may need to make some difficult decisions to create a sustainable health care
system that will support a growing economy in the future. That means getting as
many citizens across the country participating at the beginning to make it work
and delivering on its promises to retain their support.

Thank you for the opportunity to comment on this regulation.
Sincerely,

Edward J. Sekol, D.C.

Cherryland Chiropractic Centre, P.C.

1209 East Eighth Street
Traverse City, MI 49686


A “substantial change” to the provider network

Consumers believe their provider and the provider network associated with any
Plan is an integral part of the health care benefits provided by the employer. A
Termination of a hospital system or specific provider group sometimes has
Significant impact on the employee population and should be viewed as a
substantial change to the plan itself. As a guideline, we would suggest any
change in the provider network impacting over 50% of the employee population
(nationally or locally) should result in a loss of the grandfather status.

Change in issuer or third-party administrator (TPA) (including moving from
Sully-inured to self-funded)

Even if the benefit structure of a group health plan remains largely the same, a
change in administration of the plan requires new communication, new processes,
and new requirements on the part of an employee and the employer. 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. These transitions are not daily or regular events and should be
considered a change in the group health plan.

Significant change in care management/authorization requirements

The processes consumers need to follow to receive care are significan component
of their perceptions of their health benefits plan. Changing notification require-
ments , requiring referrals, or other care management strategies involved in the
delivery of care management strategies involved in the delivery of care should
also be considered as a chage to the plan. This may prevent group health plans
from maintaining their grandfather status by not necessarily elimninating a
benefit, but making it difficult to receive by changing the care management
process around it.

Even by the most optimistic estimates, a substantial portion of the employee
population will reamin outside the PPACA as of January 2014 based on the
current rules. While we understand the difficulth involved in making change,
creating another large sub-population of exclude individuals will only add to
costs, increase confusion, and mitigate the potiential impact of the legislation.
This only adds to the uncertainty surrounding the $143 billion in deficit reduction
projected by the Congressional Budget Office (CBO) when the process began.

WE believe that any changes related to the areas listed above should also result in
a loOss 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 determining wheter a group health plan is “in or out.”
The decisions we make today will determing the outcomes for tomorrow. We


Page 1 of 2
opp g Alu _ 1) 4J0
REG NP 2-
LEGAL PROCESSING DIVISION

PUBLICATION & REGULATIONS
nen BRANCH

As of: September 09, 2010

PUBLIC Statusr Posted,

posted: September 09) 2010
SUBMISSION Comments Due: August 16, 2010

Submission Type: Web

Docket: IRS-2010-0010
Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered
Health Plan Under the Patient Protection and Afforable Care Act

Comment On: IRS-2010-0010-0001
Group Health Plans and Health Insurance Coverage: Interim Final Rules for Relating to Status as
a Grandfathered Health Plan under the Patient Protection and Affordable Care Act

Document: IRS-2010-0010-0940
Comment on FR Doc # 2010-14488

Submitter Information

Name: EDWARD JOHN SEKOL
Address:
1209 EAST EIGHTH STREET
TRAVERSE CITY, MI, 49686
Email: SEKOLDC@SBCGLOBAL.NET
Phone: 231-941-8650
Fax: (231) 941-8652
Organization: CHERRYLAND CHIROPRACTIC CENTRE. P.C.

General Comment

See attached file(s)

THIS COULD CAUSE DIRECT CONFLICT WITH THE PATIENT PROTECTION AND AFFORDABLE CARE
ACT BY LEAVING THE “DOOR OPEN" FOR PROVIDER DISCRIMINATION.

CHIROPRACTIC HAS BEEN DISCRIMINATED AGAINST IN THE PAST. WHEN THIS HAPPENS
PATIENTS ARE FORCED TO RECEIVE MUCH MORE EXPENSIVE MEDICAL CARE THAT HAS PROVEN
TO BE MUCH LESS EFFECTIVE IN THE TREATMENT OF SPINAL INJURIES SUCH AS LOW BACK
PAIN. LOW BACK PAIN IS THE NUMBER ONE CAUSE OF TIME LOSS OFF OF WORK IN THE UNITED
STATES.

PLEASE CONSIDER THE RAMIFICATIONS AND THEIR COST WHEN MAKING THIS DECISION.

Attachments

https://fdms.erulemaking.net/fdms-web-agency/component/submitterInfoCoverPage?Call=P... 9/9/2010


Page 2 of 2

IRS-2010-0010-0940.1: Comment on FR Doc # 2010-14488

https://fdms.erulemaking.net/fdms-web-agency/component/submitterInfoCoverPage?Call=P... 9/9/2010


August 16, 2010

Office of Consumer Information and Insurance Oversight
Department of Health and Human Services

Attention: OCIIO-9991-IFC

P.O. Box 8016

Baltimore, MD 21244-1850

Re: Interim Final Rule for Group Health Plans and Health Insurance Coverage Relating
to Status as a Grandfathered Health Plan under the Patient Protection and Affordable
Care Act.

Below are our comments regarding the Interim Final Rule for Group Health Plans and
Health Insurance Coverage Relating to Status as a Grandfathered Health Plan under the
Patient Protection and Affordable Care Act (PPACA).

We believe that every effort should be made to increase the number of individuals
covered by PPACA, especially as of January 1, 2014 when most of the reform
components (Insurance Exchanges, Subsidies, Tax Credits, etc.) come into play.

The rule provides the seven triggers that would revoke the grandfathered status of a group
health plan:

Mergers or acquisitions with the sole intention of maintaining grandfather status

Elimination of substantially all benefits to treat a particular condition

Elimination of benefits for any element necessary to eliminate or diagnose a
condition

Any change to coinsurance level

Fixed-amount cost-sharing (Deductibles/OOP) Inflation +15%

Co-payments (Medical Inflation +15% or $5 adjusted for medical inflation)

Employer contribution (>5% reduction in Employer Contribution)

While relatively straightforward, these guidelines may still result in some confusion to
the marketplace in their application. For example, if an employer raised the co-payment
level beyond the maximum one area (i.e. outpatient services) but retained the co-payment
level for primary care doctor visits, does that mean a loss of grandfather status? Clarity
will be critical both for the employer and the employee.

The average consumer has a broad definition of “benefits.” Consumers view their health
plan beyond the covered benefits, cost sharing, and the contribution levels associated
with the plan. Other components of health care services can have a significant impact on
the individual employee, which can result in a change to their plan including: