Letter from the President 
 Goal Setting for 2009

By Debi Hardwick, Coastal TPA, Inc.

Another year is coming to an end and I for one am not ready to say good-bye to 2008.  Did you accomplish all the goals that you set for yourself and your company? I sure didn't.  What are you going to change in 2009 to be more effective in your business? Well for one thing, I am attending the 2009 HCAA Executive Forum at the Wynn Hotel & Casino in Las Vegas, February 3rd through February 5th.

During the Executive Forum, I am going to learn additional marketing and sales strategies, tools and techniques that will assist me and my organization to change to meet the challenges that we are facing; and ways that other TPAs have re-invented themselves and their product offering. I will also have the opportunity to spend time with trusted colleagues and friends. This year's conference "The Next Generation TPA: Preparing for Strategic Growth" promises to be exciting, educational and timely. Please take a look at the agenda, outlined in this newsletter, and mark your calendar now, to join us February 3-5th. Change is a-coming, whether we like it or not!!

The HCAA Board and Committees are also working on ways that we can get important information to you more quickly.  We hope that you find value in our two conferences and our quarterly newsletter; however, we also know that mandates, change and updates require more frequent communication.  Stay tuned. We will have announcements about new resources for faster communication; coming soon.

 "The Next Generation TPA:
Preparing for Strategic Growth"

2009 Executive Forum: 
February 3-5, 2009
Wynn Las Vegas

The HCAA Executive Forum is the can't-miss event of the year where you'll get firsthand insights from industry leaders on the future of healthcare and employee benefits. This event caters to a variety of issues under a central theme, giving you the big picture to make important decisions. In addition, you'll connect with other administrators and professionals who openly share their strategies for common challenges. No matter your role in the healthcare industry, the Forum has the answers to your most pressing concerns.

Online Registration Available

Online registration is available for this event. Click here for more information and to register.

Click here to view the event agenda or download the full brochure for more information on the conference.

Thank you to HCAA's Executive Forum sponsors:
(as of 12/10/08)

Annual Corporate Sponsors

A&G Healthcare Services 
American Health Holding, Inc.

Benefit Informatics, Inc.

Express Scripts, Inc. 

INETICO, Inc.
The Lungen Group

Phia Group, LLC
Preferred Medical Claim Solutions, LLC

RedCard Systems
WellDyneRx

Platinum Sponsors

Carewise Health, a SHPS Company

Coalition America, Inc.

Evolution Benefits, Inc.

First Health
Focused Health Solutions

Interface EAP
Lighthouse1, LLC
MPHASIS Eldorado

United Claim Solutions

General Session Sponsor
CVS Caremark 

Lunch Sponsor
Healthx, Inc.

Wednesday Night Reception Sponsor
The Phia Group, LLC

Conference Bag Sponsor
Paul Gitnik & Associates, LLC

Name Badge Sponsor
RESTAT, LLC

Breakfast Sponsor
First Dental Health
Emdeon

Break Sponsor
Hines & Associates


CLICK HERE for more information on becoming a sponsor for this event!

MAKE YOUR HOTEL RESERVATIONS NOW!

Wynn Las Vegas
3131 Las Vegas Boulevard South
Las Vegas, NV 89109

• $265 per night + tax - single or double occupancy 
• Reservation call-in number: 1-866-770-7555
       or 702-770-1571
• Hotel reservation deadline: Friday, January 2
• Reference 2009 HCAA Executive Forum when
       making your reservation

HCAA is an approved provider of Continuing Education Credits in the healthcare industry. Contact us for information and documentation to acquire them.

AAPPO Activities of Interest to HCAA Members
By Lynn Huls, AAPPO Senior Consultant

"Add Value Programs": AAPPO's programs identify ways that PPOs, TPAs and partner organizations can maximize the value of the services they offer - for example, by offering a high quality, high efficiency network or assisting employers to change employee's health behaviors.  Of particular interest to HCAA members may be the AAPPO ACT on Diabetes web site which includes links to free resources that improve diabetes outcomes.  Also of interest to TPAs is the AAPPO Adding Value program, which offers information and education on the new "value based benefit design" trend, along with information on how to avert costs by promoting health, wellness, and adherence.

Federal and State Legislative Impact Series: AAPPO continues to be actively involved with legislative issues at both the state and national level. Members and non-members alike joined our informative presentations and discussions on legislation passed in Indiana, Ohio, Florida and Connecticut over the past few months. Federal legislative impact webinars relating to the Wyden Bill and Model PPO Act were also recently conducted.  Recordings of these webinars are available via AAPPO's website.  

PPO Education: A Comprehensive Overview of the Healthcare System, an online fundamental course in the AAPPO Academy, was recently revamped and updated. It is available to HCAA members at AAPPO member pricing.

CMS Proposes Three National Coverage Determinations to Protect Patients from Preventable Surgical Errors

CMS PROPOSES THREE NATIONAL COVERAGE DETERMINATIONS TO PROTECT PATIENTS FROM PREVENTABLE SURGICAL ERRORS
 
The Centers for Medicare & Medicaid Services (CMS) proposed today three national coverage determinations (NCDs) to establish uniform national policies that will prevent Medicare from paying for certain serious, preventable errors in medical care. The following errors, called Never Events, being focused on by Medicare through the NCDs are identified in the National Quality Forum's (NQF's) list of Serious Reportable Events:
 
· Wrong surgical or other invasive procedures performed on a patient;

· Surgical or other invasive procedures performed on the wrong body
  part; and  

· Surgical or other invasive procedures performed on the wrong patient.
 
"These types of surgical errors can cause serious injury or death to beneficiaries and result in increased costs to Medicare due to the need to treat the consequences of the errors," said CMS Acting Administrator Kerry Weems . "The proposed national coverage policies for certain types of surgical errors are important steps for Medicare in working to reduce or eliminate their occurrence and their associated payments."
 
In 2002, prompted in part by the release of the 1999 Institute of Medicine report titled, "To Err is Human: Building a Safer Health System," the NQF created a list of 27 Never Events, which was expanded to 28 events in 2006.
 
As part of the ongoing implementation of Section 5001(c) of the Deficit Reduction Act (DRA) of 2005, CMS has addressed some of the NQF Never Events through the Hospital-Acquired Conditions (HACs) provisions in the Inpatient Prospective Payment System (IPPS) final rule for fiscal years (FY) 2008 and 2009. For discharges occurring on or after October 1, 2008, Medicare will no longer pay a hospital at a higher rate for an inpatient hospital stay if the sole reason for the enhanced payment is one of the selected HACs, and the condition was acquired during the hospital stay. CMS is exploring how to adapt this policy to its other payment systems.

In the IPPS FY 2008 final rule, CMS selected eight conditions for the HAC list, a number of which were among the 28 Never Events listed by the NQF and include retained foreign object after surgery, air embolism, blood incompatibility, stage III & IV pressure ulcers, and falls and traumas such as electric shock and burns. In the IPPS FY 2009 final rule, CMS added manifestations of poor glycemic control, including hypoglycemic coma, to the list. Hypoglycemic coma is closely related to NQF's listing of death or serious disability associated with hypoglycemia.
 
CMS determined that not all conditions included on the NQF list of Never Events can be adequately addressed by the HAC payment provision and therefore determined that the NCD process was appropriate to address coverage for the three types of surgical errors cited above.  Unlike the HAC provisions, which affect only payments to hospitals for inpatient stays, the final NCDs could affect payment to hospitals, physicians, and any other health care providers and suppliers involved in the erroneous surgeries.  
            
CMS will accept comments from the public regarding the proposed coverage policies until January 1, 2009. Comments should be submitted separately for each of the NCDs. Following the close of the 30-day public comment period, CMS will issue final NCDs within 60 days.

NOTE: For more information, including information about how to submit comments on each of the proposed NCDs, please see:

Wrong body part:  Click Here

Wrong patient:  Click Here

Wrong surgery performed on a patient:  Click Here
 
Proposed Decision Memo:  Click Here

News You Can Use from the GRA Committee

HCAA's newly formed Governmental and Regulatory Affairs Committee (GRA) is responsible for serving as a legislative and regulatory watchdog for HCAA members and communicating those legislative and regulatory updates as needed to the membership.  This committee will also identify and recommend to the HCAA Board opportunities to support organizations that have legislative and regulatory efforts which support our industry.  
 
Currently members of the GRA Committee include Dolores Green, Chair, Foundation Administrative Services, Inc; Adam Russo, The Phia Group LLC; and John Barlament, Michael Best & Friedrich LLP.  
 
If there is a topic of interest you would like the GRA Committee to address in future issues, please email HCAA at jnolan@hcaa.org.

Be sure to also watch HCAA's website at www.hcaa.org for regular updates on legislative activities between issues of HCAA Reports.

The following information is reprinted with permission from Infinisource (www.infinisource.net)

COBRA
Michelle's Law and COBRA: An Unclear Intersection

This much is clear about Michelle's Law, which was enacted in October 2008: the new federal law requires employer health plans to continue coverage for employees' dependent children who are college students when they take a certified medically necessary leave of absence. The law allows up to one year of coverage during this leave. The law takes effect for plan years beginning on or after October 9, 2009.  More

Cafeteria Plans
New Adoption Law Affects Dependent Definition

The definition of a dependent may seem to be a moving target over the past four years, with numerous laws, regulations and other guidance providing greater "clarity". In October, the definition received another slight alteration from a new law called the Fostering Connections to Success and Increasing Adoptions Act (Adoptions Act).More

Cafeteria and Transportation Plans
2009 Limits for Transportation and Cafeteria Plans

In October, the IRS issued Revenue Procedure 2008-66 and News Release 2008-118, which make cost-of-living adjustments for various employer-sponsored benefit plans. More

Cafeteria Plans
IRS Guidance Sheds Light on FSA Reimbursements

Legal fees, mileage and infant formula were three types of expenses that IRS recently reviewed to determine whether they were qualified expenses for medical care. Such expenses are tax deductible (in some cases) and are reimbursable from a Health FSA or a Health Reimbursement Arrangement (HRA).  More

TPA Marketing: Expanding
Favorable Awareness

What publications do your clients read?

One of the strategic goals of the Health Care Administrators Association is to expand favorable market awareness of the TPA industry. One of the tactics being considered to help achieve this goal is to identify business publications that are often read by the business community and those principals that are instrumental in making the decision to become a self-funded company (e.g. human resource managers, chief financial officers, etc.). In order to help us identify a list of potential publications that we should target with our marketing efforts, we are seeking feedback from you - our members - as to which publications your clients read and find to be a valuable resource. We appreciate you taking a few moments to take the brief survey below to help us identify those publications.  Please click here to take the survey. 

We also encourage you to send this link to your clients and ask them directly what publications they read most often. Note: All answers are anonymous and there is no data collected that would allow us to know who responded.  

Thank you for your support in spreading the news about TPAs!

NewsByte

The Phia Group, LLC and United Claim Solutions are pleased to announce a strategic partnership that will increase the value of services provided by both organizations to the entire at-risk insurance industry.

"We are very excited to work with The Phia Group to provide the leading edge services  of claim subrogation and claim reimbursement to our clients,"  said Joshua Carder, President, United Claim Solutions.  "With the cost of healthcare continuing to rise, The Phia Group will be able to help us look for more ways to minimize all healthcare costs for our clients."

Adam V. Russo, Esq., co-founder at The Phia Group stated, "We here at The Phia Group are extremely excited about our alliance with United Claim Solutions. This unique opportunity will present an efficient cost-containment solution to benefit plans nationwide in response to ever-rising health care expenses."
For more information about UCS please visit www.unitedclaim.com or contact Carolyn Carder, Vice President of Sales and Marketing, at (602) 863-1759 or ccarder@unitedclaim.com.

For more information about The Phia Group, please call (888) 986-0080 or visit www.phiagroup.com.

 Standard Stop-Loss
 Employer Disclosure Form

As reported in previous issues of HCAA Reports, the Self Insurance Institute of America (SIIA) and the Society of Professional Benefit Administrators (SPBA) met to develop a system to "standardize" the disclosure reporting process, with the objective that all insurers would come to accept the reporting system/form as an industry standard. As a result, they have endorsed a standardized stop-loss disclosure form, which also includes ICD-9 codes. The documents are intended to help facilitate the sharing of health data information between self-insured entities/TPAs and stop-loss insurers/MGUs for the purpose of medical stop-loss underwriting.

HCAA Reports will continue running a recurring notice in each issue of the Stop Loss Carriers and MGUs that have adopted the Standardized Form. If your company has adopted the form, please contact Jaime Nolan at jnolan@hcaa.org

AIG Medical Excess

Azeros Healthcare (MGU) on behalf of London Life Reinsurance Company

BEST Re on behalf of US FIRE & BEST LIFE 

BP Inc. (MGU) on behalf of Combined Insurance - Supplemental Insurance

Cairnstone Re

The Hartford

HCC Life

HMA MGU, LLC (MGU)

Independence Holding Company (Standard Security Life Insurance Company of New York, Madison National Life and Independence American Insurance Company)

Intermediary Insurance Services, Inc. (IISI), MGU on behalf of QBE Insurance Company and American National Life Insurance Company of Texas

Medical Risk Managers (MGU)

Mid Atlantic Underwriters, Inc., (MGU) on behalf of ACE American Insurance Company

National Benefit Resources (MGU) on behalf of UnitedHealth Group insurance companies

J. Allan Hall & Associates, Inc. (MGU) on behalf of their underwriting facility, Lloyd's of London

R. E. Moulton, Inc. / American United Life Insurance Company (OneAmerica Companies)

Spectrum Underwriters (MGU)

RMTS, LLC (MGU) on behalf of their carriers Nationwide Life Insurance Company, Gerber Life Insurance Company, and Trustmark Insurance Company (as filed)

Stop Loss Concepts, Inc., (MGU) on behalf of their carriers, Gerber Life Insurance Company and QBE Insurance Company

Swiss Re Commercial Insurance

Zurich North America

 Welcome New Members!

Ted Sweet, VP Account Management
MPHASIS Eldorado
5353 North 16th Street, Suite 400
Phoenix, AZ 85016-3228
PH:  602.604.3100
FX:  602.604.3115
tsweet@eldocomp.com
www.eldocomp.com
Type:  Software

 Join a Committee

Looking for ways to get more involved in the association?  Join a committee!  HCAA's success depends on the hard working volunteers who keep us moving forward and bring new ideas to the table.  The following information highlights the committees that are currently accepting new members.  If you are interested, email jnolan@hcaa.org

BENCHMARKING COMMITTEE
This committee is responsible for the implementation of the annual benchmarking survey.  Duties include securing and working with selected vendor, reviewing and revising survey content, providing feedback for continuous improvement, and presenting results at TPA University.

EDUCATION COMMITTEE
This committee is responsible for the following:
i.    Development and management of the Certified Self-Funding Specialist Certification (CSFS) certification program.  
ii.    Development of an Employer Education program to include HR, CE, CLE, CPA credits
iii.    Application of Continuing Education credits for HCAA conferences
iv.    Development of additional education opportunities for members (e.g. webinars, etc.)

EXECUTIVE FORUM COMMITTEE
This committee is responsible for creating the theme of the conference, identifying topics and speakers, and approving presentation content before publishing.  The committee will support HCAA staff as needed in planning of logistics.

GOVERNMENT & REGULATORY AFFAIRS COMMITTEE
This committee is responsible for serving as a legislative watchdog for HCAA members, communicating legislative updates as needed to the membership.  This committee shall also identify and recommend to the Board opportunities to support organizations that have legislative efforts which support our industry.  

MEMBERSHIP COMMITTEE
This committee is responsible to assist with the recruitment and retention of HCAA members. Duties include evaluating member benefits, making recommendations for change and/or new benefits as opportunities arise, and establishing and implementing a membership campaign.

PUBLIC RELATIONS COMMITTEE
This committee is responsible for overseeing and making recommendations for change to the HCAA website and the newsletter.  The committee is also responsible for the development and implementation of a plan to market HCAA and the TPA industry.

SPONSORSHIP COMMITTEE
This committee is responsible for evaluating the annual sponsorship campaign and making recommendations for benefits to the Board, as needed.  This committee will also assist in finding and securing sponsors for annual corporate sponsorships and the individual conference sponsorships.  

TPA UNIVERSITY COMMITTEE
This committee is responsible for creating the theme of the conference, identifying topics and speakers, and approving presentation content before publishing.  The committee will support HCAA staff as needed in planning of logistics.

 SAVE THESE DATES!

2009 Annual Executive Forum
February 3-5, 2009
The Wynn, Las Vegas

2009 TPA University
July 15-17, 2009
Disneyland Grand Californian Hotel, Anaheim, CA

In This Issue

Letter from the President

Executive Forum

AAPPO Activities

CMS Update

News from the GRA Committee

TPA Marketing: Expanding Favorable Awareness

NewsByte

Standard Stop-Loss Employer Disclosure Form

Welcome New Members!

Join a Committee

SAVE THESE DATES!

HCAA Members

A&I Benefit Plan Administrators, Inc.

Acclamation Systems, Inc.

Advantek Benefit Administrators 

AIG/Medical Excess 

 Allegiance Benefit Plan Management, Inc.

Alliance Underwriters 

AllMed Healthcare Management

 AmeriBen/IEC Group

 American Health Holding, Inc.

 Arizona Foundation for Medical Care 

Arrowhead Administrators

ASR Health Benefits

Benefit Informatics, Inc. 

 Benefit Management Administrators 

 Ben-E-Lect 

Brokerage Concepts, Inc. 

Butler Benefit Service, Inc.

Cairnstone Inc.

 Capitol Administrators 

 CBA Administrators
 
 CDS Group Health

Coalition America, Inc.

 Coastal TPA, Inc. 

 Community Health Group

Consumer Health Technologies

Core V Solutions

Coresource, Inc.

 CVS Caremark 

DataMetrix 

Delta Health Systems 

 Dentafits-RxReins

Devon Health Services

 EBA&M 

 Employee Benefit Management Services, Inc. 

Envision Rx

Express Scripts, Inc. 

First Administrators 

First Choice Health

 First Choice Health Network

First Dental Health

 First Recovery Group

FirsTier GA

 Foundation Administrative Services, Inc. 

Gilsbar, Inc.

Global Claim Resources 

Group & Pension Administrators, Inc.

 HBS Insurance Services 

 HCC Life Insurance Company 

 Health Future LLC

Health Services Benefit Administrators, Inc.

 Healthaxis, Inc. 

 HealthCare Solutions Group Inc.  

HealthComp Administrators

Health Edge Administrators

HealthFirst TPA

HealthMedia, Inc.

Healthplace America

 HealthRisk Resource Group Inc.

Healthx, Inc.

 Hines and Associates

HM Insurance Group

 Humboldt-Del Norte Fnd. For Medical Care 

 INETICO, Inc. 

 Ingenix 

Insurance Management Services

Intergrity Administrators, Inc.

 Interactive Health Solutions 

 Interface EAP 

 Intermediary Insurance Services, Inc. 

 Interplan Health Group 

 IOA RE

ISU - International Specialty Underwriters

 Keenan & Associates

Lawrence & Russell, LLP

Maxor National Pharmacy Services, LLC

Medco Health Solutions

 Medical Eye Services, Inc. 

 MedImpact HealthCare Systems, Inc. 

Medtral New Zealand 

Michael Best & Friedrich LLP 

 MMSI, Inc. 

 Mountain States Administrative Services

MPHASIS Eldorado

 Munich Re HealthCare 

 Mutual Assurance Administrators 

 Mutual of Omaha 

National CooperativeRx 

New World Administrators, Inc.

NorthWind, LLC

NuFACTOR Specialty Pharmacy Services

OneSource StopLoss Insurance Marketing 

 Orange County Fnd for Medical Care 

P5 Health Plan Solutions

 Partners Rx Management LLC 

 PCG Software, Inc. 

 Pequot Plus Health Benefit Services

 Performance Health Technology, LTD

Phia Group, LLC

 Pinnacle Claims Management, Inc.

Polsinelli Shalton Flanigan Suelthaus PC

 Preferred Medical Claim Solutions

Premier Healthcare Exchange

 Professional Benefit Administrators, Inc. 

 Professional Insurance Consultants, Inc. 

 QVI Risk Solutions Inc. 

 R. E. Moulton, Inc. 

Red Card Systems

RESTAT, LLC

RMTS, LLC

RolloverSystems, Inc.

 Self-Funding Actuarial Services, Inc.

 SOCRATES, INC. 

 Southwest Service Administrators, Inc. 

 StarLine Group 

 Summit Management Services Inc.

 SunGard, iWORKS GBAS 

 Swiss Re 

 Symetra Life Insurance Company

TC3 Health, Inc.

 The Lungen Group 

The Principal Financial Group 

The SandsTech Group, Inc.

The Sentinel Group

The TPAA

Total Administrative Services Corp.

 TRU Services, LLC 

 U. A. Local #447 Pipe Trades Trust Funds 

 United Administrative Services 

 United Medical Alliance

Universal American

Universal Health Network

US Health and Life Insurance Company/Automated Benefit Services, Inc.

USBenefits Insurance Services, LLC

 WellDyneRx 

 William J. Sutton & Co. Ltd. 

 WorldDoc, Inc.

Zurich North America