Key Provisions of the New Health Care Law

I am counting the Votes, the President has set his victory press conference already, and the final law will be published into the CFR next week.... so, here is the executive summary followed by two longer articles from competing semi-neutral papers ( Washinton Post, well maybe not neutral)

Anyway, to HR people here are the key points, until SHRM's people can do a better analysis:

• Almost every individual will be required to get health insurance.
• If you employee 50 or more people, and the government is forced to subsidize your employees, you will be forced to pay a penalty of $2000 per employee per year.
• Denial for pre-existing conditions is going away
• Insurance exchanges with minimum standard coverages will be set up.
• Dependents can stay on their parent's plans up to age 26.

How all this will be implemented will shake out in about 90 days, but it changes the way we do Health Care in America, for better or for worse, we will see.

-Editor


(The following is from Reuters)
Democrats, who have a majority in Congress, were taking a two-step process. The House was set to vote on approving the version of the healthcare legislation passed by the Senate in December. If the House passes it, that would give it final congressional approval and President Barack Obama could sign it into law.

The House also was set to vote separately on a series of proposed changes to the Senate-passed measure. If these changes win House approval, they would then go back to the Senate for senators to approve before the changes then also could be signed into law by Obama.

Here are key provisions of the Senate-passed legislation and the proposed changes.

INSURANCE MARKET REFORM

The legislation would require substantial insurance market reforms that would bar insurers from excluding people for pre-existing medical conditions and prevent them from arbitrarily dropping policy holders.

Insurance exchanges would be created in which small businesses and individuals without employer-sponsored coverage would be able to shop for coverage. Plans offered on the exchange would have to meet minimum benefit requirements.

The proposed changes would allow dependent children to remain on their parents' health policies until age 26.

The Senate bill requires insurers to spend at least 85 cents of every premium dollar on medical care in small group markets and 80 cents in large group markets. The proposed changes also would require Medicare Advantage insurers to spend at least 85 percent of revenues on medical care.

COVERAGE MANDATES, SUBSIDIES AND MEDICAID

Individuals would be required to obtain health insurance. Those who fail to obtain coverage would face fines of up to 2.5 percent of income by 2016.

Firms with more than 50 workers who do not offer medical coverage could face fines of $2,000 per full-time employee.

Federal subsidies would be provided to help people with incomes up to 400 percent of the poverty level purchase coverage on the exchange. Proposed changes would sweeten those subsidies for lower income people.

Medicaid, the government health insurance program for the poor, would be available to everyone with incomes up to 133 percent of the poverty level, which stood at $10,830 for an individual and $22,050, for a family of four. Many states have eligibility requirements below those levels.

The proposed changes would get rid of a special deal in the Senate bill that would have provided more money to Nebraska to cover costs of increased Medicaid coverage.

FINANCING

The final proposal makes some adjustments to the revenue measures in the Senate-passed bill.

The Senate bill included a 40 percent excise tax on high-cost health insurance plans. The proposed changes would delay implementation of the tax until 2018 instead of 2013. The tax would kick in on plans costing $10,200 for individuals and $27,500 for family coverage. A higher threshold is allowed for plans covering mostly women, older workers and retirees as well as those in high-risk professions.

The bill calls for raising the payroll taxes for Medicare, the government health insurance plan for the elderly and disabled, to 2.35 percent from the current 1.45 percent for individuals earning $200,000 or more and for couples earning $250,000 or more. The proposed changes would apply the tax to some investment income as well for those high-income groups.

The bill imposes fees on medical device manufacturers, insurance providers and brand-name pharmaceuticals. The proposed changes would delay implementation of those fees.

It also puts a 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.

MEDICARE

The legislation would freeze payments to insurers that provide coverage to Medicare patients in 2011 and begin reducing the subsidy in 2012.

It would also gradually close the gap in drug coverage for Medicare beneficiaries by 2020. Those who enter the coverage gap, the so-called doughnut hole, in 2010 will get a $250 rebate. In 2011 they would get a 50 percent discount on brand-name drugs.

(Reporting by Donna Smith; Editing by Deborah Charles)

-The Rest @ Reuters

Washington Post's take


-- Congressional Democrats have released a final version of President Barack Obama's health care overhaul bill in advance of a House vote planned for Sunday. Some features of the legislation, which makes changes to the bill the Senate passed on Christmas Eve:

COST: $940 billion over 10 years, according to the Congressional Budget Office.

HOW MANY COVERED: 32 million uninsured. Major coverage expansion begins in 2014. When fully phased in, 95 percent of eligible Americans would have coverage, compared with 83 percent today.

INSURANCE MANDATE: Almost everyone is required to be insured or else pay a fine. There is an exemption for low-income people. Mandate takes effect in 2014.

INSURANCE MARKET REFORMS: Starting this year, insurers would be forbidden from placing lifetime dollar limits on policies, from denying coverage to children because of pre-existing conditions, and from canceling policies because someone gets sick. Parents would be able to keep older kids on their coverage up to age 26. A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion goes into high gear. Major consumer safeguards would also take effect in 2014. Insurers would be prohibited from denying coverage to people with medical problems or charging them more. Insurers could not charge women more.


MEDICAID: Expands the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014. The federal government would pay 100 percent of costs for covering newly eligible individuals through 2016. A special deal that would have given Nebraska 100 percent federal financing for newly eligible Medicaid recipients in perpetuity is eliminated. A different, one-time deal negotiated by Democratic Sen. Mary Landrieu for her state, Louisiana, worth as much as $300 million, remains.

TAXES: Dramatically scales back a Senate-passed tax on high-cost insurance plans that was opposed by House Democrats and labor unions. The tax would be delayed until 2018, and the thresholds at which it is imposed would be $10,200 for individuals and $27,500 for families. To make up for the lost revenue, the bill applies an increased Medicare payroll tax to the investment income and to the wages of individuals making more than $200,000, or married couples above $250,000. The tax on investment income would be 3.8 percent.

PRESCRIPTION DRUGS: Gradually closes the "doughnut hole" coverage gap in the Medicare prescription drug benefit that seniors fall into once they have spent $2,830. Seniors who hit the gap this year will receive a $250 rebate. Beginning in 2011, seniors in the gap receive a discount on brand name drugs, initially 50 percent off. When the gap is completely eliminated in 2020, seniors will still be responsible for 25 percent of the cost of their medications until Medicare's catastrophic coverage kicks in.

EMPLOYER RESPONSIBILITY: As in the Senate bill, businesses are not required to offer coverage. Instead, employers are hit with a fee if the government subsidizes their workers' coverage. The $2,000-per-employee fee would be assessed on the company's entire work force, minus an allowance. Companies with 50 or fewer workers are exempt from the requirement. Part-time workers are included in the calculations, counting two part-timers as one full-time worker.

SUBSIDIES: The proposal provides more generous tax credits for purchasing insurance than the original Senate bill did. The aid is available on a sliding scale for households making up to four times the federal poverty level, $88,200 for a family of four. Premiums for a family of four making $44,000 would be capped at around 6 percent of income.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Small businesses, the self-employed and the uninsured could pick a plan offered through new state-based purchasing pools called exchanges, opening for business in 2014. The exchanges would offer the same kind of purchasing power that employees of big companies benefit from. People working for medium-to-large firms would not see major changes. But if they lose their jobs or strike out on their own, they may be eligible for subsidized coverage through the exchange.

GOVERNMENT-RUN PLAN: No government-run insurance plan. People purchasing coverage through the new insurance exchanges would have the option of signing up for national plans overseen by the federal office that manages the health plans available to members of Congress. Those plans would be private, but one would have to be nonprofit.

ABORTION: The proposal keeps the abortion provision in the Senate bill. Abortion opponents disagree on whether restrictions on taxpayer funding go far enough. The bill tries to maintain a strict separation between taxpayer dollars and private premiums that would pay for abortion coverage. No health plan would be required to offer coverage for abortion. In plans that do cover abortion, policyholders would have to pay for it separately, and that money would have to be kept in a separate account from taxpayer money. States could ban abortion coverage in plans offered through the exchange. Exceptions would be made for cases of rape, incest and danger to the life of the mother.

GOP HEALTH CARE SUMMIT IDEAS: Following a bipartisan health care summit last month, Obama announced he was open to incorporating several Republican ideas into his legislation. But two of the principle ones - hiring investigators to pose as patients and search for fraud at hospitals and increasing spending for medical malpractice reform initiatives - did not make it into the legislation released Thursday. The legislation incorporates only one, an increase in payments to primary care physicians under Medicaid, an idea mentioned by Sen. Charles Grassley, R-Iowa.

The Rest @ The Washington Post





On Twitter

Niassan America Gos to Shared HR Model

SSON spoke to Dwain Stevens, Sr Manager of HR operations, Nissan North America, about their North American HR Shared Services strategy and how HR Technology played a pivotal role in cutting costs and adding value.

SSON: I would like to start by asking you to explain Nissan North America’s HR shared services strategy.

Dwain Stevens: Our strategy was not just to develop HR shared services, it was to transform human resources throughout the entire company, to add more to the business. As part of that transformation strategy, one of the end products was to develop shared services, and the strategy for the shared services was to basically standardize all the HR practices as much as possible throughout the company, as well as remove any administrative, transactional-type tasks from the HR personnel within the different locations.

How have you leveraged technology to transform HR and effectively lower costs?

In the past we didn’t have an effective way to share information with all employees that was HR-centric. We had an employee intranet, but because of the way that it was technically designed, all the employees didn’t have access to it, just certain employees. So we needed technology, a dynamic employee portal, where we could put all kinds of HR-related information, and make it available to employees 24/7. That way, when people have a question, they can look for the answer themselves via any computer—and most of our employees do have computers, whether at work or at home. What’s more, if people needed to make some sort of change that was HR or benefits-related related, they could go online, make those changes themselves and not have to wait for someone in HR to fill out the forms, enter that data, make that change and then see the change take effect later on. Online access has improved everybody’s lives—helping employees obtain the information faster, because of the transactions being faster. It has also eliminated a lot of duplicate entry and non-value-added tasks from HR.

But you moved to a different technology platform, and what was the business case for doing that?

The business case was to save money in a much more efficient and effective way. We carried out an analysis to find out how a portal could help us do that or how can a shared services center could do that. And we ran the numbers, and believed—and have confirmed—that it did make us more effective and much more efficient.

What technology requirements did you choose, and why did you choose them?

Our technology requirements were an employee portal that was available 24/7, and was available to 100 percent of our employees. We wanted single sign-on capabilities, and we wanted it to be HR-centric—in other words, we didn’t want generic or standard service center portal or call tracking technology. We wanted an integrated solution—not two separate solutions that we would have to integrate ourselves. And, again, single sign-on capabilities, which then directly tie to our HRMS system—those were the primary requirements. After extensive research, including lots of analysis, and lots of demos, we chose the Enwisen AnswerSource HR Service Delivery suite, because it met our technology requirements, and it was a great value.

Fantastic, and what were the challenges in moving to the new platform and integrating the new system?

The main challenge that any organization faces is change. Since we were basically transforming human resources, we were going to change the way in which HR services were delivered throughout the entire company. It affected employees, the managers and especially the HR people. We found that communicating what we were doing, and when and how, and doing it in a way that encouraged the employees to believe that it was going to be better for the entire company worked best. That was one of the major changes, because if you think about it, we were going to change their jobs, what they did, where they did it and the technology that they used. We basically upset their entire world. And then from the employees’ perspective, they were used to seeing HR people, more HR people in the facility answering their questions, instead of looking for information on their own. So, through the technology we encouraged employees to do more for themselves. That was a big challenge. Many people, including myself, like somebody to their my hand.

Do you think you’ve mastered that now and has it been really accepted at ground level?

I think that it has definitely been accepted, because I would say that while they don’t have any choice but they still have the HR people in the affiliates. But what HR people are doing in the plants is very different to what they were doing before. And it is still accepted because our call volume is still steady, and at times it grows. When we have HR initiatives, we do a very good job of communicating what those initiatives are—it could be a simple benefits change, it could be a massive benefits change, and it could be communications from the CEO. So when we communicate to the employees, they will call the service center. The service center has become a hub for many different types of initiatives when the employees have questions. After the initial communication goes out, they direct the calls to the service center, for those kinds of things, as long as they are routine, and it has become much more accepted.

What do you think are the major benefits of moving to the new platform, as well as integrating a multi-tier approach?

The major benefits affect different groups of people differently. From an employee’s perspective, because we have a HR portal, a lot of HR-related information—for example, policies, even cafeteria menus—directly links into their pay system. They can see their pay slips to vendors, can find all kinds of information, such as what do they do when they have a baby, get married or just life events. With that technology, it encourages people to help themselves. People want information when they want it, and don’t want to have to wait for somebody else to provide it, so it improves their quality of life.

Then when it comes to transactions, there’s less paper to fill out. For example, they don’t have to fill out the piece of paper with the change form—they do it online. So the problems of the form getting lost, or delays when somebody receives it to when somebody enters that information, are gone. It speeds up the transactional process, from the employee’s perspective.

From HR perspective, since we removed that administrative/transactional stage from some of the HR people, we’re able to focus on different types of work. We have a group of people at the HR service center that focus on the administration as well as the transactional side, but we also partner in the service center with other groups of people, like the business affiliates, when they have a major change. We are their partners in the administering the change and we are partners with expertise when it comes to the conversation of benefits. Because we have data information, we know what the employees’ questions are and we partner with them to share information to say, "here is what they like, here is what they don’t like," and they’re better able to come up with a better benefits change. And then from the business perspective, because we have become much more efficient, much more effective, we have saved money, and saved time. So, everybody wins: the employee, HR and the business.

How much you have saved since integrating the system? Or can you put a percentage on it?

I think the amount of money that we saved would be confidential, but let me say this: When we did the analysis of HR, we were in the bottom quartile of expenditures. That means we were spending more money than our peers. Since we have instituted the HR transformation, we are now in the top quartile, spending the least amount of money compared with our peers.

How long did it take you to achieve that?

The overall transformation, if you think about it from start to finish, was probably a couple of years—maybe two to three years—but the transformation to the HR service center, which really saved the most money, was probably a year and a half from start to finish. If you look at total analysis from implementation, of the technology change, and the launch the service center that was about three to three and a half months. We did a few months prep work before that.

What were some of your key performance indicators for measuring success? You have just explained cost-savings, but how are you tracking key performance indicators and how are you meeting them?

Our primary KPIs are call-center related, and then service-related. For example, how quickly we answer the phones—that’s one KPI. The other KPI is to make sure that people don’t abandon the call. So the first KPI is service levels; the second KPI is abandonment rate. And then the other key measure is first contact resolution, which is an indication of customer service. On all those three primary KPIs, we are at or above the world-class measures.

How many CSRs do you have serving your population of 12,000 employees?

How we are structured may be different to others, because of what tasks that we’re responsible for. We basically have three groups of people, and we follow the traditional tier terminology that many HR call centers use, or any kind of call center really does. Tier Zero is our HR knowledgebase portal technology; Tier One is the HR service center staff directly answering the phones from employees. For us, Tier Two is our benefits administrators, and then we have our COEs, which is Tier Three. For Tier One we have eight people for 12,000 employees and we have two people on nights; and although we might not get any calls at night we currently do it for employee relations.

We are a non-union company, and want to maintain that, so we struck a balance between holding people’s hands and being available for people—that’s why we have the people at night. I would say this about having a HR centralized service center: some people would say, ‘well, you took a HR person away from us in the plant.’ But what we really did, instead of one person being taken away from the plant, we added eight people available to you, basically 21 hours a day, five days a week. By adding eight customer service reps, we have more people available to take your calls, so that improves customer service for employees.

Your self-service platform has obviously been quite effective, because if you can reduce it to eight people responding to 12,000 employees, would you agree with that?

Yes, I do, but it is hard to quantify how many people get their questions answered from the technology. We know how many people access the technology, but we don’t know how many people get their questions answered by it. We do know, because of the technology dashboards, that the portal does get a lot of use. When people call the service center, typically their questions are more complicated than just simple information, so that the length of calls is longer. That’s OK with us; that’s why we’re here, to answer those complex calls. I will also say that our Tier One people on the phones do other things besides answer calls, because call volume is unpredictable, and there are times when call volume is low. So we have taken administrative tasks that can be done in between calls, or we can take somebody off the phone to give them the time to do these administrative tasks. By taking on administrative tasks at Tier One, and it removes work from other higher, more expensive Tier Two and Three staff. And we have also centralized some of those tasks that used to be done by the local nationwide affiliates. So we are able to better utilize our resources.

Are there any other metrics that you could share from the 'Win' HR project?

Our service levels are in the mid 80s, so that means that we’re answering 84-85 percent of the calls within 60 seconds or less. Then our average talk time is four and a half to five minutes. Our first contact resolution rate is not as high as I would like, but there is a factor in there that is beyond our control. Our first contact resolution rate is when the rep is able to answer the first question at the first call: and that’s in the low to mid eighties, anywhere between 82-84 percent typically, sometimes higher. The reason it is not higher, is that we have partnered with other groups that don’t fall within the HR umbrella. For example, payroll does not fall under the HR umbrella, neither does a group of people called lease car, a benefit that we give our employees. Because we don’t have total access to the information that those groups do, and we’re the center point of contact, employees who call us with payroll-related questions, or their lease car questions require more time to research. And we’re able to answer those questions anywhere between 60-70 percent of the time, first contact resolution. But that brings the overall score lower. If we took out lease car, and if we took out payroll, our first contact resolution would be over the mid 90s.

What other areas of HR do you see being transformed in the next two to three years?

From the service center perspective, even from day one after we launched—we went live in September within three to four months—we started an initiative to change the way we provide health coverage. Instead of the traditional PPO plan, we went to a consumer-driven health plan, which is major change for how healthcare is delivered. Within 12 months the entire company was on this new CDHP health plan. Now that amount of work took a tremendous amount of time—not just from our CEO, but from the service center, too, and we were able to do that within a year. And this was with a newly launched service center with new people and newly launched responsibilities and, we did that very effectively.

So we have found ways to constantly standardize our processes, consolidate our policies, automate our processes, and streamline things—in other words, more ways of doing more with less. A good example for this is when we launched this new CDHP plan. When it came time for people to enroll—it was a mandatory enrolment for 13,000 employees at that time—and we were looking at how we were going to take the call volume, with eight reps, we considered hiring more reps and even outsourcing the Tier One calls. It was estimated that we needed 70 people to take all the calls based on our population and the type of plan that was changing. Nissan is very frugal, that is part of our culture and we are very aggressive on cost, too. So, we literally hired 24 people ourselves, trained them, gave them some intensive training on the new technology as well as the new plans, and then with the right tools, the right training and the right time, they were able to take the new call volume with the new CDHP enrolment. And our service levels, even though our call volume went up six times the average of the norm, our service levels were in the mid 90s, with only 24 additional people, which is a testimony to our people, as well as on how we did the training and how we partnered with our contractors but also a testimony to the technology that we used.

The automobile industry was very affected through the recession. Have you seen any "green shoots" of recovery?

Yes, HR really led the way in the re-engineering the efforts; it started a couple of years ago. The company has found ways of restructuring itself without affecting too many people. We hardly had any layoffs, we had people that volunteered to leave, and they were incentivized to do so—because we were very aggressive in our re-engineering efforts, and our cost cutting. Again, this is without massive forced layoffs, so it put us in a position to save money. So we were able to turn around a profit. I think we lost it one quarter, and then we turned it around the following quarter. So it couldn’t have happened without that aggressive re-engineering, not just within HR but from the other parts of the organization. In fact, our market share had gone up during this recession, while others have lost it. This is without any government bail outs

The Rest @ Human Resources IQ




Lee Royal
On Twitter

The Role of HR Generalist in a Small Company

Most of the smaller organizations or businesses have a position known as human resources generalist. Actually, it is not possible for these small companies to afford many human resources positions. In such organizations human resources managers do not have any human resources assistants that could assist them in their tasks.
Human resources generalist should have knowledge about all the tasks related to human resources in an organization so that he need not depend on any type of employees required for the job.
It is very important that the executives ensure that the human resources generalist that they are hiring has adequate knowledge about all the requirements of the organization. Along with being an expert in understanding the functioning of the operations and works of the business, he or she should be competent to handle all types of mediation, written, oral, organizations and interpersonal skills.
There is no one is the organization on whom the human resources generalist can delegate his duty, therefore he or she should be capable of multi-tasking. A human resources generalist should have quick learning ability as every business has specific requirements that need to be met.
A human resources generalist need to have more qualification or education than any human resource coordinator or assistants to handle various areas of work and the diverse task list. A bachelor’s degree in diverse fields of study would be an added advantage.
Human resources generalist need to understand the running of the business and the way to communicate with everyone at any level in the organization. This is very important to carry on with the tasks of human resources generalist.
Although most of the human resources generalist have good knowledge of computers and administration but a qualified generalist have an added edge over the others. To carry out tasks of clerical duties you need to have good understanding of computers programs. You would also require a good level of organization to handle all the tasks easily.
Although the limitation of requirement of human resources generalist in smaller companies limit the job prospects. Moreover, there may not be good scope for promotion to management at senior management positions and human resources department due to the limited size of business. But this is the best way to gain some experience in the field of human resources.
Once you gain some experience, you can easily step up the ladder and join some larger corporation for better management positions. In cases where you need to have some knowledge and experience to apply for a job, your this past experience of being an assistant or coordinator would be very beneficial for you. They would consider you as an individual who is experienced and is seeking for job change to work on more advanced platform and is ready to take more responsibilities.

The Rest @ Tweet My Blog




Lee Royal
On Twitter