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LEGAL PROCESSING DIVISION
PUBLICATION & REGULATIONS
7 BRANCH

As of: September 08, 2010

PUBLIC Status: Posted

Posted: September 08, 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-2010-0010-0829
Comment on FR Doc # 2010-14488

Submitter Information

Name: Donald Hilton Dearth, D.C.
Address:

2052 E. Southern Ave.

Tempe, AZ,
Email: drdearth@qwestoffice.net
Phone: 480-756-6044
Organization: Active Care Chiropractic, Inc.
Government Agency Type: Federal
Government Agency: HHS.

General Comment

August 14, 2010

Office of Consumer Information and Insurance Oversight. 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

The 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.
chiropractic 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 of health care services can have a significant impact on the individual
employee, which can result in a change to their plan including:

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A “substantial change” to the provider network

Such as the 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 plar:
itself, As a guideline, I 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) 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. This happens frequently.

Even by the most optimistic estimates, a substantiat portion of the employee population will
remain outside the PPACA as of January 2014 based on the current rules. I 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. Level the playing field to
allow the patient to select the care they choose from the licensed provider of their choice. In
today’s world we need to end the discrimination in healthcare and this is the best opportunity to
end it now...for the best care tomorrow.

Thank you for the opportunity to comment on this regulation.

Donald H. Dearth, D.C.

Active Care Chiropractic, Inc.

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