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Glenn C. Scarpelli D.C. 

Chiropractor 

171 Madison Avenue 

Suite 908 

New York, NY 10016 

Tel 212 689.4648 

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'I'"t's August 9, 2010 ' - F~"<~';it;'?~'I'~F';'" , 

Office of Consumer Infonnatiorl,ai1~InSilraIlce Oversight 

Department of Health and Hun?'~:Sen;ic~s' . , 

Attention: OClIO-9991-IFC I j ,,', 

P,O, Box 8016 

Baltimore, MD 21244-1850 

Re: Interim Final Rule for Grclup Health Plans and Health Insurance 

Coverage Relating to Status as!a::<:t~~~f~t;he,t~a Health Plan Under the 

Patient Protection and Affordabl~ Care.Act." ' 

Below are our comments regartiilgtheInteri~ Fhial Rul: for Group 

Health Plans and Health Insurailc'e.C6vetage Retating to Status as a 

Grandfathered Health Plan Under..the,Patient Protection and Affordable I .. ., Care Act (PPACA), 1";1"';' 

f:'" "',.,.. , >,,;':~i;;" , ••; , .

yve, b~lieve that every effort sh~qld'b~,fi1ade to increase the number of 

mdIvIduals covered by PPACA:~espeClany as of January ,1 ,2014 when 

most ofthe refonn componentJ'(InsuranceExchanges, Subsidies, TaX 

Credits, etc,) come i!lto play~ . 

The Rule provides the seven triggers that would revoke the 

grandfathered status of a groupl~e~lthpl~rl: " b':~~>+1"''< "v '1 :­

Mergers or acquisitions with tp,e,soleintention ofmaintaining 

grandfather status~., . .," . 

Elimination of substantially allbel}efIt~tO tre~t a particular condition 

Elimination of benefits for an~elemerifn~c~s'sary to eliminate or ' 

diagnose a condition f,· .' '" , " 


Any change to coinsurance le{,el 


Fixed-amount cost-sharing (D¢ductibles/OOP) liillation +15% 
 }".,' ,_ '1',,' ,;-'" ,_,'« I:':j, ,J,' '-:' _ , \ " '" \ 

Co-payments (Medical Inflati{m,,T l~%'or.$5 adjusted for medical 


inflation).. I: . ... ...... ,. . . 
 Employer contnbutlOn (> 5% reductlOnm EmployerContrlbutlOn) 

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171 Madison Avenue 

Suite 908 

New York, NY 10016 

Tel 212 689.4648 

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W ELL N E S S.·:.~,C ,E"N,.T.E R 

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While relatively straightforw.k"th~s~ gJ;de)ine~m~y still.result in '. 

some confusion to the marketpI~cein t,l1eir application. For example, if 

an employer raised the co-paY~~Jit~~~ye1"2eyond tl1e maximum in one ,. 

area (i.e. outpatient services) ~H!!~~i~~qJ~~.co-payment l~vel for 

prim~ry c~re doct?: visits, do~s,$h~vn~~,~.19.~§ of' grandfather status? 

Clanty WIll be CrItIcal both fqrJheemployer and the employee., 

rl:~:k :';";".::: :~:.r ,:~:'t The average consumer has a broad~efi,l1itiOIi of"benefits. " Consumers 

view their health plan beyond~hec~~eredbfneiits': cost sharing, and the l: .' i ,'~, ' :--"'{j,' ;<' ,,::', ,," ,!,' ' I"~ ',' ;

contribution levels associated jWith thepl~.' gther components ofhealth 

care services can have a significant· impaCt on the individual employee,' 

which can result in a change t6'iheirplari'inCluding: . ,.. 'I." 

A "substantial change" to tH~ priivider hetWofk ~;F:"j's':: 

t ,..".. .' .. .'. .' " .' Consumers believe their provitlet'aildtheproviaernetwork associated 

with any plan is an integral Paft ofthehea1thcarebenefits provided by 

the employer. A termination ofa:chospital'systeni or speCific provider 

group sometimes has significa'ntimpact on the employee population and 

should be viewed as a substan~ialcliange,tothe'plan itself. As a 

guideline~ we would suggest ah.y}change'in the provider network . 

impacting over 50% ofthe e~p16yeepopulation (nationally or locally) . 

should result in a loss ofthe grandfather,status.~. 

t,·" .. "." ..".;-, ... c, ' • 

Change in issuer or third-pa~ty:adJninistrator (FPA) (including moving 

fromfully-insured to self-fundf},d);,,chVY:is .' . 

t . 

Even ifthe benefit structure or~ll':ro.upshealth plan.remains largely the· .' 

same, a change in administration~of.the pl~requires new 

communication, new processe~, and.~e)y.x~q\liremt;:ntson the part of an 

employee and the employer. ~oyjng.~()m.a,funy~ipsured to a selffunded status or changing adrr}ini~t~at()~s.requires new,. processes and 

legal agreements for the groupJ~t?~lth p!~n~ Tpese transitions are not 

daily or regular events and sh6\11q ~~.c()~ide!"ed,achange in the group 

health plan. ~d:' .;:;. . I ' . 

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W ELL N E S S~C E N T E R 

171 Madison Avenue 

Suite 908 

New York, NY 10016 

Tel 212 689.4648 

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Significant change in care management/authorization requirements 

The processes consumers nee<!Lto'follow' 

l '" ..~ to receive care are a significant 

component oftheir perceptiods 'of their health benefits plan. Changing ;",~

notification requirements, req~greferrals, or other care management 

strategies involved in the delive 'ofcare should also be considered as a 

change to the plan. This may~<c:~r?~~healt~plans from .. 

maintaining their grandfather;~.I19t!~ece#iari,lyeliIninating a 

benefit,but making it difficul ,:~t.'iY~'by:,cllanging the care 

management process around i ",r ' !~L' :7 ' 

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Even by the most optimistic estimates, a substantial portion ofthe 

employee population will rem~in outside the PP ACA as of January 2014 

based on the current rules. willIe we understand the difficulty involved 

in making change, creating ~large sub-population of excluded 

individuals will only add to incre~e confusion, and mitigate the 

potential impact ofthe' . only add~ to the uncertainty 

surrounding the $143 billion projected by the 

Congressional Budget Office ' ' , began- " 

We believe that any changes ',', areas listed above should also 

result in a loss of grandfather as these are changes that heavily 

impact a patient's healthcare The Rule needs to be clear, 

reaSonable, and with no , involved in determining whether a 

group health plan is "in or out:" The decisions we make today will 

determine the outcomes for to*orrow. We may need to make some 

difficult decisions to create a siJstainable health care system that will 

support a growing economy in!,thefuture. That means getting as many 

citizens across the country partiei 'atiIlg at'the beginning to make it work 

and delivering on its promises . th~irsupPQrt.,i"C 

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~11C."(X,,"r:k(";~' 'i ' ',", '" "i,'" . mm(mt on this regulation. ' 

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