whether a group health plan is “in or out.” The decisions we make today will determine the
outcomes for tomorrow. We 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.

Jeffrey S Fedorko, DC
President Congress of Chiropractic State Associations

12531 E. Meadow Drive » Wichita, KS 67206 » Phone: 316.613.3386 + Fax: 316.633.4455
amy4hardin@yahoo.com


Page 1 of 1

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[As of: August 09, 2010

PUBLIC Status: Posted,

SUBMISSION racking No. S0bes8cb.
Comments Due: August 16, 2310

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-2010-0010-0044
Comment on FR Doc # 2010-14488

Submitter Information

Name: Jeffrey S Fedorko
Address:
12531 E, Meadow Drive
Wichita, KS, 67206
Email: vp101@aol.com
Phone: 330-494-0422
Fax: 330-494-3601
Submitter's Representative: Representative John Boccieri (OH-16)
Organization: Congress of Chiropractic State Associations

General Comment

See attached file(s)

Attachments

IRS-2010-0010-0044.1: Comment on FR Doc # 2010-14488

https://fdms.erulemaking.net/fdms-web-agency/component/submitterInfoCoverPage?Call=P... 8/9/2010


Congress of Chiropractic

t

chirsracte Sa ssacians

State Associations ...

.» promoting a more unified profession

August 6", 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
e Elimination of substantially all benefits to treat a particular condition

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

e Any change to coinsurance level

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

© Co-payments (Medical Inflation +15% or $5 adjusted for medical inflation)
e 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 copayment level
beyond the maximum in one area (i.e. outpatient services) but retained the copayment level

12531 E. Meadow Drive * Wichita, KS 67206 + Phone: 316.613.3386 » Fax: 316.633.4455
amy4hardin@yahoo.com


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:

e 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 fully-
insured 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.

© Significant change in care management/authorization requirements

The processes consumers need to follow to receive care are a significant component
of their perceptions of their health benefits plan. Changing notification requirements,
requiring referrals, or other care management strategies involved in the delivery of
care should also be considered as a change to the plan. This may prevent group
health plans from maintaining their grandfather status by not necessarily eliminating
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
remain outside the PPACA as of January 2014 based on the current rules. While we
understand the difficulty involved in making changes, creating another large sub-population
of excluded individuals will only add to costs, increase confusion, and mitigate the potential
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 loss 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
12531 E. Meadow Drive * Wichita, KS 67206 * Phone: 316.613.3386 * Fax: 316.633.4455
amy4hardin@yahoo.com