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S\Ec-- )I yr LI/2 -/ 0 

PUBLIC 

SUBMISSION 

As of: August 26, 2010 

Received: August 10, 2010 

Status: Posted 

Posted: August 26, 2010 

Tracking No. 80b2d331 

Comments Due: August 16, :ZOlO 

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-2010-0010-0454 

Comment on FR Doc # 2010-14488 

Submitter Information 

Name: Kathy Chittom 

Address: 

10636 Timberlake Avenue 

Baton Rouge, LA, 70810 

Email: kachittom@aol.com 

Phone: 225-769-5560 

Organization: Chiropractic Association of Louisiana 

General Comment 

See attached file(s) 

Attachments 

IRS-2010-0010-0454.1: Comment on FR Doc # 2010-14488 

https:llfdms.erulemaking.netlfdms-web-agency/componentlsubmitterInfoCoverPage?Call=... 8/26/2010 
Chiropractic Association of Louisiana 


10636 Timberlake Avenue 


Baton Rouge, Louisiana 70810 


225-769-5560 


August 10,2010 

Office of Consumer Information and Insurance Oversight 

Department of Health and Human Services 

Attention: OCII0-9991-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 I, 2014 when most of the reform components (Insurance Exchanges, Subsidie.>, Tax 

Credits, etc.) come into play. 

The Rule provides the seven triggers that would revoke the grand fathered 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 copayment level beyond the maximum in one area (i.e. 

outpatient services) but retained the copayment 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 I)fhealth 

care services can have a significant impact on the individual employee, which can result in a change to their 

plan including: 

• 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 ofthe grandfather status. 

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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 heal1:h plan. 

• 	 Significant change in care management/authorization requirements 

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

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 pre'cess 

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 health care benefits. The Rule needs to be clear, reasonable, 

and with no ambiguities involved in determining whether a group health plan is " in or out." The decisons we 

make today will determine the outcomes for tomorrow. We may need to make some difficult decision~i 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, 

Kathy Chittom 

Executive Director