t. 

CENTOFANTI CHIROPRACTIC 


Dr. Ernest Centofanti, D.C., C. c.s.p, •. ' Certified Chiropractic Sports Physician 

3085 South Main 126 North Almont Avenue 

Marlette, Michigan 48453 Imlay City, Michigan 48444 

Office: (989) 635-3~28 Office: (810) 724-3344 

Fax: -(989)635"3828 Fax: (8101724-2889 

Offioe of COllS1.lJr.er J:nfi.~rn1a!lDn ;;~nd Jn$HranceOvi,:[sigbt 

Depanm~nt of Health and HUm8,[l Services . 

At/entian: OCUO-999l-IFC 

?:O. Bo)( 8016 '­

.Baltimore, MD 21244-:-1850~ 

Below 4:.te ,)ur COtnmeJ1ts l'egaxding the !mer:jrr.j~Fjnai Rule for Group Health Plans and Health 

Insuran.;;e Coverage Relating to Status as a Grand(atheted He,alth Plan UrAder the Patient 

Pro;ection and Affordahle Care Act (PPACAC --':,' 

. - ". " 

\Ve believe: that ~very eft~)rtshoLlld be made to increasethe number of individuals covered bv 

PPi\C.A"es?ecialiy· as (,)[ 1!inu;lry i, 2014 when mt!st9_(the rd6rm cClmponents (Insurance • 

Exchanges,Sub£lches; TE;;>{ Credits, ..~tc:)c6m~mt~::q}iay: _.- ­

The R\lJe Drovtd;:;~,the~~·:i.~.Ven 

. ]·H~~ifh-;[~~:;·::;~~~·:; 

. -,:·t~~rgers~0f . _ " 'Uitentiori :h1aJi\taining graxldfalherStan!s 


;EHn;n;;iif~~ ~l;lb~U\iltiatl'>· iI U' b~i)ent~ ~t~' t;~af~ pnnicular' condltion ., "",.. . 


'. Elin1inatiorG:)fhineti[;:; for anye~em~mnecessary'to, eiiminate or diagnbse'aFc<lnditio:l 


Anycharige tocQjnsurancdevel;­

• Fixed-amount co~t-sharing (Deductlhles/OOP) lt1flation +150/0 , 

,­

/) Co-paynlt:nts (Medical Inflation +f5%~OL$5 "-d:just.ed for medkal-in11ation) 

• Employer contribution (> S%'~~du~ti-ori'in Emp(oyerCoptrihution) 

-. -" ':';".~~~-=.... ' -'._" <-_ .-u ~ ...w,"o..,...u~" -"~ : _-~-;.;:.;:. ~ :...:., 

gu'denrl~s may still'res;I)Jt in :~c,me confusion to the. . 

marketplace in their appiication. For :;~ample, ihn employer rai}ed the copayment icyel beyond 

themlXimu..m in one area (i.e. outpatient services) but ret.ained the copayment lcvei for primary 

care doctor visits, does that n~eali .;3. lc.ss of grandfather status? Clarity \vill be critical both for the 

emplo;.'er and the employee. 

Theaverage.conSLmer has abroad ddlI1ition of'''benefits.'' Cons~l't\ers view their health pla:n 

beyond tl:te~overedbendit",.cost sharing;Jmd.th~.contributiofl le\lelsass()ci~ted with the p!tl..O. 

Other~~oit1ponellfs e~lth care ser;ices_C:!Ul haveasign1i1camin"lpact on thelndividv13J 

ernploy:.ce:~Yt~cih:antts\.i\r;t:lil Chat1ge to theirplaD"itt~rudih~~; , ..­ . ,', .., ,­

.'·'.fi:6:fr'h'nriLiFt.:Jfw1ge" ({if"'e prj. ­ . ." ", ~ ." .:; :. . ~-;" 

ConS:lmers b,;nev; the;lt pl'cvider and the PI;ovj:de;:~r7~~twork associated with any pian is an • 

ir.t~g:ra! tan 11Y(~ hea.!th care.benefits provided by the employer. A te:m1ination Of~l 

"Improve yourplay.the,natural way" 

-. ,',. ~.~ 
· , ........ 
 .' 

hospital system or specitic provider group sometimes hag signiticant impact on thl': 

en:p!o~ee population and should be viewed as a substantial change to the plan itself. As a 

gUldehlle, we would suggest any change in the provider network impacting over 50% of 

the employee population (naliona~ly or !ocally) should :-esult ir. a loss of the grandfather 

status. ­

• 	 Change in issuer or third-party adminisr,.,,/or (FPA) (incluCling mo'Vingjr()m/uliYr 


insured to self-funded) " 


• -Even if the btfnefiCStructure-ofa -gr-outfhealth planremains'largelY~ttie same;'a~ch.arige-in~ .-~ 

administration of the plan requires new communication, new processes, and new 

l'~quir~ments on the p~ut ofan employee and the emplo}'er. Moving from a fully-insured 

to a self-funded status or changing administrators requires new processes and legal 

agreements for the group health plan. These transitions are not daily or regular events and 

should be considered a change in the group health plan. 

• 	 Significcml chLii1ge in ~'are management/authorization requirements 

, 	 I , 

The processes consumers need to follow to receive care are a significant component of 


their perceptio!1s of their health benetits plan. Changing notification requirements,' 


req"Jiring referral.;) or other care management strategies involved in the'de!ivery of.care 


should also be considered as a change to the pta."1. This may prevent group health plans 


from maintaining Iheir grandfather status by not necessarily eliminating a benetit, but 


making it difficult to receive by cha.:lging the care management process around it. 


Even by the most optimistiC estimates, a substantial portion of the em;>loyee popUlation will 


remain outside the PPACA as of Ja.nuary 2014 based cn the current rules. While w,e understand 


the diftlculty involved in makin.g Chal'lge, creating another large sub~population of,excluded 


individuals will only add to costs, increase confusiOl'l, and mitigate the potential impact ofthe 


legislation, Thi:i onJy adds to the uncertainty sunoundin£, the $143 billion in deficit reduction 


projected by the Congressional Budget Office (CaO) when the process began., 


--We bclie~etha(any changes related t~theare~ i~~ed above~o~ld alioresultinaloss of ­

grandfather Status as these are changes that heavily impact a patient's healthcare benefits. The 

Rule needs to be clear, reasonable, and with no ambiguities involved in cietem-ining whether a 

group health plan is "in or out." The decisions we make today will determine ~he outcomes for 

tomorrow. We may need to make some difficult d~cisions to create a sustainable health care 

system that will support a growing economy in the future. That means g~ni~gas In.,any citi~ens 

across the country participating at the beginning to make it work and dehvenng on lts promises 

to retain their support. 

Thank you for the opportunity to comment on this regulation. 

L1