A statement by U.S. Department of Health and Human Services Secretary Kathleen Sebelius
In August 2011, the Department of Health and Human Services issued an interim final rule that will require most health insurance plans to cover preventive services for women including recommended contraceptive services without charging a co-pay, co-insurance or a deductible. The rule allows certain non-profit religious employers that offer insurance to their employees the choice of whether or not to cover contraceptive services. Today the department is announcing that the final rule on preventive health services will ensure that women with health insurance coverage will have access to the full range of the Institute of Medicine’s recommended preventive services, including all FDA -approved forms of contraception. Women will not have to forego these services because of expensive co-pays or deductibles, or because an insurance plan doesn’t include contraceptive services. This rule is consistent with the laws in a majority of states which already require contraception coverage in health plans, and includes the exemption in the interim final rule allowing certain religious organizations not to provide contraception coverage. Beginning August 1, 2012, most new and renewed health plans will be required to cover these services without cost sharing for women across the country.

After evaluating comments, we have decided to add an additional element to the final rule. Nonprofit employers who, based on religious beliefs, do not currently provide contraceptive coverage in their insurance plan, will be provided an additional year, until August 1, 2013, to comply with the new law. Employers wishing to take advantage of the additional year must certify that they qualify for the delayed implementation. This additional year will allow these organizations more time and flexibility to adapt to this new rule. We intend to require employers that do not offer coverage of contraceptive services to provide notice to employees, which will also state that contraceptive services are available at sites such as community health centers, public clinics, and hospitals with income-based support. We will continue to work closely with religious groups during this transitional period to discuss their concerns.

Scientists have abundant evidence that birth control has significant health benefits for women and their families, is documented to significantly reduce health costs, and is the most commonly taken drug in America by young and middle-aged women. This rule will provide women with greater access to contraception by requiring coverage and by prohibiting cost sharing.

This decision was made after very careful consideration, including the important concerns some have raised about religious liberty. I believe this proposal strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services. The administration remains fully committed to its partnerships with faith-based organizations, which promote healthy communities and serve the common good. And this final rule will have no impact on the protections that existing conscience laws and regulations give to health care providers.

Hospital Corporation of America (HCA)

As you are aware, Hospital Corporation of America (“HCA”) terminated their California Commercial Hospital Agreements with Anthem Blue Cross effective March 3, 2012.  Despite the contract terminations, both parties continued active negotiations with the hope that the hospitals would again participate in Anthem Blue Cross’s network.

We are pleased to announce a multi-year Agreement has been reached with an effective date of April 1, 2012.  Consequently, there is a lapse in participating status from March 3, 2012 through March 31, 2012.  The HCA hospitals include the following facilities:

• Good Samaritan Hospital – San Jose, located in San Jose, California
• Los Robles Regional Medical Center, located in Thousand Oaks, California
• Regional Medical Center of San Jose, located in San Jose, California
• Riverside Community Hospital, located in Riverside, California
• West Hills Hospital and Medical Center, located in the West Hills District of Los Angeles, California

All subscribers, physicians, medical groups, agents, brokers, and clients, who were originally notified about the contract terminations, will receive a letter telling them that the HCA hospitals are again participating facilities in Anthem Blue Cross’s network.

If you have further questions about Anthem Blue Cross’ new Agreements with the HCA hospitals, please email the PE&C Regulatory Affairs Department at: RAD Department-Wellpoint-SM.

Workplace violence has significant cost and effect to business.  We’ve seen reports in the news about employees who commit violent acts against their companies and their coworkers.  Employers have a duty to protect employees from violent acts in the workplace.

The National Institute of Occupational Safety and Health (NIOSH) defines workplace violence as any physical assault, threatening behavior or verbal abuse that occurs in the work setting. Acts such as psychological trauma due to threats, obscene phone calls, intimidation and harassment of any kind are included.

Workplace violence may also include damage to company resources or capabilities that result from any acts of violence.  Many employers are also including bullying in their consideration of act of violence in the workplace.  Even violence outside the workplace can enter a company through incidents of domestic violence through acts of assault, or threats to an employee or employees.

NIOSH has classified perpetrators of workplace violence and domestic abuse into 4 categories.

Type 1: Violence by strangers:  involves verbal threats, threatening behavior or physical assaults by an assailant who has no legitimate business relationship to the workplace. The person enters the affected workplace to commit a robbery or criminal act. Violence by strangers is responsible for the majority of fatal injuries related to workplace violence nationally. Workplaces at risk of violence by strangers commonly include late-night retail establishments and taxi cabs.

Type 2: Violence by customers or clients:   involves verbal threats, threatening behavior or physical assaults by an assailant who either receives services from or is under the custodial supervision of the affected workplace or the victim. Assailants can be current or former customers or clients, such as passengers, patients, students, inmates, criminal suspects or prisoners. The workers typically provide services to the public, such as municipal bus or railway drivers, health care and social service providers, teachers, sales personnel and other public or private sector service employees. Law enforcement personnel are also at risk of assault, for example, from individuals over whom they exert custodial supervision. Violence by customers or clients may occur on a daily basis in certain industries.

Type 3: Violence by coworkers:  involves verbal threats, threatening behavior or physical assaults by an assailant who has some employment-related involvement with the workplace, such as a current or former employee, supervisor or manager. Any workplace can be at risk of violence by a coworker.  In committing a threat or assault, the individual may be seeking revenge for what is perceived as unfair treatment. This type of violence accounts for a much smaller proportion of the fatal workplace injuries than violence by strangers.

Type 4: Violence by personal relations:  involves verbal threats, threatening behavior or physical assaults by an assailant who, in the workplace, confronts an individual with whom he or she has or had a personal relationship outside of work. Personal relations include a current or former spouse, lover, relative, friend or acquaintance. The assailant’s actions are motivated by perceived difficulties in the relationship or by psycho-social factors that are specific to the assailant.

Anthem and HCA have been engaged in commercial hospital contract negotiations for several months to reach agreement on reasonable reimbursement rates and contractual terms that are beneficial to both organizations. Unfortunately, to date, Anthem and HCA have been unable to reach an acceptable agreement and the commercial hospital contract may terminate effective 12:00am, March 3, 2012.

Anthem continues to negotiate in good faith with HCA in an effort to reach agreement before the expiration date.
Hospitals Affected
HCA includes the following hospitals:
Good Samaritan Hospital / Medicare ID 050380
Los Robles Regional Medical Center / Medicare ID 050549
Regional Medical Center of San Jose / Medicare ID 050125
Riverside Community Hospital / Medicare ID 050022
West Hills Hospital / Medicare ID 050481

How Members are Affected
What Anthem products are affected by this hospital termination?
This termination affects the out-of-pocket obligations for most Anthem members who are enrolled in PPO, HMO, POS, EPO, Senior Secure, Healthy Families EPO, AIM EPO, and MRMIP benefit plans and receive care at any of the HCA hospitals listed below.

Will members be notified about the contract termination?
As required by state law and regulations applicable to health care service plans licensed by the Department of Managed Health Care (DMHC), Anthem must mail letters to PPO members
enrolled in a DMHC-regulated health plan who reside within a 15-mile radius of a HCA hospital telling them about the termination.

Anthem will also mail letters to Healthy Families EPO, AIM EPO, and MRMIP members who reside within 15 miles of a HCA hospital. The letter instructs members to call the Customer Service number on their ID card if they are in a current course of treatment at one of the terminating hospitals or have questions or concerns about the contract termination.

How are Anthem HMO members affected by the HCA termination?
All non-emergency hospital services must be approved by the member’s participating medical group/IPA. If approved, Anthem will cover the claim at the member’s in-network benefit levels. If not approved by the member’s participating medical group/IPA, the claim will be denied, as stated in the members Evidence of Coverage (EOC).
Physicians, Medical Groups & Alternate Hospitals

What other participating Anthem network hospitals are available in HCA’s geographic area?
Anthem has a statewide hospital network of over 300 acute care facilities.
Find a Doctor can be used to locate a participating hospital in a specific area. The following is a partial list of alternate participating general acute care hospitals within the vicinity of each terminating HCA hospital:

Alternate Hospitals for Good Samaritan Hospital:
O’Connor Hospital, 2105 Forest Avenue, San Jose, CA 95128
El Camino Hospital, 2500 Grant Road, Mountain View, CA 94040
Santa Clara Valley Medical Center, 751 S. Bascom Avenue, San Jose, CA 95128
Stanford University Hospital, 300 Pasteur Drive, Palo Alto, CA 94305
Alternate Hospitals for Los Robles Regional Medical Center:
Providence Tarzana Medical Center, 18321 Clark Street, Tarzana, CA 91356
St. Johns Regional Medical Center, 1600 N. Rose Avenue, Oxnard, CA 93030
St. Johns Pleasant Valley Hospital, 2309 Antonio Avenue, Camarillo, CA 93010
Simi Valley Hospital, 2975 Sycamore Drive, Simi Valley, CA 93065
Alternate Hospitals for Regional Medical Center of San Jose:
El Camino Hospital, 2500 Grant Road, Mountain View, CA 94040
Santa Clara Valley Medical Center, 751 S. Bascom Avenue, San Jose, CA 95128
Washington Hospital, 2000 Mowry Avenue, Fremont, CA 94538
O’Connor Hospital, 2105 Forest Avenue, San Jose, CA 95128
Thousand Oaks Surgical Hospital, 401 Rolling Oaks Drive., Thousand Oaks, CA 91361Menlo Park Surgical Hospital, 570 Willow Road, Menlo Park, CA 94025
Alternate Hospitals for Riverside Community Hospital:
Community Hospital of San Bernardino, 1805 Medical Center Drive, San Bernardino, CA 92411
Corona Regional Medical Center, 800 S. Main Street, Corona, CA 92882
Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354
Parkview Community Hospital, 3865 Jackson Street, Riverside, CA 92503
Redlands Community Hospital, 350 Terracina Blvd., Redlands, CA 92373
St. Bernardine Medical Center, 2101 N. Waterman Avenue, San Bernardino, CA 92404
Vibra Specialty Hospital of San Bernardino, 1760 W. 16th Street, San Bernardino, CA 92411
Alternate Hospitals for West Hills Hospital:
Mission Community Hospital-Panorama Campus, 14850 Roscoe Blvd., Panorama City, CA 91402
Northridge Hospital Medical Center, 18300 Roscoe Blvd. Northridge, CA 91325
Pacifica Hospital of the Valley 9449 San Fernando Road, Sun Valley, CA 91352
Providence Holy Cross Medical Center, 15031 Rinaldi Street, Mission Hills, CA 91345
Providence Tarzana Medical Center, 18321 Clark Street, Tarzana, CA 91356
Simi Valley Hospital, 2975 Sycamore Drive, Simi Valley, CA 93065
Thousand Oaks Surgical Hospital, 401 Rolling Oaks Drive., Thousand Oaks, CA 91361
Valley Presbyterian Hospital, 15107 Vanowen Street, Van Nuys, CA 91409

Additional Member Information
How do members know if their doctor will be affected by this hospital termination?
Many doctors have admitting privileges at more than one hospital. Just because a member’s doctor may have admitting privileges at a HCA hospital does not necessarily mean that a doctor cannot still treat his or her patients at another Anthem participating hospital.
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Will Anthem Notify PPO physicians and admitting HMO medical groups about the contract termination?
On February 2, 2012, Anthem informed admitting medical groups and PPO physicians who maintain privileges/affiliations at a HCA hospital about the pending contract termination and included a list of alternate participating hospitals for them to direct Anthem members.

PPO physicians and HMO medical groups agreed in their contracts to admit members to participating Anthem hospitals to ensure that members receive the maximum benefit levels under their benefit agreement.

Will Anthem assist physicians in acquiring admitting privileges at an alternate hospital?
Anthem is ready and willing to assist our physician and medical group partners in acquiring admitting privileges at a participating hospital if necessary. In the event that a member’s physician cannot admit to an alternate hospital after a hospital contract termination, then Anthem will work with the physician or other healthcare professional to admit members to an in-network facility.

Post Termination Care
If a member is in-patient at a HCA hospital at 11:59 PM on March 2nd, 2012, the member will continue to receive uninterrupted care until he or she is discharged. In addition, the member’s in-network benefit levels
will apply for the entire in-patient stay.

Continuity of Care
California law provides for completion of covered services/continuity of care for certain medical conditions following a provider’s termination if, among other things, the provider and the plan agree on a rate of payment.

If the hospital agrees to the proposed rate, Anthem will provide completion of covered services/continuity of care in accordance with the law. Therefore, if a member began a course of treatment at a HCA hospital prior to the termination for one of the following conditions, the member or his/her physician can request continuity of care by calling Anthem’s Customer Service Department:

Members in an active course of treatment for an acute medical or behavioral health condition
Members in an active course of treatment for a serious chronic condition
Members who are pregnant, regardless of trimester
Members with a terminal illness
Members who are newborn children between the ages of birth and 36 months
Members with a surgery or other procedure that was authorized by Anthem or a delegated provider (HMO medical group) prior to the termination date and scheduled to occur within 180 days after the termination date.
Eligibility for continuity of care depends on factors outlined in the member’s EOC. Continuity of care/completion of covered-services will be considered by Anthem’s Transition Assistance Department on a case by case basis. When a case is approved, the claim(s) is/are processed at in-network benefit levels.

Please note: HMO members and physicians wishing to request continuity of care/completion of covered services would not contact Anthem because all medical management is delegated to the provider group. HMO members and physicians should contact their participating medical group.

Important: Anthem communications to PPO members enrolled in a DMHC-regulated health plan who reside within a 15-mile radius of a HCA hospital are legally required to contain the following message regarding completion of covered services/continuity of care: “If you have been receiving care from a health care provider, you may have a right to keep your provider for a designated time period. Please contact the Anthem Blue Cross customer service department, and if you have further questions, you are encouraged to contact the Department of Managed Health Care, which protects HMO/PPO consumers, by telephone at its toll-free number, 1-888-HMO-2219, or at a TDD number for the hearing impaired at 1-877-688-9891, or online at www.hmohelp.ca.gov.

This change impacts all of the commercial and individual business. Medicare Part D and state-sponsored business are not impacted.

For additional details, contact your sales representative.

I can tell you all about what makes Guardian’s approach to dental network unique. But first, I’d like you to a view this quick video that highlights how our customized recruitment strategy will ensure that your client’s network has the right dentists, at the right discounts.

1. This is a new requirement; effective immediately, employers should use the DLSE form for hiring all non-exempt employees. Employers may use their own offer letter; however it is our suggestion to use the DLSE template form. Also, add the complete at-will employment statement in writing on the form. The form is attached for your reference.

2. For employee handbooks, there are two action items; 1). We will include the new “gender expression” terminology in our EEO and anti harassment policies. 2). There is a significant change to pregnancy disability leave which requires that we update the FMLA/CFRA/PDL policy.

If your handbook was not updated in 2011, you’ll need to update to be current to January 2012. In 2011 we added breaks for nursing mothers and organ donor leave policies. Also, if you desire or require any other changes, this is a good time to do them.

3. This significant change to pregnancy-disability leave requires employers with 5 or more employees to maintain and pay for health insurance coverage for female employees who take pregnancy disability leave up to a maximum of four months. This extends the requirement for those employers subject to FMLA/CFRA from three months of medical coverage to four months.

4. There are minimum wage increases in various states effective January 1st. Rather than list them all, contact us to get the current information for your offices outside of California.

5. Employer alert! Additional penalties apply for willful misclassification of independent contractors. If you employ individuals classified as independent contractors, you should evaluate those job classifications to ensure they comply with the IRS 20 factor test. The new penalties are onerous and could harm your company financially. Call us for assistance.

Other Updates: Other items that are significant to managing employer risk but do not require immediate action.
NLRB Posting: The NLRB, National Labor Relations Board posting has been delayed until April 30, 2012. If you’ve posted the notice, it is suggested that you take it down. We will not post the NLRB notice until April 30 or until we receive notice of the final guidance.

Credit Checks: Employers may continue to do credit checks on certain types of managerial positions. If you currently conduct credit checks as part of your background process, please contact your rep at OHR for guidance and proper procedure on conducting those credit checks. This is a liability issue.

Changes Recently Passed:
Organ and Bone Marrow Donor Leave: There is additional guidance on the leave time period. Your handbook should contain an organ and bone marrow donor leave policy.

Genetic Information Act: Applies to companies with 5 or more employees. The recent change amended the Fair Employment and Housing Act to state that employers are prohibited from discriminating against employees on the basis of genetic information.

Leave Rights: New language prohibits employers from interfering with the rights of employees under the leave laws. We suggest you provide training to your managers on recognizing and managing leaves so that you can avoid any possibility of a manager inadvertently interfering with an employee’s leave rights.
Workers Compensation: There are a number of changes to workers compensation.

On the Horizon:
Sales Commission Plans: A heads up for an expected change coming in 2013. Effective next year, sales commission plans must be in writing. It’s not required today, but it’s a good idea to start putting those notifications and plans together so that you may obtain timely legal review of your sales commission plans.

Through the year, employers should complete the log 300. On February 1st, employers must post the summary only (300A). The summary reflects the activity for the prior year. Thereafter the employer must keep the log and summary for 5 years. Do not send the log or summary to OSHA.

The summary includes the number of reported cases, the number of days away from work and the types of injury/illness. Also include the establishment information. The log should be posted in a public area near the required compliance posters.