PPACA: STATES REVIEW OF HEALTHCARE PREMIUM INCREASES

Under the Affordable Care Act each state has been given the authority to evaluate every instance where carriers are requesting increases of greater than 10% in the individual and small group market.  "Rate review will help bring down the cost for small businesses and consumers.  According to healthcare.gov, "Rate review assesses whether proposed increases in health insurance premiums are based on reasonable estimates, reflecting medical cost trends and health care utilization instead of unjustified assumptions that serve to increase the price to the consumer."  Thanks to grants from the Affordable Care Act, Maryland was able to reduce premium increases in 10 of the 22 rate filings approved during the third quarter of 2010.  On September 1, 2011, HHS (Health and Human Services) issued an amendment that extended the above provision to all individual and small group health plans that are sold through associations effective November 1, 2011.

Free Money For Small Group Wellness Programs!! Maybe.....

If you are thinking of starting a Wellness Program for your small group (Under 100 Employees), there may be funding available for you.  Under PPACA (Health Reform) certain provision have been set-up to fund a five year $200 Billion grant program.  However, with the nations check-book getting a little light, who knows if and when there will be funding available and to what extent. 

Starting with the next fiscal year (October 1, 2011), the PPACA authorizes an appropriation of $200 million over five years (fiscal years 2011 through 2015) for certain small businesses that implement wellness programs.[Section 1201 of H.R. 3590, adding section 2705 to PHSA]

• A five-year/$200 billion grant program will be available to small employers (less than 100 employees working 25 hours per week) that did not provide a wellness program as of March 23, 2010.  The grants are intended to apply to "comprehensive" wellness programs that include the following components:

• Health awareness initiatives (including health education, preventive screenings and HRA(Health Risk Assessment)
• Efforts to maximize employee engagement (including mechanisms to encourage employee participation).
• Initiatives to change unhealthy behaviors and lifestyle choices (including counseling, seminars, online programs and self-help materials).
• Supportive environment efforts (including workplace policies to encourage healthy lifestyles, healthy eating, increased physical activity and improved mental health). 
• It is expected that regulations will be issued to clarify various aspects of the program, such as the criteria for a qualifying wellness program, how to apply for a grant, etc.

Grant application
Eligible employers seeking to participate in the grant program must submit an application to the Secretary of HHS that contains a proposal for a comprehensive workplace wellness program meeting the criteria and requirements listed above.  However, the PPACA fails to indicate whether grants will cover part or all of the cost of a qualifying wellness program. It is anticipated that HHS will issue guidance on the grant application and other details surrounding workplace wellness programs prior to October 2011.