Happiest of Holidays!

The sweater pictured above is pretty ugly but it did NOT snag first place in LAAHU’s ugly sweater contest. That honor deservedly went to the amazing Ross Pendergraft. Get in touch with Ross if you’d like to see what he wore! Also, bravo to LAAHU members for raising money for such a worthy cause. Proceeds from this year’s Zoom holiday event went to the LA Regional Food Bank. Here’s a shot of the party:

 

If you have an event you want mentioned, send us the details at editor@calbrokermag.com!

HEALTH

Eleven state insurance commissioners provide ACA policy recommendations to President-elect Biden

A group of the nation’s state insurance commissioners, including California Insurance Commissioner Ricardo Lara, joined together in a pledge to work with President-elect Joe Biden by providing health policy recommendations to the incoming administration. A letter sent by the group of commissioners detailed six immediate or critical policy recommendations and six longer-term recommendations for the Biden/Harris Administration to consider.

Immediate policy recommendations
  • Ensure immediate access to the federal marketplace, Healthcare.gov, through a special enrollment period.
  • Provide immediate relief from Affordable Care Act (ACA) subsidy clawbacks created by COVID-19 uncertainty.
  • Provide clarity on COVID-19 testing coverage requirements, especially in regard to tests that are ordered as part of state-based contact tracing efforts.
  • Partner with states in actively focusing on programs and practices that address the needs of historically marginalized communities.
  • Address problematic elements of the recently proposed Notice of Benefit and Payment Parameters (NBPP) for Plan Year 2022.
  • Allow flexibility for states aiming to pursue progressive policy aims by empowering them to apply for ACA innovation waivers beyond reinsurance.
Longer-term policy priorities
  • Reverse policies, such as the weakening of non-discrimination protections and the public charge rule, that undermine the ACA and deny health care coverage to many people.
  • Encourage both people and small businesses to enroll in ACA programs, and stop encouraging enrollment in insurance plans that do not provide the ACA’s most critical consumer protections.
  • Improve income counting rules to allow consumers greater flexibility.
  • Extend premium tax credits to Deferred Action for Childhood Arrivals (DACA) recipients so that legally present noncitizens have access to health care coverage.
  • Modernize U.S. Department of Labor oversight of the Employee Retirement Income Security Act to ensure all health insurance coverage is held to similar standards.
  • Consider a national reinsurance program to stabilize health insurance markets and improve affordability of health insurance coverage.
The policy recommendations aim to provide immediate relief to many Americans affected by the COVID-19 crisis, provide states with flexibility to strengthen health insurance markets, remove discriminatory barriers to health coverage, protect the coverage needs of Americans with pre-existing conditions, and ensure comprehensive health insurance access is available to all Americans.
The following state insurance commissioners developed the recommendations and say they are committed to working with the Biden Administration on health care:
Commissioner Ricardo Lara, California
Commissioner Michael Conway, Colorado
Commissioner Trinidad Navarro, Delaware
Commissioner Colin M. Hayashida, Hawaii
Director Anita G. Fox, Michigan
Temporary Commissioner Grace Arnold, Minnesota
Commissioner Andrew R. Stolfi, Oregon
Commissioner Jessica K. Altman, Pennsylvania
Health Insurance Commissioner Marie Ganim, Rhode Island
Commissioner Mike Kreidler, Washington
Commissioner Mark Afable, Wisconsin
A Review of 2020 if You Can Take It
Many of you don’t want to replay 2020. We get it. But in case that’s not you, check out The Commonwealth Fund’s Health Care in 2020: Year in Review. Warning: it will not warm your heart.

COVID-19

AHCA/NCAL Remind All To Remain Vigilant Around Holiday Gatherings To Protect Vulnerable Populations

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) recently released an updated report showing how nursing homes are experiencing the worst outbreak of new cases and deaths since the spring due to a high rate of community spread among the general population, surpassing previous peaks since the Centers for Medicare & Medicaid Services (CMS) started tracking cases in the facilities. Independent research shows that community spread is the top factor in outbreaks in nursing homes and assisted living communities.

AHCA/NCAL reminds us to please pay attention to the Centers for Disease Control and Prevention (CDC) guidance, including:

    • Postpone travel and stay home (If travel is necessary, check COVID-19 infection rates on state, local, territorial, or tribal health department websites).
    • Celebrate virtually or with only members of the same household. If you have others over, celebrate outside if possible.
    • Wear a mask.
    • Stay at least six feet away from others who do not live together.
    • Avoid crowded, poorly ventilated indoor spaces.
    • Wash hands regularly.
    • Get a flu shot as soon as possible.
    • Attend virtual religious services.

DMHC Directs Insurers to Remove Administrative Burdens on Hospitals

The California Department of Managed Health Care (DMHC) this week directed health plans regulated by the Department to remove administrative burdens on hospitals during the COVID-19 surge. This includes directing plans to take immediate steps to reduce or remove unnecessary barriers to the efficient admission, transfer, and/or discharge of health plan enrollees.

Health plans must report to the DMHC the steps they are taking to support hospitals in removing barriers to providing efficient care during this unprecedented time, which could include the following, among other actions:

  • Waiving prior authorization requirements or providing blanket pre-authorizations in certain circumstances.
  • Increasing the number of health plan staff available to respond to hospitals’ requests to admit, transfer or discharge plan enrollees.
  • Working with durable medical equipment suppliers, pharmacies, and other suppliers to ensure they are available to quickly provide needed equipment, medications and services to plan enrollees who are being discharged from a hospital.

The DMHC has also enacted new reporting requirements for health plans to ensure plans are sufficiently supporting providers to acquire COVID-19 supplies, such as Personal Protective Equipment (PPE), to safely deliver services to plan enrollees.

If health care providers experience problems with receiving support from their contracted health plan, they can reach out to DMHC at: 1-877-525-1295 or by email at providercomplaintunit@dmhc.ca.gov.

INSURTECH

PayPro Administrators Welcomes “Pat”

AI-Driven Chatbot answers benefits questions anytime

Riverside-based PayPro Administrators, a one-stop employee benefit administration and payroll processing provider, announced the addition of an artificial intelligence-driven chatbot to the new benefits technology platform they launched in 2020. Pat, the name PayPro bestowed on its virtual assistant, is a secure, AI-driven chatbot that quickly answers questions for benefits plan participants. Plan participants can enter natural language questions or phrases and get back contextual responses specific to their FSA, HSA, HRA, etc. accounts. Examples of things Pat helps participants complete include: checking balances, submitting receipts, understanding claim denials, finding tax documents and reporting lost or stolen cards. Find out more at pagroup.us.

EVENTS

  • LAAHU’s Zoom Happy Hour is the first Wednesday of the month from 4-5p.m. Members and nonmembers welcome. Register here.
  • NAHU Power Hour, 4th Wednesday of the month from 4-5p.m. Pacific. Members and nonmembers welcome. Register here.
  • NAIFA-Los Angeles 68th Annual Will G. Farrell Award & Leadership Recognition Event, Virtual, Feb. 18, 2021. More info here.
  • CAHU Women’s Leadership Summit, April 7-9, 2021!The latest news from CAHU’s WLS committee is that the CAHU Women’s Leadership Summit will now take place April 7 –9, 2021, at Green Valley Ranch in Las Vegas. Questions should be emailed to info@cahu.org.