Medicare Part D Notices Due by October 15

From ChamberChoice

Employers whose health care plans include prescription drug benefits for active employees, retirees, COBRA participants, or spouses and dependents who are Medicare-eligible must notify those covered individuals by Oct. 15 of each year whether their drug benefit is creditable or non-creditable coverage. This means the health plan is expected to cover, on average, as much as the standard Medicare Part D prescription drug plan.

Under regulations issued by the Center for Medicare and Medicaid Services (CMS), disclosure notices must be provided to Part D eligible individuals at the following times:
• prior to commencement of the annual coordinated election period (ACEP) for Part D;
• prior to an individual’s initial enrollment period (IEP) for Part D;
• prior to the effective date of coverage for any Part D eligible individual that enrolls in the employer’s prescription drug coverage;
• whenever the employer no longer offers prescription drug coverage or changes it so that it is no longer creditable or becomes creditable;
• upon request by the Part D eligible individual.

However, if disclosure notices are provided to all plan participants annually, prior to October 15 each year, CMS will presumably consider the listed disclosure times met (with the exception of the notice being requested). Thus, JRG Advisors suggests that employers distribute this notice to all plan participants at open enrollment with enrollment materials.

CMS posts the Model Disclosure Notices on its website.

This notice is especially important to those who are Medicare eligible, since if they are not covered with creditable coverage and decline to enroll in Part D, a penalty will likely be imposed when enrolling at a later date.

Employers Need to Know:
• The Notice of Creditable or Non-Creditable Coverage is an employer responsibility.
• Check with the health plan insurer to verify if coverage is creditable or non-creditable, especially if offering a qualified High Deductible Health Plan.
• Notice must be provided no later than Oct. 15 of each year.
• Distribution to all participants during open enrollment meets the October 15 deadline and other time requirements to provide the notices.

ChamberChoice to Offer Webinar on Successful Open Enrollment

ChamberChoice will offer a webinar on open enrollment titled “Guarantee a Successful Employee Open Enrollment” this Thursday, Oct. 12, at 10 a.m. It is available free-of-charge to all Chamber members as a benefit of membership through the Chamber’s affinity programs through ChamberChoice

To register for this webinar and for a list of other upcoming webinars on topics of workplace benefits, visit here.

Bloomsburg Council Candidates Discuss Flood Protection, Parking and Open Government

Ten candidates vying for Bloomsburg Town Council expressed their views on the most pressing issues facing the Town, how to better interact with Bloomsburg University, and how to support business growth at a candidate forum held Wednesday, Oct. 4 at the Alvina Krause Theatre, home of the Bloomsburg Theatre Ensemble. Several candidates emphasized the need to address parking management as a major issue for the Town. Stormwater management and flood protection were also discussed, as was managing the annual spring Block Party event. Challengers expressed the importance of having open government. The event was sponsored by the Joint Governmental Affairs Committee of the Chamber and the Columbia-Montour Visitors Bureau.

Audio from the candidate forum is available. The first portion of the program included the eight candidates running for four general Council seats. Responses to the first question begin with Vince DeMelfi with the following order: James Garman, William Kreisher, Doug Reiter, Toni Bell, Joe Martarano, Bonnie Crawford, and Sandy Davis. The second question begins with Mr. Garman and follows the same order, etc. The second portion of the forum was for the two registered mayoral candidates and responses begin with Eric Bower, followed by Carey Howell.

A second forum is being sponsored by the Bloomsburg Area Landlord’s Association on Wednesday, Oct. 18 from 7-9 p.m. at the Greenly Center on Main Street in Bloomsburg. Please note the correct time, as the time was incorrectly reported as 6-8 p.m. at the first forum.

PA Chamber Sets Pro-Business Fall Legislative Agenda

From PA Chamber of Business & Industry

On the legislative front, the fall legislative session is in full swing, and while the PA Chamber continues to keep a close eye on the yet-to-be resolved budget stalemate, we are also working on a host of other pro-business issues. Part of our agenda this fall includes two important updates to Pennsylvania’s Workers’ Compensation law that will help to rein in rising costs for employers. 

One important reform that we are advocating to enact is H.B. 18 – legislation that would implement a workers’ compensation drug formulary in which doctors writing prescriptions that are not FDA-approved or otherwise demonstrated to be effective must at least explain why the prescription is necessary for the patient. Drug formularies have been shown to address overuse of and addiction to prescription drugs among injured workers. For example, in the three years after Ohio implemented its formulary in 2011, the number of workers’ compensation patients considered opioid dependent was reduced by half. The bill passed the House Labor and Industry Committee; however a parliamentary procedural motion led by Rep. Gene DiGirolamo, R-Bucks, circumvented a vote by the full House earlier this year.

A recent article in the Philadelphia Inquirer shed some light on some of the true motives of those who are leading opposition to the bill. The newspaper investigation unveiled a complex system wherein a large scale, well known workers’ compensation claimants law firm in the Philadelphia area is directing their clients to specific doctors who prescribe medications with dubious legitimacy and then funnel the unsuspecting patients to pharmacies that are owned by the doctors and lawyers themselves. According to the article: “The pharmacy then charges employers or their insurance companies for the workers’ pain medicine, sometimes at sky-high prices.” Several examples were highlighted in the article, including one instance in which the pharmacy charged $1,900 for a tube of cream that retails for around $14 – an over 13,000 percent mark-up. The law firm highlighted in the article has been a leading opponent of H.B. 18. Following the publication of the article, the PA Chamber issued a press release calling on the legislature to quickly pass H.B. 18 in order to help improve outcomes for injured workers, while at the same time combat the Commonwealth’s prescription drug and opioid crisis.

The second issue we are working on is a legislative fix to the Protz V. Workers’ Compensation Appeals Board case – an issue that was the topic of a House Labor and Industry Committee informational hearing last week. In a recent decision, the state Supreme Court eliminated Impairment Rating Evaluations – an important cost-containment provision of the state’s Workers’ Comp Act – based on a technicality. IREs have been in existence since 1996 and are used by physicians – in tandem with guidelines from the American Medical Association – to assess an employee’s level of impairment and determine their disability status. As a result of this court action, in August, the Pennsylvania Compensation Rating Bureau took the unprecedented action of filing for a mid-year loss cost increase. We issued a statement at the time warning employers that this filing could lead to workers’ comp cost increases. We are leading a multi-industry coalition in support of legislation that will help ensure the constitutionality of the IRE process by updating the law with the most recent edition of the AMA guidelines and applying it to current and future claims.

Over the next several weeks, the PA Chamber will be working hard to help move these important bills through the legislative process and to the governor’s desk – where they will hopefully be signed into law.

Coalition Memo Urges Support for Legislation to Address Workers’ Compensation Case

The PA Chamber organized a multi-industry coalition letter last week urging House lawmakers to sign on as cosponsors and lend support to soon-to-be-introduced legislation that would accommodate a recent state Supreme Court decision related to workers’ compensation.

In August, the court ruled in the Protz v. Workers’ Compensation Appeals Board case to throw out Impairment Rating Evaluations that have been integral over the last two decades in bringing structure, fairness and stability to the workers’ compensation system. Conducted by physicians using guidelines from the American Medical Association, IREs have been part of the system since 1996 to assess an injured employee’s level of impairment and determine if they should receive lifetime wage benefits. When the court made its ruling, the PA Chamber issued a press release that warned business leaders about the significant cost hikes they could see in the near future and called for a legislative remedy.

The coalition letter stresses that the court’s decision to declare IREs unconstitutional was only made because AMA guidelines are updated periodically (twice since the law was first enacted) and therefore, since the current version differs from the version used in 1996, the Court said their use is an unconstitutional delegation of authority. Both House and Senate Labor and Industry Committee Chairs Rob Kauffman, R-Franklin, and Kim Ward, R-Westmoreland, respectively, have indicated their intention to introduce legislation that aims to fix this issue by updating the law with the most recent edition of the AMA guidelines and applying it to current and future claims. Chairman Kauffman hosted an informational committee meeting on the topic last Wednesday.

“IREs also helped stabilize the overall workers’ compensation system which had experienced massive cost increases in the late 1980s and early 1990s,” the coalition wrote. “We urge you to cosponsor this legislation.”