Letter from the President

By Todd Archer

Dear HCAA Member:

I want to thank everyone who attended and participated in our Executive Forum at Encore at Wynn Las Vegas last month. It was another successful event that provided timely content with engaging presenters along with the opportunity to spend time with your peers and others in realizing The Value of Connection. Our events continue to grow and if you missed this last one, we hope you will consider joining us at the TPA University in Denver, CO, July 21 - 23, 2010.

I also want to remind and encourage everyone to have your organization participate in the 2010 Benchmarking Survey. It is easy, fast and confidential. The deadline is fast approaching on April 1. By participating in the survey, your company will receive comparative benchmarking information to measure your operations against your industry peers. This information can be a key in helping improve your company's performance through:

• Benchmarking its operations against industry peers
• Measuring and improving productivity
• Evaluating employee effectiveness
• Tracking emerging trends
• Monitoring and managing expenses
• Protecting your bottom line ROI

To obtain a copy of the survey so your firm can participate, please contact jnolan@hcaa.org

From the two conferences each year (Executive Forum in February, and TPA University in July), to our LinkedIn members-only group, blog posts, webinars, and the Certified Self Funding Specialist® designation, our association is working to provide information that benefits us individually and collectively. Daniel J. Boorstin, the twelfth Librarian of the United States Congress, said "Education is learning what you didn't even know you didn't know." As TPAs, we are expected to successfully navigate an increasingly complex system, where what you didn't even know you didn't know, can have significant consequences. By actively participating in HCAA and its activities, you will be better at "Gearing Up for a Changing Industry." Stay tuned to see how.

Respectfully,

Todd E. Archer
President

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HCAA CELEBRATES 30 YEARS OF CONNECTIONS

2010 marks the Health Care Administrators Association's 30th anniversary.

HCAA was formed in 1980 as the Independent Administrators Association, a California-based not-for-profit that acted as a legislative and regulatory advisory group for third-party administrators and related service providers. Following the passage of ERISA and similar laws, third-party administrators needed a voice in Washington as well as educational opportunities with leading experts in the industry.

Today, HCAA's members are nation wide and in Canada. The membership consists of TPAs, insurance carriers, managing general underwriters, audit firms, physician hospital organizations, broker/agents, human resource managers and health care consultants.

HCAA is the preferred resource for healthcare administrators to stay on the forefront of industry business issues while enjoying as open exchange of ideas.

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Record Attendance Achieved at 2010 Executive Forum

Over 270 self funding industry representatives attended the 2010 Executive Forum February 9 - 11 in Las Vegas. The conference, "Effective Leadership in a Time of Change," held at Encore at Wynn Las Vegas, focused on navigating the turbulent economy and ensuring a company's viability in unpredictable times.

HCAA was honored to welcome Ernie Clevenger, President of MyHealthGuide, LLC and CareHere, LCC as the conference facilitator. As facilitator, Clevenger shared his knowledge of industry trends and various reform initiatives, along with his professional insights in a dynamic, interactive way that clarified the key points from each presentation.

Photos from the event are posted on the HCAA Web site. Click here to see photos from this year and past Forums.

A special "Thank You" to all our sponsors:

Corporate Sponsors
A&G Healthcare Services; American Health Holding, Inc.; Benefit Informatics, Inc.; INETICO, Inc.; Preferred Medical Claim Solutions; RedCard Systems; Strategic Recovery Partnership, Inc.; TC3 Health, Inc.; The Phia Group, LLC; WellDyneRx

Platinum Sponsors
A&S Financial Services, Inc.; CIGNA LifeSOURCE Transplant Network; Coalition America, Inc.; Data Dimensions; ELDORADO Computing, Inc.; Evolution Benefits, Inc.; Express Scripts; Global Excel Management, Inc.; Healthation, Inc.; Health Risk Resource Group (HRGI); Script Care, Ltd.; Smart Data Solutions; United Claim Solutions

Gold Sponsors
Ebix Health; NCN; Nevada Preferred

General Session Sponsor
CVS Caremark

Lunch Sponsor
HealthX, Inc. Attendee

Flash Drive Sponsor
Partners RX Management, LLC

Notepad/Pen Sponsor
Star Line Group

Water Bottle Sponsor
TC3 Health, Inc.

Conference Bag Sponsor
American Specialty Health

Name Badge Sponsor
RESTAT Program

Binder Sponsor
Health-e-Web, Inc.

Continental Breakfast Sponsors
TRU Services LLC; informedRX an SXC Health Solutions, Inc. company

Wi-Fi Hotspot Sponsor
Lighthouse1

Conference Break Sponsors
INTERLINK Health Services, Inc.; Ancillary Care Services

Thursday Keynote Book Sponsor
Bases Loaded, Inc.

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How Does Your Organization's Claim Cost Compare to the Industry?

How many times have you wished you could have industry information that would allow you to compare your company's performance characteristics with others in the TPA industry? When you complete the 2010 HCAA Benchmarking survey you receive this type of industry information. All participating companies will receive an Individualized Respondent Report that shows your company's survey response along side the industry benchmarks. You will receive your customized summary at HCAA's 2010 TPA University at the Westin Tabor Center in Denver, CO, July 21 - 23. If you are unable to attend, your company's report will be available 10 days after the conference. All results are confidential.

There is still time to submit your completed survey. The deadline is April 1, 2010.

If you aren't sure about completing the survey, we encourage you to do so. Having industry comparative information is useful to improving your company's performance. The information from the HCAA survey can help your company:

• Benchmark its operations against industry peers
• Measure and improve productivity
• Evaluate employee effectiveness
• Track emerging trends
• Monitor and manage expenses
• Protect your bottom line ROI

See how your company compares in:

• Productivity and staffing ratios
• Financial benchmarks (cost per claim, new business rates, revenue per fte, etc.)
• Emerging technology usage
• Operational characteristics

Thank you to those who have already completed the survey. If you have not, please take advantage of the extended April 1 deadline. If you have questions, or would like to complete the survey, please contact rachel@hcaa.org.

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Certified Self Funding Specialist® - CSFS® - Moves Forward

HCAA's Certified Self Funding Specialist® designation continues to see positive growth. Since the launch nine months ago, a total of 23 people have completed all seven courses to become CSFS® designees. A total of 140 courses have been completed with another 151 courses ordered.

CSFS® designees receive a certificate and plaque from HCAA memorializing their accomplishment. With these awards will come a letter from the Association congratulating them on their accomplishment, a sample press release that they might use to publicize their work and a protocol for their usage of the CSFS® acronym.

HCAA is also pleased to announce that the Certified Self Funding Specialist® designation and the acronym CSFS® are registered trademarks by the United States Patent and Trademark Office (USPTO).

We continue to enhance the test base and materials for CSFS® to remain current with the changing health care landscape. We have Continuing Education credits available in 14 states and have filed for credits in the other 36 states. As we hear from each additional state, we will publicize their approval of credits.

As announced at the Executive Forum in Las Vegas, HCAA is adding an interactive map to our Web site. This map contains listings of CSFS® students, designees and course credits by state. The map is an important and additional way to publicize the CSFS® program and allow our designees an opportunity to publicize their achievement.

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Proposed State Legislation on Provider Contracts

States continue to address issues related to health plans, provider contracting and payor entities. The number of bills introduced in almost every state is staggering and reflects the growing unrest by the patient and provider community over what they claim are unfair or deceptive insurance practices. Although most of the bills are titled "Provider Contracts" the impact to TPAs is great. You will see a theme amongst the bills which is to limit the ways a provider contract can be accessed by a payor and to control under what circumstances The following is a small sample of some of the bills working their way through the legislative process. For more indepth information on these bills, go to the HCAA Web site under the "Legislative and Regulatory Updates" section. Also posted there is a Silent PPO Whitepaper recently released by AAPPO, while aimed at the PPO and provider community, it has a major impact on TPA business practices.

CONNECTICUT S.B. 17 - PROVIDER CONTRACTS
Summary: Requires that internet Web site and telephone listings of covered entities be updated at least every 90 days. Prohibits covered entities from granting subsequent access to third parties to health care services, discounted rates or fees established in contracts between health care providers and contracting entities. Specifies that violations are deemed unfair or deceptive insurance practices. The definition of a "covered entity" is any entity that has not contracted directly with a health care provider but that buys, leases, rents, is assigned or accesses a contract or terms of a contract with a health care provider, that is responsible for (A) the payment or coordination of health care services, or (B) the establishment or extension of health care provider networks.

CONNECTICUT S.B. 429 - PROVIDER CONTRACTS
Summary: Provides that "most-favored-nation clause" means a contractual provision that: (1) prohibits, or grants a contracting health organization an option to prohibit, a medical provider from contracting with another payer to provide health care services at a lower rate than the payment or reimbursement rate specified in the contract with the contracting health organization; (2) requires, or grants a contracting health organization an option to require, a medical provider to accept a lower payment or reimbursement rate if the medical provider agrees to provide health care services to any other payer at a lower rate; (3) requires, or grants a contracting health organization an option to require, termination or renegotiation of an existing health care contract if a medical provider agrees to provide health care services to any other payer at a lower rate; or (4) requires a medical provider to disclose the medical provider's contractual payment or reimbursement rates with other payers. Provides that no contract between a contracting health organization and a medical provider or hospital shall contain a most-favored-nation clause.

FLORIDA H.B. 291 - PPOS, PROVIDER CONTRACTS
Summary: Provides that a contract between a health insurer and a health care practitioner for the provision of services to patients may not contain any provision that requires the practitioner to provide services to the policyholders of the health insurer at a fee set by the health insurer unless such services are covered services under the applicable health insurance policy. Covered services is defined as "services reimbursable under the applicable health insurance policy, subject to any contractual limitations on an insured's benefits that may apply." Provides that this applies to all contracts entered into or renewed on or after July 1, 2010.

GEORGIA S.B. 50 - PPOS, PROVIDER CONTRACTS
Summary: Current version (February 17) prohibits access to a provider's health care services and contractual discounts by certain contracting entities under certain circumstances. Defines a "contracting entity" as any person or entity that enters into direct contracts with providers for the delivery of health care services in the ordinary course of business. Provides that a contracting entity shall not lease, rent or otherwise grant to a third party access to a provider network contract unless the third party accessing the contract is: 1) a payer or third party administrator or another entity that administers or processes claims on behalf of a payer; 2) a preferred provider organization or preferred provider network, including a physician organization or physician hospital organization; or 3) an entity engaged in the electronic claims transport between the contracting entity and the payer that does not provide access to the provider's services and discounts to any other third party.

Provides that a contracting entity shall not grant access to a provider's health care services and contractual discounts in a provider network contract unless: 1) the contract specifically states that the contracting entity may enter into an agreement with a third party allowing the third party to obtain the contracting entity's rights and responsibilities under the provider network contracts as if the third party were the contracting entity; 2) the provider network contract, and all agreements between a contracting entity and any third party, prohibits such third party from increasing the contractual discount or otherwise reducing the compensation to a provider to an amount below that which the provider was entitled from the contracting entity for health care services at the time the third party was granted access to the provider network unless such third party becomes a contracting entity; and 3) the third party accessing the provider network contract is contractually obligated to comply with the terms, limitations and conditions of the provider network contract.

Provides that a contracting entity that grants access to a provider's health care services and contractual discounts shall: 1) give to the provider a written or electronic list of all third parties known at the time of contracting to which the contracting entity has or will grant access to the provider's health care serves and contractual discounts under a provider network contract; 2) maintain a website or toll free number for which the provider can obtain a listing of third parties which the contacting entity or a third party has executed contracts for access to a provider's health care services and contractual discounts; 3) provide the third party that contracts with the contracting entity to gain access to the provider network contract with information that enables the third party to comply with the terms, limitations, and conditions of the contract; 4) require that the third party who contracts with the contracting entity to gain access to the provider network contract identify the source of the contractual discount on each remittance advice or explanation of payment form; 5) notify the third party who contracts with the contracting entity to gain access to the provider network contract of the termination of the contract no later than 30 days after receipt of notice of the termination of the contract and require those that are contract eligible to claim the right of access to a provider's discounted rate for services rendered after termination of the provider network contract.

Provides that a third party's right to access a providers health care services and discounts ends on the date the provider network contract is terminated and that claims for health care services performed after the termination shall not be eligible for processing and payment. Claims performed before the date of termination, but processed after the termination date are eligible for processing and payment.

Provides that a third party that has been granted access to a provider's health care services or contractual discounts that grants access to another third party or enters into a contract with another third party to access a provider's health care services and discounts are obligated to comply with the proposed provisions of this Act.

Provides that a violation of this Act is an unfair trade practice. Provides that the monetary penalty for a violation shall not be more than $25,000 for each and every act or violation, unless the person knew or reasonably knew or reasonably should have known that they were in violation, in which case the penalty shall not be more than $50,000 for each and every act or violation. Allows any person to file a civil action for damages arising from a violation of the Act.

ILLINOIS H.B. 5250 - PPOS, PROVIDER CONTRACTS
Summary: Sets provisions concerning restrictions on payment and reimbursement. Provides that a contracting entity, insurer, or third-party administrator may not grant access to a provider's health care services and contractual discounts pursuant to a provider on a discounted fee basis for covered services that are provided to an insured unless certain conditions are met. Provides that a party to a preferred provider contract may not sell, lease, or otherwise transfer information regarding the payment or reimbursement terms of the contract without notification to and the authority of the other contracting parties.

MISSOURI H.B. 1495 - PPOS, PROVIDER CONTRACTS
Summary: Requires that the Department of Insurance, Financial Institutions, and Professional Registration shall establish after due consultation with accident and sickness insurers, health services corporations, health maintenance organizations, insurance producers, and after a public hearing, uniform application forms for applicants. Provides that an agreement between a health carrier and a participating provider shall not contain a provision that: 1) prohibits or grants the health carrier an option to prohibit, the participating provider from contracting with another health carrier to accept lower payment for health care services than the payment specified in the agreement; 2) requires or grants the health carrier an option or require, the participating provider to accept a lower payment from the health carrier if the participating provider agrees with another health carrier to accept lower payment for health care services; 3) requires or grants the health carrier an option of, termination or renegotiation of the agreement if the participating provider agrees with another health carrier to accept lower payment for health care services; or 4) requires the participating provider to disclose the participating provider's reimbursement rates under contracts with other health carriers.

NEW JERSEY A.B. 372 - PPOS, PROVIDER CONTRACTS
Summary: Establishes requirements for granting access to physician discounts under a provider network contract, in order to prevent the improper selling or leasing of these contractual discounts under a silent PPO (preferred provider organization) arrangement. Imposes a registration requirement on contracting entities as defined in the bill, and allows them to grant to third parties access to the network discounts that they have negotiated with physicians and certain other health care providers, only under certain circumstances and with certain disclosures. Provides that a contracting entity that grants to a third party access to a provider's health care services and contractual discounts pursuant to a provider network contract shall, in situations in which the provider network contract is terminated, provide certain notices to the third party of the termination of the provider network.

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The HCAA Interactive Map "Services Offered/RFP Resource Tool" Goes Live in April 2010.
Update Your Contact Information Today!

At the 2010 Executive Forum in February, HCAA proudly introduced the new web based Interactive Map to the membership. The Interactive Map provides new opportunities for all HCAA members.

First, you have the ability to search and locate a listing of CSFS® designees and students, as well as the Continuing Education credits available by state.

Second, the Services Offered/RFP Resource Tool was developed to support the sales and marketing efforts of our members. The CSFS® designation brings unique traffic to the Web site that includes brokers, consultants and human resource executives. We want to encourage these visitors to seek services from our members in support of self funding health care benefits.

In order to be listed in the Services Offered/RFP Resource Tool, you need to sign on and update your contact information in our HCAA Membership Database. If you had previously done so, please log-in again to ensure we have your updated demographic information as well as the states your company does business in.

The Services Offered/RFP Resource Tool goes live on the HCAA Web site April 13, 2010. Please login and update your information by Thursday, April 1, 2010.

If you decide not to have your firm listed on the Services Offered/RFP Resource Tool, please update your information to ensure HCAA has accurate information as we continue to keep you informed of everything from legislative updates to webinars and upcoming events.

Visit www.hcaa.org and select the Members Only Login on the right hand side of the page. Enter your primary e-mail address. Your password is hcaa2009. You will be asked to change your password the first time you log-in. If you have previously logged in and do not know your password, contact rachel@hcaa.org.

Once you are logged in, select "My Information" from the menu on the left hand side of the page. You will then be transferred to your page containing all your contact information. To edit this information, select "Edit Information" located at the top of the page.

The primary contact for your company must log in to activate the RFP Resource Tool feature. Under "My Information" you will see your company name is blue. Click on your company name and you will be transferred to its information page. Select "Edit Information" at the top of the page. At the bottom of the page you will see a drop down box where you will be able to select your company's "Business Type" and "Marketing States." You will need a mouse to click and accept the types and states. To select multiple types and/or states hold the "Ctrl" key while using your mouse. Contact rachel@hcaa.org with any questions. .

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HCAA Web Site Gets New Navigation

You may have noticed some changes and additions to the HCAA Web site since the start of the New Year. First, a new navigation menu was added to help support two new pages on our site. The first page is a job postings page. Both members and non-members have the ability to post job openings within their respective organizations to this page. There is no fee for members to post openings; however, there is a $95 charge for non-members. Currently, there is one position posted on the Web site. If you have an opening you'd like to post, contact rachel@hcaa.org or visit www.hcaa.org/jobpostings.html and complete the job postings form. All job openings will remain on the HCAA Web site for 30 days. If the position is filled within these 30 days, please notify HCAA and the posting will be removed.

The second page added to the Web site is a "Recent News" page. This page serves as a place for the Association to post any and all press releases that are sent out. Posting our press releases on the Web site keeps all visitors up to date on what the Association is current involved in and working on.

The "Recent News" page also serves as the host page for a link to the new HCAA blog, "Connections." The blog is updated monthly by the Public Relations Committee and serves as a forum to express opinions and engage the membership in conversations surrounding timely topics. To read the blog visit http://hcaa.typepad.com/.

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CHANGES IN CALIFORNIA LICENSING LAWS BECAME EFFECTIVE JANUARY 1, 2010.
AB 800 (Chapter 254, Statutes of 2009) became effective January 1, 2010. This bill made several changes to the California Insurance Code (CIC) for the purpose of encouraging online fillings from insurance producers and to bring California closer to uniformity with other states' producer licensing laws. More information on this change is available on the HCAA Web. Click here to read more. As HCAA becomes aware of licensing changes in other states, we will post information on our Web site as well as notify members via e-mail blasts.

COASTAL HEALTHCARE GROUP GAINS FOOTHOLD IN SANTA CLARA COUNTY [1]
San Jose - Costal Healthcare Administrators, a Salinas, Calif.-based organization that offers a select physician network and flexible self insured health benefits and management services to employer groups in four seaside counties, has gained a foothold in Santa Clara County, where it hopes to build momentum in 2010.

Debi Hardwick, president and CEO of Coastal, says the integrated managed care group took over most of the current contracts of the Santa Clara Foundation for Medical Care that had been losing business in the stagnant economy and was closing. Coastal was able to assume a little of the existing business and network contracts between physicians, hospitals, and ancillary providers.

"We are committed to delivering the best healthcare services available and are excited to extend our services to Santa Clara County," says Hardwick of the venture. "Right now we're going to stabilize the provider network, make sure contracts are in place, and perform due diligence with physician credentialing," continues Hardwick. "We won't start actively marketing our products until after the first of the year."

[1] California Healthfax, December 21, 2009. Volume 16. Number 45.

INETICO, Inc. RECEIVES URAC CASE MANAGEMENT ACCREDITATION
Tampa, FL - On December 15 INETICO, Inc. announced its INETICARE Care Management program was awarded Case Management Accreditation by URAC, a Washington, DC - based health care accrediting organization that establishes quality standards for the health care industry.

"Receiving accreditation from URAC for Case Management fits completely with INETICO's goals to exceed the requirements and expectations of our clients through quantifiable standards," said Joseph C-W Hodges, INETICO President and CEO. "This is one of the many steps INETICO is taking to demonstrate commitment to results-oriented care and claims products and services."

URAC's Case Management standards require companies to establish a process to assess, plan and implement case management interventions and to ensure the establishment of appropriate patient protections, such as policies for confidentiality of patient information, safety, informed consent and dispute resolution.

"By applying for and receiving Case Management Accreditation, INTETICO, Inc. has demonstrated a commitment to quality health care," said Alan P. Spielman, URAC president and CEO. "Quality health care is crucial to our nation's welfare and it is important to have organizations that are willing to measure themselves against national standards." URAC, an independent, nonprofit organization, is a leader in promoting health care quality through accreditation and certification programs.

URAC's standards keep pace with the rapid changes in the health care system, and provide a mark of distinction for health care organizations to demonstrate their commitment to quality and accountability. For more information, visit www.urac.org.

HEALTHNOW NEW YORK ANNOUNCES EXPANSION OF ADMINISTRATIVE & OUTSOURCING SERVICES
Subsidiary will focus on the self-funded market and third party administration
Buffalo, NY - HealthNow New York, Inc., one of the Northeast's leading health insurance and employee benefits companies, has announced a national expansion through a newly-formed subsidiary, HealthNow Administrative Services (HNAS).

The subsidiary is an administrative and outsourcing services company specializing in self-funded benefit plans targeting mid to large employer groups (100 to 1,000 plus employees), brokers, and agents. Additionally, HNAS will partner with small third party administrators, providing the man power, claims operations and technology infrastructure they need to remain competitive in today's marketplace. "At HealthNOW New York, we continue to seek and drive sustainable growth initiatives while exploring options to position this organization for it's long-term future," said Alphonso O'Neil-White, president & CEO of HealthNOW New York, Inc. "Many internal and external forces are changing the shape of this industry. Those organization who not only adapt but continually look to ways to reinvent themselves will survive. HNAS is one element to our continued evolution."

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American Benefit Plan Administrators (ABPA)
www.abpa.com

AmeriHealth Administrators, Inc.
www.amerihealth-tpa.com

Ancillary Care Services Inc.
www.anci-care.com

Bases Loaded Inc.
www.baseload.com

Benefit & Risk Management Services
www.brmsonline.com

Cancer Treatment Centers of America
www.cancercenter.com

CAS Management

Delphi of Florida, Inc.
www.delphimap.com

FirstHealth
www.firsthealth.com

Infinity HR
www.infinity-ss.com

Innovative Care Management
www.innovativecare.com

LifeWise Assurance Company
www.lifewiseac.com

Lockhurst Consulting

MES Solutions
www.messolutions.com

National Health Benefits Corp.
www.nhbc.com

Nationwide Specialty Health
www.nationwide.com

Outsource Marketing Strategies, Inc.

Premier Healthcare Exchange, Inc.
www.phx-online.com

ProForma Document Management Services, Inc.
www.proformadocuments.com

Script Care, Ltd
www.scriptcare.com

TSYS Healthcare
www.tsyshealthcare.com

US Imaging
www.usimagingnetwork.com

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2010 TPA University Just Around the Corner!

The 2010 TPA University, "Gearing Up for a Challenging Future" is July 21 - 23, 2010 at the Westin Tabor Center in Denver, CO. This three-day event offers the most comprehensive view of a single trend or issue within third party administration.

Registration is now open. Click here to register online. Hotel rooms are also available for the conference. Click here to book your room online (click on "Reserve" to being the reservation process) or call 1-800-228-3000 to make your reservation. Refer to HCAA TPA University 2010 when making your reservation to get the group rate. Hotel reservation deadline is June 29, 2010.

Thank you to our 2010 TPA University Sponsors (as of 3/25/2010)

2010 Corporate Sponsors
A&G Healthcare Services; American Health Holding, Inc.; Benefit Informatics, Inc.; INETICO, Inc.; Preferred Medical Claim Solutions; RedCard Systems; Strategic Recovery Partnership, Inc.; TC3 Health, Inc.; The Phia Group, LLC; WellDyneRx

Platinum Sponsors
ELDORADO Computing, Inc; Envision Pharmaceutical Services; Navitus Health Solutions; A&S Financial Services; Global Excel Management; Healthation, Inc.; GlobalCare; ProPeer Resources, Inc.; Partners Rx Management, LLC

General Session Sponsor
CVS Caremark

Lunch Sponsor
HealthX, Inc.

Notepad/Pen Sponsor
Lighthouse1

Water Bottle Sponsor
Star Line Group

Name Badge Sponsor
RESTAT

Sponsorship opportunities are still available. Contact sean@hcaa.org or call 888-637-1605 for more information.

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