Compliance Corner: Podcasts

Chase Cannon and Suzanne Spradley focus on the parts of the US system that are working well, focusing on the employer-sponsored group health insurance market. Chase orates a brief history of the employer-based insurance model, including why employer groups were originally (and still today) the ideal group market target for insurance companies. Chase explains that between 180 and 185 million people (or 55 to 60 percent of the US population) are currently covered through an employer group health plan; the vast majority of whom are happy with their plan and benefits. Chase and Suzanne outline the importance of employer engagement in employee’s health care benefit coverage, and how the employer market has seen lower cost increases than the individual market. Chase describes the built-in incentives for employers and carriers to develop innovative plan design and cost-saving strategies, and how the private market (as compared to the government) is better suited to stoke the embers of further innovation. The two conclude that the employer model is working well: It’s a stable system that has lower premium rate increases, less adverse selection, more incentives for innovation, and that already covers the majority of US citizens. The better approach is to develop fixes for the more problematic individual market.

In this episode, Suzanne Spradley and Chase Cannon announce a three-part mini-series aimed at better understanding the challenges facing a single payer system (sometimes called “Medicare for All”) in the US. In the first part, Suzanne re-sets the discussion on single payer systems and describes some of the different arrangements and titles that fall under that general term. Suzanne describes the challenges facing different single payer systems in the UK and in Canada, including information on wait times and quality of care outlined in recent studies. Chase and Suzanne discuss funding of single payer systems, and how single payer systems generally result in higher taxation across the board. Suzanne finishes with a description of the challenges facing the Veterans Affairs (VA) program, which is a version of a government-run health care system right here in the US. The two outline the next two parts to the mini-series: part two will focus on parts of the US system that are working, including the employer-sponsored group health insurance market, and part three will dig deeper into the financing and funding of some of the proposals thrown around in US political debates.

In this episode, Jill Brooking joins Chase Cannon to discuss the impact the government shutdown may have on employer group health plans, particularly for governmental contractors, whose employees may be out of work due to the shutdown. Jill breaks down the benefits issues employers should look at for employees that are out of work or on furlough as a result of the shutdown, including plan eligibility terms and carrier (or stop-loss) contracts, and the risks in covering employees outside the plan’s eligibility terms. Jill describes how the ACA’s employer mandate may impact an employer’s offer of coverage, depending on whether the employer is using measurement/stability periods for employees. Jill also discusses premium payment options for employers and employees during an unpaid leave of absence, and at what point COBRA comes into play. Lastly, Jill and Chase discuss what should happen when – if ever – the government shutdown ends, including collecting premiums in arrears and the rehire rules under both Section 125 and the ACA’s employer mandate.

In this episode, Suzanne and Chase review the recent district court ruling that the individual mandate is unconstitutional and, as a result, the entire ACA is invalid. While the ACA remains in place pending appeal, Suzanne outlines the basis for the case, the reason why intervening states had to step in for the DOJ, and why the individual mandate may or may not be “inseverable” from the rest of the ACA. Suzanne gives a basic overview of civil procedure and appeals, and describes the process by which the case here will be appealed. Suzanne and Chase also discuss a bit of constitutional law and the balance of powers — the limitations on courts as they interpret and decide the constitutionality of legislation passed by Congress. The two close with important points on employer obligations while the case is appealed and the potential political fallout with a split Congress and the looming 2020 elections.

In this episode, Suzanne and Chase review the Office of Civil Rights (OCR, a subdivision of HHS) list of HIPAA violation settlements that occurred in 2018. To lead off, though, Chase breaks down the purpose of the HIPAA privacy and security rules, and what the basic HIPAA requirements are for employers. Suzanne and Chase then discuss several OCR investigations of employer HIPAA violations that eventually led to settlements. Chase breaks down HIPAA violations resulting from several situations. First: a doctor’s response to media inquiries regarding a patient’s complaint. Second: a hospital group that developed policies and procedures, but failed to implement them and later experienced a breach when unencrypted USB drives were lost and an unencrypted computer was stolen. Third: a document retention company that left a box of files containing sensitive information in an unlocked truck in its parking lot. The final case involves hospitals that failed to obtain authorization from patients while filming a TV mini-series. Chase and Suzanne close with a discussion of HIPAA compliance learning points for employers and their group health plans.

In this episode, Suzanne and Jill discuss year-end considerations for employer plan sponsors. Many employers are currently in or have just completed their open enrollment process. Jill and Suzanne answer the question of whether an employer should accept enrollment requests after open enrollment has ended. They also remind employers about which notices need to be distributed, including the frequently forgotten COBRA Initial Notice for employees and spouses who newly enroll during open enrollment. Lastly, they discuss how employers should prepare for upcoming reporting obligations.

In this episode, Suzanne and Chase look at the benefits compliance environment since the midterm elections. The two start off with a recap of election results and then immediately dive into the impact a divided Congress could have on the ACA. There could be bi-partisan support on simplified reporting and on repeal of the Cadillac tax. The two also discuss the Texas v. United States case involving the Republican challenge to the constitutionality of the ACA in consideration of the 2019 repeal of the ACA’s individual mandate and assess how a divided Congress might react to a loss of protections for those with pre-existing conditions. Chase outlines issues to consider post-election on prescription drug prices, medical tourism, the issues of a single-payer system (sometimes referred to as “Medicare for All”) and Medicaid expansion (and how that might interact with the employer group market). The two close with post-election impact on the court challenge of the DOL’s association health plan regulations.

In this episode, Suzanne and Chase address the advantages and disadvantages of medical tourism, and how an employer’s compliance obligations may be impacted if they incorporate some type of medical tourism into the group health plan. Suzanne leads off with a definition of ‘medical tourism,’ including travel for medical services and procedures both within and outside the US. Suzanne delves into some of the costs and coverages, including travel costs, that are generally included in medical tourism, issues regarding quality of care for treatment received in foreign countries, and how the tax consequences may play out for both the employer and the employee. Suzanne addresses transportation of foreign drugs back into the US following a foreign-performed surgery, and how the FDA may treat that drug transportation. Chase and Suzanne close with some of the practicalities in administration and compliance, including HIPAA, ERISA and vendor relations.

In this episode, Suzanne Spradley and Chase Cannon discuss different delivery methods available to employers when distributing health plan notices and disclosures to employees. The two address hand delivery, delivery by mail, email and intranet delivery, and building the notices into online enrollment systems. Chase outlines which notices are best suited for electronic delivery, and how electronic delivery requires special accommodations for some populations of employees—those who may not have phone or email access as a big part of their job. Suzanne and Chase then discuss a recent White House executive order that could impact the DOL as it formulates electronic disclosure rules, as well as industry groups that may be opposed to an all-electronic disclosure regime. They close with an overview of what it all means for employers.