The following are excerpts from an article in Insurance Journal:

“New York chiropractors don’t like the new medical treatment guidelines adopted last December by the New York State Workers’ Compensation Board. These changes focus on the treatment for the mid- and low-back, neck, shoulder and knees. The state’s main chiropractic association is lobbying state lawmakers to reverse the new guidelines.”

“The Business Council of New York State, a business organization, supports the new medical guidelines. “The Business Council supports evidence-based medicine and a system where the merits of the treatment matter,” said Communications Director Robert Lillpopp. He said New York was one of the last states to adopt impartial medical treatment guidelines, which reflect medical consensus on appropriate and effective care for injured workers.

“These guidelines were developed by a team of medical professionals. The AFL-CIO and The Business Council both supported this approach to ensure injured workers receive medical treatment backed up by solid medical evidence on its effectiveness,” Lillpopp said.

The Business Council charged that a legislative effort to reverse these guidelines is “being pushed largely by a single sector of medical providers — chiropractors — whose services and income are now subject to evidence-based limits for major categories of injuries.”

To read more click here.

According to a release from the Governor’s office:

“Governor Cuomo and Superintendent Lawsky suggested the following measures for New Yorkers with property losses:

• The first step to getting your home restored is to contact your insurance company and/or agent with your policy number and other relevant information. Be aware that your policy might require that you make this notification within a certain time frame.
• Take photographs or video of the damage before clean-up or repairs. After you’ve documented the damage, make repairs necessary to prevent further damage to your property, such as covering broken windows, leaking roofs and damaged walls. DO NOT have permanent repairs made until your insurance company has inspected the property and you have reached an agreement on the cost of repairs. Be prepared to provide the claims adjuster with records of any improvements you made prior to the damage. Save all receipts, including those from the temporary repairs.
• If your home is damaged to the extent that you cannot live there, ask your insurance company or insurance agent if you have coverage for additional living expenses.
• Ask what documents, forms and data you will need to file the claim. Keep a diary of all conversations you have with the insurance company and your insurance agent, including names, times and dates of the calls or visits and contact details.
• Be certain to give your insurance company all the information they need. Incorrect or incomplete information may cause a delay in processing your claim.
• If the first offer made by the insurance company does not meet your expectations, be prepared to negotiate. If there is a disagreement about the claim, ask the company for the specific language in the policy in question and determine why you and the company interpret your policy differently. If you believe you are being treated unfairly, contact the Insurance Department at www.ins.state.ny.us. You can file a complaint about an insurance company at http://www.ins.state.ny.us/complhow.htm.
• Consumers should contact their insurance company, agent or broker to get answers to specific questions about their policies. Consumers who need further help should feel free to contact the New York State Insurance Department’s Consumer Services Bureau at 800-342-3736 which operates from 9 a.m. to 4:30 p.m., Monday through Friday. Disaster related calls only should go to the Department’s disaster hotline at 800-339-1759, which will be open starting Monday from 8 a.m. to 8 p.m. for as long as needed
• In addition, health insurance companies have been instructed to accommodate consumers who had to evacuate their homes and as a result have to seek care from out-of-network doctors or other health providers.”

  To read the entire press release click here.

An article in The New York Times states:

The total damage inflicted by Hurricane Irene may reach $7 billion by the time the storm dissipates in the coming days, making one of the insurance industry’s worst years even tougher, according to an early estimate by the Kinetic Analysis Corporation in Silver Spring, Md.

Most of the loss will very likely come from property in New York and New Jersey, according to industry experts. Although Irene had diminished to a tropical storm by the time it reached New York early Sunday, those two states have the most valuable coastal property on the Atlantic Coast.

At $7 billion in possible losses, Irene would be among the 10 costliest catastrophes in American history, according to the Insurance Information Institute.

The most expensive disaster by far was Hurricane Katrina in 2005, which caused $45 billion worth of damage, not counting costs that were covered by the National Flood Insurance Program. The second, at about $23 billion, was the Sept. 11, 2001, terrorist attacks on the World Trade Center and Pentagon, which the institute counts as a single event.

To read the entire article click here.

Cara Matthews writes on pressconnects.com - “Independent pharmacists and mail-order drug companies continue to spar this week about pending legislation that would prohibit insurers from requiring patients to get prescriptions through the mail.

The Pharmacists Society of the State of New York said approval of the bill would help counter the loss of jobs and community drugstores. But pharmacy-benefits managers countered that the number of licensed pharmacists has been growing steadily and that mail-order drug businesses provide hundreds of jobs in New York.

The bill, which has not been sent to Gov. Andrew Cuomo yet, would allow people to fill any prescription covered by mail order at an independent retail pharmacy as long as the pharmacy price was comparable. The Pharmacists Society led a news conference in Albany as it tries to convince Cuomo he should sign it.”

To read more click here.

In a letter sent to State Senator James L. Seward by the Federal Trade Commission on an assembly bill (A5520-B) which regulates the use of mail order pharmacies by health plans offering prescription drug coverage they recommend that the bill not be enacted.

In part of that letter they state, “The Bill will limit a health plan’s ability to steer beneficiaries to a lower cost mail order vendor of maintenance drugs,3 via financial incentives or other terms of coverage, whenever a competing retail pharmacy is willing to fill prescriptions at “comparable” prices. By restricting a health plan’s ability to offer favorable treatment to a low cost mail order pharmacy, the Bill undercuts pharmacies’ incentives to bid aggressively for a share of that health plan’s business. Reducing those incentives is·1ikely to raise the prices that consumers pay for the prescription drugs that their health plans cover. Some cost increases may be passed on to plan beneficiaries in the form of higher out-of-pocket prices. In some cases, plans may respond to higher costs by reducing the scope of prescription drug coverage, or by eliminating prescription drug coverage entirely. For those reasons, FTC staff recommend that the Bill not be enacted.”

To read the letter click here.

Health care spending continues to be the “elephant in the room.” That doesn’t stop any number of entities continuing to provide the data.

The latest National Institute for Health Care Management (NICHM) Foundation Data Brief on U.S. health care found that between 2005 and 2009, total national health spending rose 23 percent from $2.021 trillion to $2.486 trillion. Over the same time period, national spending on premiums for private health insurance rose nearly 15 percent.

And a recent article in Health Affairs on health spending projections to 2020, notes “In 2010, US health spending is estimated to have grown at a historic low of 3.9 percent, due in part to the effects of the recently ended recession. In 2014, national health spending growth is expected to reach 8.3 percent when major coverage expansions from the Affordable Care Act of 2010 begin. The expanded Medicaid and private insurance coverage are expected to increase demand for health care significantly, particularly for prescription drugs and physician and clinical services. Robust growth in Medicare enrollment, expanded Medicaid coverage, and premium and cost-sharing subsidies for exchange plans are projected to increase the federal government share of health spending from 27 percent in 2009 to 31 percent by 2020. This article provides perspective on how the nation’s health care dollar will be spent over the coming decade as the health sector moves quickly toward its new paradigm of expanded insurance coverage.”

The State Senate concluded its session in late June without taking action on legislation to set the implementation of a NY Health Exchange in motion. They are not set to return to Albany until late September at the earliest. The absence of a governance structure and statutory authority has not stopped planners from proceeding with design elements which will have significant influence on the ultimate look and functionality of a health exchange. The Department of Health released a Health Benefit Funding Availability Solicitation on July 15, seeking to award a 4 year contract for the delivery of an operational system. The FAS also notes that it is the Department’s intent to award the successful bidder of this FAS the operational phase for the exchange.

The initial 30 day timeframe for interested parties to submit a bid to this 162 page document has been extended through September 6, 2011. The bid observes that “As an Early Innovator state, the target date for “Operational Readiness” of the NY-HX Solution is October 10, 2012, to facilitate re-use by other states.” NYS is not the only Early Innovator grantee to not pass authorizing exchange legislation; Kansas and Wisconsin legislative sessions ended without agreement on a bill and Oklahoma returned its EI grant to the federal government. Maryland has become a leader among states on exchange implementation – passing its legislation in April, appointing its 9 member board in May which held its first meeting in early June.

With an aggressive timeframe, and with state budget-provided authority to award without competitive bid, the Department of Health will proceed with designing and “building” a health exchange system that will likely anticipate policy decisions, rather than being informed by policy decisions related to the functionality needed for this customer interface.

Early this morning, negotiations concluded on the framework for the establishment of New York’s Health Exchange.  An analysis of the agreed-upon bill, which is expected to pass both houses of the Legislature today, can be found here.

Significantly, this agreed-upon bill preserves the role of the Legislature in making public policy by requiring the Exchange Board to seek statutory authority on issues such as selective contracting, standardizing benefits available through the exchange, etc. The Exchange in the agreed upon bill will be governed by a Board of 9 members, and will establish 5 regional advisory committees each with 5 members whose role will be to annually review and report on regional variations in the operation of the exchange.

The Board, once appointed, will have a very aggressive timetable to complete and report back to the Legislature and Governor by April 1, 2012 on twenty-two different policy areas.  These studies need not be stand-alone, and their completion may be delayed if federal rulemaking has not been released.

The Business Council believes this negotiated bill takes the proper approach in establishing the governance structure, identifying areas of policy upon which further study and data is required, and will allow for broad stakeholder input and participation.

Please feel free to Maggie if you have any questions.

The Business Council of New York State opposes this legislation which would permit health care providers, including physicians, to form unions for the purpose of collectively bargaining with health plans.

At a time when changes resulting from implementation of the federal Affordable Care Act will substantially alter the landscape of health care delivery, this is not the time to introduce state-specific authorization to permit health care providers to organize for the purpose of collectively bargaining with health plans. When the two largest payers in the country are Medicaid and Medicare, and neither reimburse health care providers at a sufficient level relative to providers’ true costs, a network of doctors collectively bargaining would likely seek to offset losses of Medicare and Medicaid revenue by charging more to privately insured patients – merely shifting costs rather than innovating and evaluating their own business practice models to wring efficiencies out of the system.

To read the bill memo in opposition click here.

Business Council member The Travelers reports a large increase in insurance customers filing claims from mobile devices.

The Travelers study broadly examined insurance claims filed over the past 16 months using mobile devices. In reviewing claims data comparing the first four months of 2010 versus the same time period in 2011, the number of claims filed via mobile devices more than tripled.

“The faster our customers report claims to Travelers, the faster we can help them,” said Jay Gauthier, Vice President, Travelers Personal Insurance Marketing. “That’s why we continue to develop technologies that make it easy for our customers to communicate with us in the way that’s most convenient to them, whether online, over the phone, or through their mobile devices, 24 hours a day, 7 days a week.”

Read more.