Federal Laws Protecting Medical Insurance Coverage

Consolidated Omnibus Budget and Reconciliation Act of 1986 (COBRA)
COBRA gives qualified employees and their families the right to temporarily continue health insurance coverage at group rates when coverage is lost due to certain specific events or qualifying events, such as voluntary or involuntary job loss, reducing work hours, divorce or legal separation, the covered person becoming entitled to Medicare or the death of the employee. COBRA allows people to continue coverage of their group medical insurance for a period of up to 18 months or 29 months if a beneficiary is considered disabled.
The law generally covers health plans maintained by private-sector employers with 20 or more employees, employee organizations, or state or local governments. The employer must notify an employee of its availability, within 30 days after the qualifying event.

COBRA must be elected by the former employee within 60 days of stopping employment. Continuing insurance coverage is available if the premium is paid and until the individual becomes covered under another group policy.

Patients should be advised that the cost of the COBRA premium is usually far less than the cost of treatment should they let their health policy lapse.

COBRA is administered by the U.S. Department of Labor, COBRA information & FAQs are available on their Web site.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
This bill has several clauses that can possibly benefit cancer patients:

The Secretary of Labor enforces the health care portability requirements on group health plans under ERISA, including self-insured arrangements. In addition, participants and beneficiaries can file suit to enforce their rights under ERISA, as amended by
HIPAA.

The Secretary of the Treasury enforces the health care portability requirements on group health plans, including self-insured arrangements. A taxpayer that fails to comply may be
subject to an excise tax.

For more information about HIPAA contact your state department or commission of insurance.

The Family and Medical Leave Act of 1993 (FMLA)
FMLA requires employers (with at least 50 employees) to provide up to 12 weeks of unpaid, job-protected leave to eligible employees for certain family and medical reasons. Employees are eligible if they have worked for a covered employer for at least 1250 hours in the previous 12 months.

For the time period of the FMLA leave, the employer must maintain the employee's medical insurance coverage under any company group health plan. This act is regulated by the U.S. Department of Labor's Wage and Hour Division. They can provide additional information. Check the telephone directory in your area under U.S. Government, Department of Labor.

The Americans with Disabilities Act of 1990 (ADA)
The ADA act offers protection against discrimination in the workplace to anyone who has, or has had, certain disabilities, including any diagnosis of cancer. Parents of dependent children with cancer are also protected under this law. It requires private employers who employ 15 or more people, labor unions, employment agencies, and government agencies to treat employees equally, including the benefits offered them, without regard to their disabling condition or medical history.

It also does not allow employers to screen out potential employees who have children with disabilities. This act, along with the Family and Medical Leave Act, makes it easier to change jobs and move from one group insurance arrangement to another. This law is administered by the U.S. Equal Employment Opportunity Commission (EEOC). The American Cancer Society also publishes information for cancer patients on the Americans with Disabilities Act.

Source:
The American Cancer Society

Women’s Health and Cancer Rights Act of 1998 
Under the Women’s Health and Cancer Rights Act (WHCRA) of 1998 health insurance plans must cover breast reconstruction in connection with a mastectomy if the patient decides to have reconstruction and received insurance benefits from her plan for the mastectomy.

There are three different types of coverage that the law may apply to:

WHCRA does not apply to Medicare and Medicaid as they are public health plans not issuers of health insurance.

WHCRA does not require health plans or issuers to pay for mastectomies. However, if a group health plan or health insurance issuer does cover mastectomies the plan or issuer is generally subject to WHCRA requirements.

The required coverage under WHCRA includes:

The WHCRA coverage requirements are not limited to cancer patients; patients whose insurance plan covers mastectomies and are receiving benefits in connection with a mastectomy for reasons other than cancer are also covered under this law.

The WHCRA is administered by the U.S. Department of Labor and the U.S. Department of Health and Human Services. Both of these agencies have Web pages with information about WHRCA including a list of frequently asked questions.  

Breast and Cervical Cancer Prevention and Treatment Act
On October 24, 2000, the Breast and Cervical Cancer Prevention and Treatment Act (BCCPT) of 2000 was signed into law. The Act, which became effective October 1, 2000, gives states the option to provide medical assistance through Medicaid to eligible women who were screened through the Centers for Disease Control and Prevention's (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and found to have breast or cervical cancer, including pre-cancerous conditions.

In 2002 Congress passed a technical amendment to the BCCPT Act. The Native American Breast and Cervical Cancer Treatment Technical Amendment Act of 2001, extends benefits of the BCCPT Act to American Indian and Alaska Native women.

To be eligible for Medicaid under this option, the woman must:

Participation in the BCCPT is optional for States. States that do participate receive an enhanced matching rate for women who enroll. Under the BCCPT law, women whose cancers were found through the CDC’s NBCCEDP may be eligible for Medicaid benefits for the duration of their cancer treatment.

The National Breast Cancer Coalition (NBCC) reports that as of May 2004, all 50 states and the District of Columbia have passed legislation to opt in to the CDC’s Treatment Program.

The Older Americans Act
The Older Americans Act provides Federal funds for state and local social service programs that help frail and disabled people age 60 and older remain independent in their community. This funding covers home care aide, personal care, meal delivery, and escort and shopping services. The U.S. Administration on Aging maintains the Eldercare Locator which provides information about assistance for older people. The Eldercare Locator can be reached by phone at 1–800–677–1116, or at Eldercare Locator.

CONTACT US
Risë Marie Cleland
Rise@Oplinc.com

Oplinc, Inc.
315 W. Mill Plain Blvd.,
Suite 204
Vancouver, WA 98660
360.695.1608 office
360.695.6937 fax
www.Oplinc.com
Rise@Oplinc.com

UPCOMING ISSUE
Comments and suggestions for future issues are welcome, please forward correspondence to Risë Marie Cleland by email at: Rise@Oplinc.com

NEWSLETTER ARCHIVES
Volume 4 Issue 2
Volume 4 Issue 1
Volume 3 Issue 8
Volume 3 Issue 7
Volume 3 Issue 6
Volume 3 Issue 5
Volume 3 Issue 4
Volume 3 Issue 3
Volume 3 Issue 2
Volume 3 Issue 1
Volume 2 Issue 7
Volume 2 Issue 6
Resource Guide Issue 5
Volume 2 Issue 4
Volume 2 Issue 3
Volume 2 Issue 2
Volume 2 Issue 1

ABOUT THE EDITOR
Risë Marie Cleland is the founder and President of Oplinc, Inc., a national organization of oncology professionals. Through Oplinc, Inc. Ms. Cleland publishes the weekly Oplinc Fax Tracts focusing on the timely dissemination of information pertaining to billing, reimbursement and practice management in the oncology office and Oplinc’s Best Practices Review, which provides a more in-depth look at the issues and challenges facing oncology practices. Ms. Cleland also works as a consultant and advisor for physician practices, pharmaceutical companies and distributors.

IMPORTANT NOTICES
Please note that this newsletter is presented for informational purposes only. It is not intended to provide coding, billing or legal advice. Regulations and policies concerning Medicare reimbursement are a rapidly changing area of the law. While we have made every effort to be current as of the issue date, the information may not be as current or comprehensive when you review it. Please consult with your legal counsel for any specific reimbursement information. For Medicare regulations visit: www.cms.hhs.gov.

CPT® is a Trademark of the American Medical Association Current Procedural Terminology (CPT) is copyright 2007 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein.