Updated Topics

The Handbook is updated quarterly and all topics in the Handbook are reviewed annually to be sure the information provided is relevant, accurate, and current. Below are examples of some of the topics updated during 2019.

LEGISLATIVE TOPICS

ERISA – information added on a federal court conclusion regarding association health plans.

Mental Health Parity Act – Updated with information on nonquantitative treatment limitations and disclosure requirements.

Timeline of Federal Benefits Legislation – Updated with ACA reforms effective in 2019.

Medicare - 2019 premiums, deductible and copayments were updated.  Information was added that Medicare Cost Plans will not be offered in 2019.  Information on MACRA was added.  

Affordable Care Act Overview – information added on CMS’ finalization of the Benefit and Payment Parameters rule for 2020.

Affordable Care Act and Lifetime/Annual Limits – Updated with the 2020 proposed out of pocket maximums for non-grandfathered plans.

Affordable Care Act and Preventive Care - information added on the nationwide preliminary injunction preventing the enforcement of the 11/15/18 final rules allowing employers to deny women health insurance including contraceptive coverage based on moral or religious reasons.

Genetic Information Nondiscrimination Act of 2008 – Updated with information on the EEOC’s final rule removing the incentive sections in its final regulations on wellness programs.

Regulation of Insured and Self-Insured Health Insurance – Updated with additional information on the NJ Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act.

State Assessments on Health Related Claims - Updated with current assessment information by state.

Product Liability – Additional medications and devices involved in lawsuits were added.

Flexible Benefits Administration - Maximum HSA contribution amounts and HDHP minimum deductible and out of pocket limits for 2019 and 2020 were updated.

Overview of Health Insurance – Updated with information on regulations issued expanding the use of HRAs.

Mental Health Parity Acts of 1996 and 2008 – Information on the issuance of FAQs Part 39 was relating to nonquantitative treatment limitations was added.

Privacy and Confidentiality – Updated with information on OCR and HHS’ release of FAQ guidance relating to HIPAA permitted disclosures.

Health Insurance Portability and Accountability Act of 1996 – Information added on the HHS final rule to implement certain inflation adjustments to the civil monetary penalties imposed on violations of the administrative simplification rules of HIPAA.

 

PROCEDURAL TOPICS

Coding & Billing - updated with information the latest release of the ICD-10-CM, CPT-4 and CDT-2019.  Updated place of service code “02” for the CMS-1500 was added.

Occupational, Physical and Speech Therapy – Updated with information on the requirement of clinicians to still use the KX modifier to indicate ongoing medical necessity for therapy services.  

Prescription Drugs – Information on potentially excluded drugs was updated.  

STD - Other Disability Income Sources - Disability benefits by state were updated.

STD Benefit Taxation - The Social Security taxable wage base was updated.

Dental Plan Overview – Procedures requiring submission of X-rays or periodontal charting were updated.  Information on the ADA’s position on teledentistry was added.

Dental Topics – Additional covered and non-covered services were added.

 

MEDICAL TOPICS

Attention Deficit Hyperactivity Disorder – Information on a new FDA-approved device was added.

Autistic Spectrum and Learning Disorders – Additional covered and non-covered devices were added.

Biofeedback – Information on a new certification program for biofeedback therapists was added.  Additional covered conditions were added.

Behavioral Health Overview – Information on litigation surrounding coverage for wilderness therapy programs was added.

Bone Healing Systems - Updated with additional covered and non-covered services.

Cochlear Impants and Auditory Brainstem Implants – A chart of the usual medically necessary frequency of replacement parts was added.

Cosmetic Surgery – An additional non-medically necessary service was added.

Diagnostic Imaging Services – Additional medically necessary services were added.

Endometrial Ablation – Information added on the FDA approved AEGEA Vapor System.  Additional investigational services were added.

Fetal Surgery – Updated with additional investigational procedures.

Genetic Testing – Updated with additional covered and non-covered services.

Growth Hormone – Updated with new FDA-approved medications.

Home Oxygen Therapy - Updated with additional covered and non-covered services.

Hyperhidrosis – Covered surgical treatments were expanded.

Impotence/Erectile Dysfunction – Additional experimental services were added.

Infant Apnea Monitor – An additional medically necessary service was added.

Infertility – Additional investigational medications were added.

Nerve Conduction Studies - Updated with additional investigational procedures.

Obesity –  Additional investigational bariatric procedures were added.

Obstructive Sleep Apnea – Updated with additional investigational procedures.

Podiatry Expense – Updated with several additional covered and investigational services.

Psoriasis Treatment – An additional FDA approved medication was added.

Self-Inflicted Injuries –  New Jersey was added to the list of states with death with dignity laws.

Surgery Payment Guidelines - updated with current Medicare National Physician Fee Schedule Relative Value File information.

Telehealth – Updated with 2019 CPT and HCPCS telehealth code additions.

TMJ – Updated with additional medically necessary services and investigational treatments.

Transplants – Additional investigational procedures were added.

Vaccines/Immunizations - updated with current information on the CDC’s Recommended Immunizations Schedules.

Varicose Veins – An additional investigational service was added.

 

OPERATIONAL TOPICS

Appeals Processing -  Updated with information on the HHS administered Federal external review process.

Surgery Payment Guidelines - The Medicare National Physician Fee Schedule Relative Value File information was updated.

Claim System Considerations – Vendor chart was updated.

Claims Cost Containment –The chart of vendors was updated.  Updated on the requirement for every hospital to post its standard chargemaster on-line.

Coordination of Benefits – Information added on the implementation of the order of benefit determination rules in the NAIC model regulations.

Overpayment Recovery – Information added on cross-plan offsetting.

SAS 70/SSAE-16/SSAE-18 Audits – Information on the three types of SOC audits was added.

Vendor Selection & Monitoring – The list of NCQA accreditation, certification and recognition programs was updated.

 

LISTINGS AND DIRECTORIES

CMS Regional Offices - Listing was updated.

Internet Sites – Links were updated.

Organizations in the Insurance Industry – list of professional educational programs offered by LOMA and AHIP were updated.

Regional Organ Procurement Organizations - updated with current information.

State Dental Board Directory - updated with current information.

State Insurance Department Directory - updated with current information.

State Intoxication Levels – Chart of legislation by state was updated.

State Medical Boards - listing updated with current information.