased in favor of a government-option in health insurance, with the potential to inappropriately steer people away from opting for private health insurance plans.

PIA believes that Congress should build on the private health care delivery system, not seek to dismantle it. PIA vehemently opposes the creation of government-funded insurance agencies or brokerages for health care insurance that would displace professional insurance agents.

"It is our hope that this flawed section of Sen. Kennedy's bill that creates federally-backed insurance brokerages with no expertise in health insurance will be removed as the legislative process continues," said PIA Director of Federal Affairs Mike Becker.

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Thursday, June 11, 2009

Senate Bill to Protect Patients' Healthcare by Amending Medicare Coverage

/PRNewswire/ -- The U.S. Senate has introduced a bill, S. 1221, "The Medicare Prompt Pay Correction Act," a companion bill to H.R. 1392, which was introduced in the U.S. House of Representatives and currently has 45 co-sponsors.

The Senate bill was introduced by Senators Arlen Specter (D-PA) and Pat Roberts (R-KS). The bill is a step forward in addressing problems with Medicare reimbursement for cancer drugs and in alleviating a national problem affecting the delivery of cancer care treatment to patients, almost all of whom are treated in community oncology clinics close to their homes.

"Community cancer clinics play a critical role in our nation's fight against cancer, especially in rural areas where families do not have access to larger centers," said U.S. Senator Arlen Specter (D-PA). "I am pleased to introduce this legislation which will help ensure access for Medicare beneficiaries' to potentially life-saving cancer treatments."

This bill will amend title XVIII of the Social Security Act to ensure more appropriate payment amounts for drugs and biologicals under Part B of the Medicare Program. It excludes customary prompt pay discounts extended to wholesalers from the manufacturer's Average Sales Price (ASP). These discounts artificially reduce Medicare Part B drug reimbursement rates for community oncology clinics, jeopardizing the viability of these providers and thus endangering patient access to affordable, quality cancer care in their communities.

Excluding distributor prompt pay discounts from the ASP methodology is consistent with existing policy and will create greater uniformity among federal healthcare programs. The Medicaid Average Manufacturer Price (AMP) methodology already excludes these terms.

This legislation is an effort to improve the delivery of cancer care treatment to patients. Cancer care must be understood as different from general healthcare in that it is catastrophic in its threat to life, its potency of treatment and its cost. The cancer care delivery system is now in first-stage crisis because Medicare has substantially cut payment for cancer drugs and essential services.

Almost all Americans are currently treated in community cancer clinics, many of which have had to cut staff and close satellite facilities.

Patients with insufficient or no insurance, especially seniors and the swelling ranks of the unemployed, are increasingly being sent elsewhere for treatment and some patients are actually foregoing treatment.

"Especially during these tough economic times, millions of patients should not have to opt-out of quality cancer treatment because they can't afford it," said U.S. Senator Pat Roberts (R-KS).

The problem not only centers on payments for cancer drugs, but also on essential services provided to cancer patients, such as treatment planning, which are not reimbursed by Medicare.

The Community Oncology Alliance (COA) has aggressively advocated for the prompt pay solution.

"We appreciate the leadership of Senator Specter, who has long supported cancer care funding issues, and Senator Roberts for cosponsoring this important legislation," said Patrick Cobb, M.D., president of the Community Oncology Alliance (COA) and managing partner of Hematology-Oncology Centers of the Northern Rockies in Billings, Montana.

"This bipartisan bill is a welcomed and needed first step in supporting community cancer clinics," he continued. "The passage of these congressional bills will enable community oncology clinics to continue providing patients with cancer care treatments currently not properly reimbursed by Medicare."

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Wednesday, June 10, 2009

New Single Source Location for HIPAA & HIT Information

/PRNewswire/ -- Several nationally recognized healthcare experts have joined forces to create, a single-source resource site where visitors will find access to HIPAA regulations, American Recovery and Reinvestment Act (ARRA) updates, and practical guidance on what to do to meet new regulations.

"Most of our readers are seeking help on ARRA's requirement that Business Associates become covered entities, effective February 20, 2010," says Edward D. Jones, III, founding partner of and leading authority on healthcare, insurance, electronic remittance/payments, and electronic health record (EHR) issues. Jones also was a founding commissioner of the Electronic Healthcare Network Accreditation Commission (EHNAC) and served as the Chair of the Workgroup for Electronic Data Interchange (WEDI).

While serves as a single-source search site, the founders are clear about not offering legal advice. "We refer these inquiries to our health law partners, many of whom will soon be listed on our site," says David Cargile, co-founder of Cargile is CEO of Cargile Consulting, Inc. and previously served as the CEO of the Centris Group, U.S. Benefits, and USF Reinsurance Company and Reinsurance Facilities Corporation.

" is the go-to resource for all information and services related to privacy laws and policies. [] has expanded to guide health systems and providers in benefiting from the new Health Information Technology stimulus dollars. is now a great source for both privacy and HIT," says Joseph E. Scherger, MD, MPH, Vice President of Primary Care at the Eisenhower Medical Center in Rancho Mirage, CA.

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Monday, June 01, 2009

HHS Releases $30 Million to Help Medicare Beneficiaries Access Their Benefits

HHS Secretary Kathleen Sebelius today released $25 million in grants to
help older people, individuals with disabilities and their caregivers
apply for special assistance through Medicare, and an additional $5
million for a national resource center to support these important

These grants, made possible by the Medicare Improvements for Patients
and Providers Act of 2008 (MIPPA), will provide valuable support at the
state and community levels for organizations involved in reaching and
providing assistance to people likely to be eligible for the Low-Income
Subsidy program (LIS), Medicare Savings Program (MSP), the Medicare Part
D Prescription Drug Program and in helping beneficiaries to apply for
benefits. This initiative also includes special targeting efforts to
rural areas of the country and to Native American elders.

"Medicare is essential to our effort to provide high-quality health care
to all Americans," said Secretary Sebelius. "Many people could be
eligible for extra help through Medicare and not even know it. We know
that beneficiaries with the greatest needs are often the most difficult
to reach," said Secretary Sebelius. "Through these new collaborations at
the federal, state and local levels, we will better be able to target
and provide one-on-one assistance to our most vulnerable citizens."

This MIPPA funding, which is jointly administered by HHS' Administration
on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS),
is being awarded to State Health Insurance Assistance Programs (SHIPs),
State Agencies on Aging, Area Agencies on Aging (AAAs), Aging and
Disability Resource Centers (ADRCs), Native Americans Tribal
Organizations and local communities to help seniors, caregivers and
those with disabilities on Medicare. These organizations are important
members of HHS' national network of state, tribal and community-based
organizations that assist seniors, caregivers and those with
disabilities with health benefits information and information on other
services, and enable them to remain independent and living in their
communities as long as possible.

"HHS is working hard to reach people who are unaware, unsure or unable
to apply for assistance for the benefits they deserve," said Charlene
Frizzera, acting administrator for CMS. "Through this collaboration
between AoA and CMS, state and community-based organizations will be
able to work in partnership and make maximum use of these federal funds
to help seniors and those with disabilities on Medicare." CMS and AoA
have worked closely together on this and other outreach efforts to
assist older Americans, those with disabilities and their families to
access important benefits and services.

"MIPPA presents a new opportunity to build on the successful partnership
between AoA and CMS through the Medicare Part D outreach efforts, our
Chronic Disease Self-Management Programs, ADRCs, and the National
Clearinghouse for Long-Term Care Information," said Edwin L. Walker,
acting Assistant Secretary for Aging. "This new effort allows us to
team up again so that we can leverage federal, state and local resources
to deliver health and long-term care services and information to those
who need it most."

The National Center for Benefits Outreach and Enrollment, administered
by the National Council on Aging (NCOA), will help inform beneficiaries
about benefits available under federal and state programs, utilize
cost-effective strategies to find older individuals with the greatest
economic need, coordinate state and local efforts by providing a best
practice clearinghouse, data collection, training and technical

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