Thursday, February 27, 2014
Wednesday, February 26, 2014
Submit Abstracts Online for 2014 ACS Clinical Congress
Submit Abstracts Online for 2014 ACS Clinical Congress
Surgeons and residents may now submit abstracts electronically for the Surgical Forum, Scientific Paper and Poster Programs, and Video-Based Education for the American College of Surgeons’ 2014 Clinical Congress, October 26–30 in San Francisco, CA. New in 2014, a self-assessment question and multiple-choice response set has been added to the submission requirements.
The deadline for submitting abstracts is 5:00 pm (CST) Monday, March 3, and abstracts will be accepted online only. Revisions may be made until the deadline. No late submissions will be accepted. For more information, send an e-mail to the appropriate abstract program coordinator:surgicalforum@facs.org, ACSpostersessions@facs.org,papersessions@facs.org, or acsvideoeducation@facs.org.
Surgeons and residents may now submit abstracts electronically for the Surgical Forum, Scientific Paper and Poster Programs, and Video-Based Education for the American College of Surgeons’ 2014 Clinical Congress, October 26–30 in San Francisco, CA. New in 2014, a self-assessment question and multiple-choice response set has been added to the submission requirements.
The deadline for submitting abstracts is 5:00 pm (CST) Monday, March 3, and abstracts will be accepted online only. Revisions may be made until the deadline. No late submissions will be accepted. For more information, send an e-mail to the appropriate abstract program coordinator:surgicalforum@facs.org, ACSpostersessions@facs.org,papersessions@facs.org, or acsvideoeducation@facs.org.
Tuesday, February 25, 2014
Sunday, February 23, 2014
Thursday, February 20, 2014
11th Circuit Invalidates Law on Prompt Insurance Pay
11th Circuit Invalidates Law on Prompt Insurance Pay
Panel says law aimed at self-funded plans conflicts with federal statute
A federal appeals court has said Georgia's expansion of requirements for quick processing of insurance claims is invalid.
The legislation, signed into law by Governor Nathan Deal in 2011, was long sought by the state's doctors. A group of insurance companies challenged the law as in conflict with a federal statute, securing a temporary injunction of the law before it was set to go into effect. Last week, a panel of the U.S. Court of Appeals for the Eleventh Circuit upheld the preliminary injunction.
A spokeswoman for Attorney General Sam Olens, who has been defending the law on behalf of the state's insurance commissioner, said Olens' office was discussing further appellate options with its client.
The ruling is a setback for the state's doctors, who have been wrangling with insurance companies over speed of payment for more than a decade. The Medical Association of Georgia's executive director, Donald Palmisano Jr., said his group would have to evaluate whether a new statute is possible under the court's decision.
In 1999, Georgia enacted the Prompt Pay Act, which required insurers of employee benefit plans to process claims on a given schedule. But that law didn't apply to processing of claims under increasingly popular self-funded plans, in which an employer retains at least some of the risk of paying claims and hires a third party to process them. Often the third-party administrator is one of the same well-known insurance companies that act as insurers with respect to other plans.
According to a 2013 report by the Kaiser Family Foundation, 61 percent of covered workers are in a self-funded plan, up from 49 percent in 2000.
In 2010, the Legislature approved a bill, opposed by insurance companies, that would expand the prompt pay law to administrators of self-funded plans. But Gov. Sonny Perdue vetoed the measure, saying in a press release that he thought language in the bill inserted at the insistence of MAG likely was pre-empted by the federal Employee Retirement Income Security Act of 1974, commonly known as ERISA.
Doctors returned to the Legislature, pursuing similar legislation during the 2011 session. The Georgia Chamber of Commerce, which opposed the measure, made it a scorecard issue. The measure, called the Insurance Delivery Enhancement Act, nonetheless handily passed again. Deal, the new governor, signed it into law.
Under the law, insurers and third-party administrators must either pay on a claim or give an itemized notice of denial of claims within 15 days for electronic claims and 30 days for paper claims. Violations of the rule were to trigger an additional annual interest rate of 12 percent on the claim. The law also authorized the state insurance commissioner to levy a fine if more than 5 percent of an insurer's claims in a given quarter are not processed in compliance with the deadlines.
Doctors' groups have said the law was needed to protect doctors and patients alike. Palmisano has said that when insurance companies hold back payments, physicians are unable to expand their practices to reach areas that need care. The insurers say having state-specific deadlines for paying claims would be burdensome and drive up costs because each state will have different rules, potentially making it harder for employers to offer coverage.
An insurance trade association, America's Health Insurance Plans (AHIP), sued Insurance Commissioner Ralph Hudgens in August 2012, ahead of the law's Jan. 1, 2013, effective date. Hudgens, as a state senator, had sponsored the legislation that was the blueprint for the changes.
AHIP, backed by the Georgia Chamber, contended that although fully insured employer health plans can be indirectly regulated by states, self-funded plans generally cannot. The insurers said that, with some exceptions, ERISA pre-empts any state laws that "relate to" an employer-based plan, contending that three federal appeals courts had said ERISA pre-empts similar state laws. They argued that ERISA provides civil enforcement mechanisms that are the exclusive remedies for untimely claims processing. The insurers also said that the state law was trumped by federal regulations establishing more lenient timeliness standards for employer-based plans.
Doctors' groups and the state argued the prompt payment expansion didn't "relate to" employer health plans in the way the U.S. Supreme Court has interpreted that phrase. The high court has said state laws that don't regulate substantive aspects of coverage determinations of ERISA plans aren't pre-empted, they argued. Instead, the doctors' groups and the state asserted, the court found that ERISA pre-empted state laws that change benefit determinations, change beneficiaries or mandate certain types of coverage.
U.S. District Judge William Duffey Jr. of the Northern District of Georgia on Dec. 31, 2012, issued a preliminary injunction agreeing with the insurance trade association that the state's attempt to extend its prompt payment requirements to employer-funded programs is expressly prohibited by ERISA. An Eleventh Circuit panel of Senior Eleventh Circuit Judges James Hill and Emmett Ripley Cox and visiting U.S. District Judge Donald Middlebrooks of West Palm Beach, Fla., affirmed Duffey in a Feb. 14 ruling.
Middlebrooks wrote that the prompt pay provisions targeted at self-funded plans impermissibly "relate to" ERISA plans.
"[The] timeliness requirements fly in the face of one of ERISA's main goals: to allow employers 'to establish a uniform administrative scheme, which provides a set of standard procedures to guide processing of claims and disbursement of benefits,'" wrote Middlebrooks. "If these provisions were to go into effect, employers offering self-funded health benefit plans would be faced with different timeliness obligations in different states, thereby frustrating Congress's intent."
The panel rejected the state's attempt to cast the prompt-pay requirements as merely procedural and thus not "relate[d] to" ERISA plans. "[The law's] requirements will not necessarily directly alter the coverage decision-making process, but they will compel certain action (prompt benefit determinations and payments) by plans and their administrators," wrote Middlebrooks. "The statutes will also impact the amount paid to beneficiaries in the case of late payment or notice."
Miguel Estrada, a partner at Gibson, Dunn & Crutcher in Washington, made the winning Eleventh Circuit argument for AHIP. A spokeswoman for AHIP, Clare Krusing, said in an email that her group was "pleased that the Court upheld the vital role of ERISA in enabling self-funded employers to provide uniform health benefits to their employees across the country."
The state's argument at the Eleventh Circuit was made by Assistant Attorney General Alex Sponseller. Brian Casey of Barnes & Thornburg also was permitted time to argue on behalf of MAG and the American Medical Association, who were participating as amicus curiae.
Palmisano, a lawyer who heads the Georgia doctors' group, said the ruling means doctors will continue to be left without a remedy for untimely payments, adding there was a question about whether a physician has standing to bring a claim under ERISA. "The physicians have nowhere to bring their issues when the claims aren't being paid timely," said Palmisano.
Asked whether it was possible to enact any sort of state prompt payment requirement for self-funded plans under the Eleventh Circuit's ruling, Palmisano said, "we would have to go back to the drawing board on that and see based on the decision that's been laid out ... if there's a way for a state law to address the timeliness of payments for these claims."
The case is America's Health Insurance Plans v. Hudgens, No. 13-10349.
Wednesday, February 19, 2014
Tuesday, February 18, 2014
Monday, February 17, 2014
Sunday, February 16, 2014
Thursday, February 13, 2014
Wednesday, February 12, 2014
Monday, February 10, 2014
Sunday, February 9, 2014
Thursday, February 6, 2014
Wednesday, February 5, 2014
Tuesday, February 4, 2014
Monday, February 3, 2014
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