Compliance Toolkit Overview Webinar Replay: Learn About Humaculture’s CAA and Transparency Compliance Toolkit

This Compliance Toolkit Overview Webinar Replay will help you understand the Toolkit contents and how to use each aspect effectively to help meet the compliance requirements. The video addresses questions from the participants in the original webinar.

On November 11, Humaculture, Inc. released its Compliance Toolkit. Humaculture, Inc. designed the Toolkit to help you comply with Requirements Under the Consolidated Appropriations Act (“CAA”) and the New “Transparency in Coverage” Regulations. The Toolkit includes over one hundred and seventy-five (175) pages and contains over fifty-five (55) Exhibits and Attachments.

On December 14, 2021, Actuary Steve Cyboran, Wes Rogers, and Attorney Howard Lapin reviewed the contents of the Humaculture, Inc. Compliance Toolkit and explain how to use it to comply with the new requirements under the CAA and the “Transparency in Coverage” regulations.

This Webinar focuses on how to use the Compliance Toolkit, not the compliance requirements. To better understand the compliance requirements or download the presentation slides, please access our prior Blog Post.

Ordering

When you order the Compliance Toolkit, it will be provided to you in a Word file and can be easily branded for use with your clients.

How do I order? Contact us.

You can purchase the Compliance Toolkit for only $450 by responding to this email and we will invoice you for the purchase price.

The price includes quarterly updates through September 30, 2022 at no extra charge.

As soon as we receive your payment, we will send you a copy of the Compliance Toolkit.

If you would like to see a sample, please contact us and we will schedule time to review the Toolkit with you.

Questions? If you have any questions before or after ordering the Compliance Toolkit, please contact us.

Available Support

We are available to support you in your compliance and financial needs. This Compliance Toolkit, including Financial Analysis Tools will help facilitate self compliance. Our team of consultants, including actuaries, clinicians, behavioral health, pharmacy, and legal resources are also available to guide you through the compliance process, or we can take the lead. We would be happy to have a conversation regarding your needs and can customize a proposal for the level and type of support you may need.

Watch

Watch the Compliance Toolkit Webinar Replay below, or via Rumble.

Hidden Opportunities, A Strategic Compliance Series

Hidden Opportunities, Strategic Compliance Series

Please join us on the third Thursday of the month over the next five months for our upcoming strategic compliance series. This series will focus on harnessing Hidden Opportunities in the No Surprises Act and Transparency in Coverage regulations.

In this webinar series we explore ways organizations can go beyond basic compliance and improve their “organizational soil” through a strategic response to the No Surprises Act and the Transparency in Coverage regulations. Our goal is to help organizations create a competitive advantage. Does it make sense to expend limited resources to merely comply with the law and regulations, or is there a way to strategically “design the compliance away” while strategically differentiating the employee value proposition?

For example, a knowledgeable horticulturist may use the high temperatures of the summer season, which are a normal part of the environment just as law and regulation are a normal part of the business environment, to solarize the soil. This is a low cost and simple process of spreading a plastic sheet over an area of soil to trap and intensify the sun’s energy. It is a process that works well to destroy weed seeds and pathogens. Similarly, a knowledgeable Humaculturist® can employ techniques to leverage laws and regulations to strategically improve the organization. This webinar series seeks to identify some of these techniques.

The topics for the upcoming series will include:

Hidden Opportunities: No Surprises Act 
January 20, 2022 12:00-12:30 CSTSurpassing Mere Compliance – Including Reference Based Pricing
February 17, 2022 12:00-12:30 CSTPreserving the Harvest…Leveraging HSAs
Hidden Opportunities: Transparency 
March 17, 2022 12:00-12:30 CSTA “Dope” Response to Pharmacy Transparency
April 21, 2022 12:00-12:30 CSTMental Health Parity…A Lucid Approach
May 19, 2022 12:00-12:30 CSTPest Management, Minimizing Plan Losses through Fee Disclosure

To view a video on the Humaculture, Inc. Compliance Toolkit that can help support your basic compliance efforts, click here.

Available Support

We are available to support you in your strategy, design, compliance, financial, and monitoring needs. To that end, our team of consultants, including actuaries, clinicians, behavioral health, pharmacy, and legal resources are available to guide you through the compliance process. Please contact us.

Wishing you and your loved ones a joyous Christmas and an abundant New Year!

Compliance Toolkit Overview – Navigating Compliance with the Patchwork of New Transparency Laws and Regulations

View a replay of this webinar HERE.

Join us for a free 45 minute webinar on December 14, 2021 at 1:00 PM CST.

Actuary Steve Cyboran, Wes Rogers, and Attorney Howard Lapin will conduct a new free webinar to review the contents of the Compliance Toolkit and explain how to use it to comply with the new requirements under the CAA and the “Transparency in Coverage” regulations.

This Webinar focuses on how to use the Compliance Toolkit. To view the Webinar presenting details of the compliance requirements, or download the presentation slides, please access our prior Blog Post.

On November 11, Humaculture, Inc. released its Compliance Toolkit. Humaculture, Inc. designed the Toolkit to help you comply with Requirements Under the Consolidated Appropriations Act (“CAA”) and the New “Transparency in Coverage” Regulations. The Toolkit includes over one hundred and seventy-five (175) pages and contains over fifty-five (55) Exhibits and Attachments.

Consider attending this Webinar to understand the Toolkit contents and how to use each aspect effectively to help meet the compliance requirements. The Webinar will:

  • Include a question and answer period,
  • Be recorded, so you will be able to access the recording at anytime in the future, and
  • Be limited to 500 participants.

After registering, you will receive a confirmation email containing information about how to join the webinar with a link to add an appointment to your calendar.

If you have any comments or questions regarding any of the above information, please do not hesitate to Contact Us.

Compliance Toolkit Available Now – Navigating Compliance with the Patchwork of New Transparency Laws and Regulations

Compliance Toolkit First Quarterly Update

Many of the new requirements in the Consolidated Appropriations Act and the New Transparency in Coverage Regulations are effective in 2022, and some were effective earlier this year. Humaculture, Inc.’s Compliance Toolkit is designed to support your compliance needs. View a replay of our webinar overview of the Compliance Toolkit here.

Are you ready?

Do you know what to do as an Employer, Insurer, or Third-Party Administrator for group and individual health plans?

The new law and regulations require many changes to plan documents, Summary Plan Descriptions, administrative services agreements, and claim procedures. In addition, new disclosures must be provided to covered individuals and new reporting must be submitted to several governmental agencies.

If you do not comply, the penalties for noncompliance can be severe, up to $100 per day per affected individual.

Compliance Toolkit Contents

To address the situation, Attorney Howard Lapin, Actuary Steve Cyboran, and I have created a Compliance Toolkit to address all of the requirements in the new law and regulations. It contains over forty documents, including:

  • A detailed explanation of the law and regulations;
  • A compliance tool that highlights all of the required changes and what steps needed to be taken to comply;
  • Sample provisions for plan documents, Summary Plan Descriptions, and administrative services agreements;
  • All of the model notices that have to be provided to covered individuals;
  • Sample notices that have to be provided to participants; and
  • Sample disclosures and reports that have to be made to the governmental agencies.

There are over one hundred and seventy-five (175) pages of documents in this Compliance Toolkit. It has been specially designed for use by employers, insurers, brokers, and third-party administrator to help them effectively to comply with all of the requirements.

Notice: All items contained in the Compliance Toolkit comply with our current understanding of the requirements of the Consolidated Appropriations Act and the New Transparency in Coverage Regulations. The Sample Language, Model Language, Sample Reports, explanations, etc. have been prepared before all guidance has been released by the various governmental agencies. If any changes are required after any guidance is released, the Compliance Toolkit will be amended to reflect any changes (quarterly through September 30, 2022 at no additional cost). In addition, you are advised to seek legal counsel in the use of this Compliance Toolkit.

Webinar Reviewing the Compliance Toolkit

On December 14 at 1:00 pm we conduced a free webinar to review the Compliance Toolkit. We reviewed its contents and explained how it can be used to comply with the requirements. You can view the webinar here. Don’t miss it!

Ordering

When you order the Compliance Toolkit, it will be provided to you in a Word file and can be easily branded for use with your clients.

How do I order? Contact us.

You can purchase the Compliance Toolkit for only $450 by responding to this email and we will invoice you for the purchase price.

The price includes quarterly updates through October 31, 2022 at no extra charge.

As soon as we receive your payment, we will send you a copy of the Compliance Toolkit.

If you would like to see a sample, please contact us and we will schedule time to review the Toolkit with you.

Questions? If you have any questions before or after ordering the Compliance Toolkit, please contact us.

Available Support

We are available to support you in your compliance and financial needs. This Compliance Toolkit, including Financial Analysis Tools will help facilitate self compliance. Our team of consultants, including actuaries, clinicians, behavioral health, pharmacy, and legal resources are also available to guide you through the compliance process, or we can take the lead. We would be happy to have a conversation regarding your needs and can customize a proposal for the level and type of support you may need. Please contact us.

Steve Cyboran Brings Humaculture® Perspective on Data Driven Results

Steve Cyboran on a Panel to Discuss Data Driven Results

Steve Cyboran brings the Humaculture® Perspective to a panel discussion on Data Driven Results for HR Professionals. Join Steve on October 21, 2021 at the Junior League for the Houston Compensation & Benefits Luncheon.

When:

October 21, 2021
11:30 AM CDT – 1:15 PM CDT
Add to Calendar

Where:

Junior League of Houston
1811 Briar Oaks Lane
Houston, TX 77027

Register: Here

Transparency Webinar Replay: Big Changes Coming! How to Comply with the Consolidated Appropriations Act (CAA) and Transparency in Coverage Rules!

View the Transparency Webinar Replay: Navigating compliance with the patchwork of new transparency laws and regulations

A replay of and presentation deck for our July 20 Webinar is now available. This webinar addresses several new laws and regulations that significantly impact group health plans and individual insurance coverage. The Consolidated Appropriations Act (CAA), signed into law December 27, 2020, contained the No Surprises Act (NSA) and rules for the additional analysis required for Mental Health Parity (MHP). In addition, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Agencies) issued final “Transparency in Coverage” regulations requiring certain disclosures for group health plans and individual insurance.

Compliance Responsibility for Penalties

The following table summarizes the CAA, NSA, MHP, and Transparency in Coverage rules, including the responsible party, applicability, who will enforce the law or rules, and which party is subject to penalties. As of this date, there are still several uncertainties which we expect to be resolved as more guidance is made available by the DOL, HHS, and Treasury. We are working with the CMS oversight group to determine if, or how, these rules may, or may not, apply to self-funded student health plans.

Insured Group HealthSelf-Funded Group HealthIndividual/Insured
Student Health
Self-funded Student Health
No Surprises Act
Responsible PartyUncertainEmployerUncertainUncertain
ApplicabilityYesYesYesUncertain
EnforcementState, then HHSHHS, DOL, IRSState, then HHSUncertain
Subject to PenaltiesUncertainEmployerUncertainUncertain
Transparency
Responsible PartyUncertainEmployerUncertainUncertain
ApplicabilityYes, except Grandfathered PlansYes, except Grandfathered PlansYesUncertain
EnforcementHHS, DOL, IRSHHS, DOL, IRSState, then HHSUncertain
Subject to PenaltiesUncertainEmployerUncertainUncertain
Mental Health Parity
Responsible PartyInsurerEmployerInsurerMEC Plan Sponsor
ApplicabilityYesYesYesMaybe
EnforcementState, then HHSHHS, DOL, IRSState, then HHSState, perhaps
Subject to PenaltiesUncertainEmployerUncertainUncertain
Fee Disclosure
Responsible PartyService Provider1Service Provider1InsurerUncertain
ApplicabilityERISA PlansERISA PlansYesUncertain
EnforcementDOLDOLHHSUncertain
Subject to PenaltiesService Provider1Service Provider1UncertainUncertain
1Service provider for fee disclosure includes brokers, consultants, administrators, but not insurers or pharmacy benefit managers (PBMs).

Why is transparency compliance important?

For group health plans, the penalty for non-compliance will be up to $100 per participant per day. For a group of 1,000 affected participants, the penalty could be about $36 million over the course of one year of non-compliance.

Available Support

We developed a Compliance Toolkit to facilitate self compliance, which is now available. Watch a replay of an overview webinar of the Compliance Toolkit. Our team of consultants, including actuaries, clinicians, behavioral health, pharmacy, and legal resources are also available to guide you through the compliance process, or we can take the lead. Please contact us.

Mental Health Transparency Implications

Mental health and substance abuse disorders (MH/SUD) are a big issue as a result of the COVID-19 response, economic shut down, and social isolation resulting from the transition to virtual work and education. As a result, we have seen significant increases in depression, where rates of depression tripled, substance abuse, and opioid use, in particular, where related deaths are were up 80% in 2020 to 90k, expanding on over 40 years of exponential increases in mortality.

With the passage of the CAA transparency rules, health plans are immediately required to conduct a detailed Comparative Analysis of both financial and non-financial treatment limitations if an Agency or plan participant requests the analysis, report, and supporting documentation. The Agencies are ramping up staff to focus on compliance.

In addition to complying with MHP, we also recommend developing a plan to mitigate the behavioral health issues in your organization. Compliance alone will not likely address the impact on your employees. An effective approach will require a more sustainable approach focusing on a purposeful culture, a healthy culture, and cultural alignment of all reward and benefit programs.

The webinar addresses these topics in much greater detail.

Humaculture, Inc. Sponsors Misericordia Fundraiser

Misericordia Fundraiser: Creating organizations that allow people with various special needs to realize their potential and thrive is a key aspect of the Humaculture® philosophy and approach.

Creating organizations that allow people with various special needs to realize their potential and thrive is a key aspect of the Humaculture® philosophy and approach. As such, we are proud to announce that Humaculture, Inc. sponsored the “Marshalls for Misericordia Golf Outing”. Misericordia is located in Chicago, Illinois. It is home to over 600 individuals with a broad range mental and physical disabilities. The annual “Marshalls for Misericordia Golf Outing” raises funds to benefit Misericordia Home. You can learn more about Misericordia at https://www.misericordia.com/.

Free Webinar: New Transparency Rule/No Surprises Act

View the Transparency Webinar Replay: Navigating compliance with the patchwork of new transparency laws and regulations

This webinar can now be accessed from Here.

Our Humaculture, Inc. approach to partnering with the best and brightest continues to grow and produce successes for our clients and partners alike.

As part of our continued efforts to bring to you the best resources, we want to make you aware of a free webinar on July 20, 2021 at 1:00 PM CDT.

Please register Here for the webinar.

The Consolidated Appropriations Act and the “Transparency in Coverage” regulations are potential game changers, affecting how health plans set prices for services, negotiate provider contracts and pay for out-of-network emergency care, report information and provide disclosures to participants.

These substantial new requirements will be effective for plan years beginning on or after 2022.

Steve Cyboran, Chief Behavioral Officer and Actuary, and Wes Rogers, Chief Guidance Officer, at Humaculture, Inc., will join attorneys Howard Lapin and Larry Grudzien to conduct a new free webinar reviewing the requirements for the Consolidated Appropriation Act and the “Transparency in Coverage” regulations on July 20 at 1 PM CDT.

The Webinar will be 90 minutes in length, and will cover a lot of detail and answer questions like:

Preventing Surprise Billing:

  • What new requirements will be imposed to prevent surprise billing?

General Transparency:

  • What new requirements must be added to insurer and TPA contracts to meet the new transparency requirements?
  • What new EOBs must be provided to participants before any scheduled care?
  • What new services must be provided to a “continuing care patient”?
  • What new price comparison guidance must to be provided by phone or Plan website to participants?
  • What new advanced explanation of benefits must be provided to participants if requested for scheduled services?
  • What new provider directories must be provided and how often must they be updated?
  • What new disclosures must be made to the plan for broker, TPA and other vendor fees?

Mental Health Parity Transparency:

  • What detailed comparative analysis must be provide to governmental agencies if the plan provides both medical/surgical benefits and mental health/substance abuse benefits?

Reporting:

  • What new reporting must be made to governmental agencies on drug prices?

Transparency in Coverage:

  • What information must a health plan publicly report on negotiated in-network and out-of-network amounts?
  • What information must health plans provide to participants on cost sharing?

We will also provide suggested steps to comply with these new reporting and disclosure requirements.

To mitigate technical issues, we are limiting the registration for this webinar to 500.

This Webinar will include a question and answer period.

A copy of the slides will be provided for all who register. After registering, you will receive a confirmation email containing information about joining the webinar.

View System Requirements

If you have any comments or questions regarding any of the above information, please do not hesitate to contact us.

Employee Benefits – The Humaculture® Perspective

Photos above: Just as different plants thrive in different soils, different people also thrive in different organizations. Aloe vera thrives in thin, rocky, dry soil. Similarly, there are also certain organizations that employ people who may primarily have access to benefits through a spouse or parent and don’t require rich benefits. Other organizations may need moderate benefits (like drip irrigation on grapes) designed and structured to nurture them to thrive properly. Still other organizations may require benefits designed to protect and nourish employees, much like lettuce requires mulch and abundant moisture.

Did any person, or any organization, ever become great by striving to be average? Many business leaders instinctively look at what every other organization in their particular industry is doing, then defensively adopt benefits that make their organization “competitive” with their peers. But, does this approach really make an organization distinctive and magnetic to talented people who will lead to success? Is it really a good idea to attract employees who are concerned primarily about benefits?

Understanding the Nature of the Organization – Vision, Mission, and Strategy

The horticulturist understands that different plants, different production goals, and different climates require soils to be built in specific and intentional ways. Each planting bed is designed with climate, soil texture and drainage, fertility, pH, and other factors in mind based on the types of plants and crops desired. So, the successful horticulturist begins with a vision and mission, then develops a strategy based on the vision and mission while considering climate and available resources. While other inputs may be required (irrigation, support, row covers or other protection), the soil is the key. Without well designed soil one can typically expect mediocre results at best. The most successful gardens “feed the soil, not the plant.” A well-chosen plant in well-designed and prepared soil will naturally thrive and produce the desired fruit.

To be successful and highly effective, organizational leaders must take a similar approach. Each organization has different goals, different purposes, and operates in different business, social and legal environments. All of these factors will have tremendous impact on how the organization is able to attract, engage, grow, retain, sustain, and transition employees or other people who will in some way be a part of, and grow, in the organizational “soil.” Many leaders have at least some idea of their organization’s vision and mission, even if only informally. They also know they need the “right” employees to carry out the strategy to accomplish the vision and mission, so much so that the focus becomes “feeding the plant, not the soil.” But failing to understand the importance of building a good organizational “soil” substantially reduces the effectiveness of recruiting, compensation, benefits, well-being initiatives, engagement, safety, and any other perk or program directed at employees.

Pitfalls of the “We Offer Excellent Benefits” Approach

One large health system sought to have only the “very best” benefits, desiring to be viewed as cutting edge to potential employees and to motivate current employees, which is popular among progressive and innovative organizations. The health system combined the Paid Time Off (PTO) benefits for 7 recently integrated entities by adopting a richest benefit approach. This put the new, larger system above the 75th percentile of its peers. However, the workforce plan and job designs did not allow employees to effectively use those benefits, which led to a lot of frustration and inequitable use. It’s a little like over fertilizing plants, they may be “burned” by the excessive fertilizer. The intent of PTO is to recharge and re-energize people so they can better perform in their job. In this case, the employees felt resentment over a benefit they couldn’t readily access and still meet the patient and business needs of their jobs. There must be an appropriate balance between no time off and full time off. It is important that the PTO be designed for optimal performance. The strategic workforce plan and jobs should then be designed for the level of time off provided (e.g., preparing organizational “soil” to allow the employees to use the PTO benefit to help them thrive).

Similar scenarios are repeated in many organizations, especially as organizations look to benefits and other benchmark surveys to guide their benefit choices. So often, organizations implement or modify benefits programs based on benchmark studies, then struggle with high benefits costs and look for the latest “cost containment” measures, programs, or services. For example, a large utility maintained a traditional sick leave program to remain “competitive” with its industry peers. The 100% pay replacement led to over-utilization, excessive costs, scheduling challenges, and increased time to manage employee relations issues related to absence. It simply became much harder to manage and was not attracting and retaining the employees who would best thrive and contribute to continue to build the organizational “soil.” Yes, “everyone else” was doing it but the choice to be average led to high costs and failed to make this organization distinctive and magnetic to the employees who could best produce the intended “fruit” and nourish the “soil”.

How We Design Benefits from a Humaculture™ Perspective

Humaculture™ recognizes that the organization itself is the key to a thriving, engaged, and contributing workforce that leads to success. Benchmarks are good against which to test designs and cost levels to assure they are distinctive and magnetic, but the designs should first support the vision and mission of the organization. While many advisors may suggest, for example, a healthcare organization should provide rich health care benefits, the Humaculture™ approach would view it a little differently. Humaculture™ would focus on the vision to model healthier behaviors, understand the consumer choices their patients are making, and differentiate the type of talent that may choose their organization (e.g., make the benefits less rich for those who aren’t willing to engage in healthier behaviors).

Such a design would support the organization’s effort to attract, engage, grow, retain, sustain, and transition employees who will buy-in to the vision and mission, be fruitful, and contribute to the tilth of the organizational “soil.” Well-designed soil requires fewer inputs of fertilizer, pesticides, water, etc. to successfully produce a crop. Likewise, well-designed organizations, including benefits and compensation that are aligned to support the vision and mission of the organization, will have much lower costs and achieve greater results than those organizations who “burn” the employees with rich or misaligned benefits. For example, one health plan had a copay for emergency room (ER) visit but applied the deductible and coinsurance for office visits. After switching the design to copays for office visits and increasing the ER copay, ER utilization dropped by 20% and non-emergent ER costs dropped by 99%. Overall, the broader behavioral redesign rolled back the cost levels 3 years of double digit increases without increasing plan participant costs.

So, what steps should be taken to design and implement benefits that support the organizational vision and mission, as well as reduce costs and support employees who thrive? How should you begin to develop an effective Humaculture™?

  1. Either develop or formalize and articulate the Organization’s vision, mission, and strategic priorities.
  2. Consider and design benefits that support the vision, mission, and strategic priorities.
  3. Optimize benefit design by applying principles of behavioral economics and choice architecture.
  4. Develop metrics that will provide actionable insights into the performance of the benefit designs.
  5. Evaluate benefit effectiveness relative to vision, mission, and strategic priorities and performance.
  6. Modify designs accordingly and continue to measure and evaluate.

Applying these Humaculture™ principles will move your organization toward providing fertile “soil” for employees, reduce benefit costs (even before “cost management” techniques or services are used), and contribute to a much more productive and profitable organization. Please see our real world applications of this approach and the outcomes achieved with time off, health care, and financial well-being benefits. Take the Humaculture™ Benefits Assessment to conduct a high level analysis of how you are doing.

About Humaculture, Inc.
Humaculture, Inc. transforms organizations—the way organizational leaders understand the organization and the relationships among the people in it, and the way people think about their position and role in the organization. Humaculture™ is a philosophy and systematic approach for creating profitable, aligned, and healthy organizations conceptualized as “soil” in which people can thrive. Humaculture™ helps organizations create the right culture in order to naturally attract, engage, retain, sustain, grow, and transition people who enable the business—and each other—to thrive. More information can be found at: Humaculture.co. Learn more about our team at https://humaculture.co/who-are-we/.

Authors:
Wes Rogers, Chief Guidance Officer for Humaculture, Inc. Wes has almost 35 years’ experience in consulting and senior management positions with a variety of organizations, facilitating groups of people with diverse perspectives and objectives to coalesce around a singular vision and marshal resources to achieve the vision. This experience provides exceptional insights into how organizations operate and succeed.  Contact Wes at [email protected].

Steve Cyboran, ASA, MAAA, FCA, CEBS, Chief Behavioral Officer, Consulting Actuary for Humaculture, Inc. Over the past 30 years, Steve has worked extensively with leading corporations, higher education institutions, and health systems across the country to articulate a vision for a healthy and effective workplace culture, develop a total rewards strategy to support that vision and brings deep benefits expertise with a behavioral approach and sound analytics to achieve and measure the desired outcomes. Contact Steve at [email protected].