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.
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.
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.
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.
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.