HEALTHCARE UPDATE - OCTOBER 2009

Early Intervention State-Mandated Change

Effective July 1, 2009, the annual and lifetime dollar benefit maximums for medically necessary early intervention services furnished by an early intervention provider for an enrolled child from birth through age two will be removed.  This state mandated change is being applied to all insured group and non group plans and administrative service contract (ASC) 32B accounts, excluding Medicare Advantage, Medex, Medicare supplement plans, and Managed Blue for Seniors, effective on a one-day change as of July 1, 2009.

2010 Minimum Creditable Coverage Plan Compliance

There are two changes to Massachusetts’ minimum creditable coverage requirements that are effective on January 1, 2010:

All health plans must contain a newly expanded broad range of medical benefits, including:

  • Ambulatory patient services, including outpatient, day surgery, and related anesthesia
  • Diagnostic imaging and screening procedures, including  X-rays
  • Emergency services
  • Hospitalization (including, at a minimum, inpatient acute care services, which are generally provided by an acute care hospital for covered benefits in accordance with the member’s subscriber certificate or plan description)
  • Maternity and newborn care
  • Medical/surgical care, including preventive and primary care
  • Mental health and substance abuse services
  • Prescription drugs
  • Radiation therapy and chemotherapy
Federally qualified high-deductible health plans (i.e. Health Savings Account compatible) must also meet certain MCC standards.  An HAS-compliant plan with deductibles exceeding $2,000 individual /$4,000 family and/or out-of-pocket maximums for in network covered services exceeding $5,000 individual/$10,000 family will meet the requirements if:
  • The underlying health benefits include a “broad range of medical benefits” as listed above, and pre-deductible preventative care requirements.
  • Plan sponsors or carriers provide individuals enrolled in these plans with access to an Health Savings Account.  Individuals may decide whether or not to open or fund the Health Savings Account.
Michelle’s Law

Michelle’s law prohibits a group health plan from terminating coverage for an eligible student under a subscriber’s policy who takes a leave of absence from a post-secondary school for medical reasons.  Changes to eligibility provisions in plan benefit designs to reflect eligibility for continued coverage for up to one year will become effective as of the account’s renewal date on or after October 1, 2009.

The federal law also requires group health plans to include a description of a student’s right to an additional year of coverage due to a medical leave of absence in any notice requiring certification of student status.

For administrative service contract accounts that currently participate in the annual student recertification program, Blue Cross Blue Shield of MA will update the recertification notices for the November 2010 recertification (letters will be mailed in August 2010 and September 2010).  Since the eligibility changes is not effective until your renewal on or after October 1, 2009, the notices mailed in August 2009 and September 2009 will not be changed for the November recertification.

It is advisable to consult with your legal counsel to ensure your enrollment and termination practices for full time students are consistent with the requirements of law and eligibility.   

Medicare Creditable Coverage Update

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 requires sponsors that provide prescription drug coverage to Medicare Part D-eligible individuals to provide a written disclosure notice to all covered Medicare-eligible individuals annually.  This includes:

  • Medicare-eligible working individuals and their dependents
  • Individuals enrolled in Medigap plans with prescription drug coverage
  • COBRA-eligible individuals and their dependents
  • Disabled individuals covered under a prescription drug plan
  • Retirees and their dependents

The Centers for Medicare and Medicaid Services has updated the Creditable Coverage Guidance and Model Disclosure Notices to be used after January 1, 2009.  To view or download the notices, go to www.cms.hhs.gove/CreditableCoverage and select Creditable Coverage Guidance and Model Disclosure Notices to be used after January 1, 2009 from the left column.