Friday, December 23, 2011
More Changes in Medicaid Allowances
In Missouri the personal needs allowance has been increased from $30.00 a month to $35.00. Though only a slight increase, this change affects many seniors in our area.
New Bill to Grant Coma Rights in Missouri
A new bill in the Missouri House of Representatives is set to finally allow family members to make decisions for relatives in a coma. Missouri is one of the few states without these laws in place. This could mean big changes for health care providers and personal health care directives. Below is a copy of the bill.
HOUSE BILL NO. 1087
93RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVES SCHAAF (Sponsor), TILLEY, MOORE, SMITH (118),
WHORTON, FISHER, PAGE, THRELKELD AND COOPER (155) (Co-sponsors).
Pre-filed December 8, 2005 and copies ordered printed.
STEPHEN S. DAVIS, Chief Clerk
3749L.01I
AN ACT
To repeal sections 383.035, 383.079, 383.105, 383.160, and 383.165, RSMo, and to enact in lieu
thereof seventeen new sections relating to insurance for health care providers in
Missouri.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Sections 383.035, 383.079, 383.105, 383.160, and 383.165, RSMo, are
2 repealed and seventeen new sections enacted in lieu thereof, to be known as sections 383.035,
3 383.079, 383.105, 383.111, 383.160, 383.165, 383.300, 383.302, 383.304, 383.306, 383.308,
4 383.310, 383.312, 383.314, 383.316, 383.330, and 383.335, to read as follows:
383.035. 1. Any association licensed pursuant to the provisions of sections 383.010 to
2 383.040 shall be subject to the provisions of the following provisions of the revised statutes of
3 Missouri:
4 (1) Sections 374.010, 374.040, 374.046, 374.110, 374.115, 374.122, 374.170, 374.210,
5 374.215, 374.216, 374.230, 374.240, 374.250 and 374.280, RSMo, relating to the general
6 authority of the director of the department of insurance;
7 (2) Sections 375.022, 375.031, 375.033, 375.035, 375.037 and 375.039, RSMo, relating
8 to dealings with licensed agents and brokers;
9 (3) Sections 375.041 and 379.105, RSMo, relating to annual statements;
10 (4) Section 375.163, RSMo, relating to the competence of managing officers;
H.B. 1087 2
11 (5) Section 375.246, RSMo, relating to reinsurance requirements, except that no
12 association shall be required to maintain reinsurance, and for insurance issued to members who
13 joined the association on or before January 1, 1993, an association shall be allowed credit, as an
14 asset or as a deduction from liability, for reinsurance which is payable to the ceding association's
15 insured by the assuming insurer on the basis of the liability of the ceding association under
16 contracts reinsured without diminution because of the insolvency of the ceding association;
17 (6) Section 375.390, RSMo, relating to the use of funds by officers for private gain;
18 (7) Section 375.445, RSMo, relating to insurers operating fraudulently;
19 (8) Section 379.080, RSMo, relating to permissible investments, except that limitations
20 in such section shall apply only to assets equal to such positive surplus as is actually maintained
21 by the association;
22 (9) Section 379.102, RSMo, relating to the maintenance of unearned premium and loss
23 reserves as liabilities, except that any such loss reserves may be discounted in accordance with
24 reasonable actuarial assumptions;
25 (10) Sections 383.100 to 383.111 relating to reports from medical malpractice
26 insurers;
27 (11) Sections 383.300 to 383.316 relating to notification, data reporting, and rating
28 requirements.
29 2. [Any association which was licensed pursuant to the provisions of sections 383.010
30 to 383.040 on or before January 1, 1992, shall be allowed until December 31, 1995, to comply
31 with the provisions of this section as they relate to investments, reserves and reinsurance.
32 3.] Any association licensed pursuant to the provisions of sections 383.010 to 383.040
33 shall file with its annual statement a certification by a fellow or an associate of the Casualty
34 Actuarial Society. Such certification shall conform to the National Association of Insurance
35 Commissioners annual statement instructions unless otherwise provided by the director of the
36 department of insurance.
37 [4.] 3. The director of the department of insurance shall have authority in accordance
38 with section 374.045, RSMo, to make all reasonable rules and regulations to accomplish the
39 purpose of sections 383.010 to 383.040, including the extent to which insurance provided by an
40 association may be extended to provide payment to a covered person resulting from a specific
41 illness possessed by such covered person; except that no rule or regulation may place limitations
42 or restrictions on the amount of premium an association may write or on the amount of insurance
43 or limit of liability an association may provide.
44 [5.] 4. Other than as provided in this section, no other insurance law of the state of
45 Missouri shall apply to an association licensed pursuant to the provisions of this chapter, unless
46 such law shall expressly state it is applicable to such associations.
H.B. 1087 3
47 [6.] 5. If[, after August 28, 1992, and] after its second full calendar year of operation, any
48 association licensed under the provisions of sections 383.010 to 383.040 shall file an annual
49 statement which shows a surplus as regards policyholders of less than zero dollars, or if the
50 director of the department of insurance has other conclusive and credible evidence more recent
51 than the last annual statement indicating the surplus as regards policyholders of an association
52 is less than zero dollars, the director of the department of insurance may order such association
53 to submit, within ninety days following such order, a voluntary plan under which the association
54 will restore its surplus as regards policyholders to at least zero dollars. The director of the
55 department of insurance may monitor the performance of the association's plan and may order
56 modifications thereto, including assessments or rate or premium increases, if the association fails
57 to meet any targets proposed in such plan for three consecutive quarters.
58 [7.] 6. If the director of the department of insurance issues an order in accordance with
59 subsection [6] 5 of this section, the association may, in accordance with chapter 536, RSMo, file
60 a petition for review of such order. Any association subject to an order issued in accordance with
61 subsection [6] 5 of this section shall be allowed a period of three years, or such longer period as
62 the director may allow, to accomplish its plan to restore its surplus as regards policyholders to
63 at least zero dollars. If at the end of the authorized period of time the association has failed to
64 restore its surplus to at least zero dollars, or if the director of the department of insurance has
65 ordered modifications of the voluntary plan and the association's surplus has failed to increase
66 within three consecutive quarters after such modification, the director of the department of
67 insurance may allow an additional time for the implementation of the voluntary plan or may
68 exercise his powers to take charge of the association as he would a mutual casualty company
69 pursuant to sections 375.1150 to 375.1246, RSMo. Sections 375.1150 to 375.1246, RSMo, shall
70 apply to associations licensed pursuant to sections 383.010 to 383.040 only after the conditions
71 set forth in this section are met. When the surplus as regards policyholders of an association
72 subject to subsection [6] 5 of this section has been restored to at least zero dollars, the authority
73 and jurisdiction of the director of the department of insurance under subsections 5 and 6 [and
74 7]of this section shall terminate, but this subsection may again thereafter apply to such
75 association if the conditions set forth in subsection [6] 5 of this section for its application are
76 again satisfied.
77 [8.] 7. Any association licensed pursuant to the provisions of sections 383.010 to
78 383.040 shall place on file with the director of the department of insurance, except as to excess
79 liability risks which by general custom are not written according to manual rates or rating plans,
80 a copy of every manual of classifications, rules, underwriting rules and rates, every rating plan
81 and every modification of the foregoing which it uses. Filing with the director of the department
82 of insurance within ten days after such manuals, rating plans or modifications thereof are
H.B. 1087 4
83 effective shall be sufficient compliance with this subsection. [Any rates, rating plans, rules,
84 classifications or systems in effect or in use by an association on August 28, 1992, may continue
85 to be used by the association.] Upon written application of a member of an association, stating
86 his reasons therefor, filed with the association, a rate in excess of that provided by a filing
87 otherwise applicable may be used by the association for that member.
383.079. The director shall compile a statistical summary of all data submitted and shall
2 issue a public report to the Missouri Bar and the supreme court of the state of Missouri.
3 Beginning not later than December 31, 2006, and annually thereafter, the director shall
4 report to the general assembly an accurate report as to the actual rates charged for
5 malpractice insurance and any changes in those rates from the previous year.
383.105. 1. Every insurer providing medical malpractice insurance to a Missouri health
2 care provider and every health care provider who maintains professional liability coverage
3 through a plan of self-insurance shall submit to the director of the department of insurance a
4 report of all claims, both open claims filed during the reporting period and closed claims filed
5 during the reporting period, for medical malpractice made against any of its Missouri insureds
6 during the preceding three-month period.
7 2. The report shall be in writing and contain the following information:
8 (1) Name and address of the insured and the person working for the insured who
9 rendered the service which gave rise to the claim, if the two are different;
10 (2) Specialty coverage of the insured;
11 (3) Insured's policy number;
12 (4) Nature and substance of the claim;
13 (5) Date and place in which the claim arose;
14 (6) Name, address and age of the claimant or plaintiff;
15 (7) Within six months after final disposition of the claim, the amounts paid, if any, and
16 the date and manner of disposition (judgment, settlement or otherwise);
17 (8) Expenses incurred; and
18 (9) Such additional information as the director may require.
19 3. As used in this section, "insurer" includes every insurance company authorized to
20 transact insurance business in this state, every unauthorized insurance company transacting
21 business pursuant to chapter 384, RSMo, every risk retention group, every insurance company
22 issuing insurance to or through a purchasing group, every entity operating under this chapter,
23 and any other person providing insurance coverage in this state[. With respect to any insurer
24 transacting business pursuant to chapter 384, RSMo, filing the report required by this section
25 shall be the obligation of the surplus lines broker or licensee originating or accepting the
26 insurance], including self-insured health care providers.
H.B. 1087 5
383.111. 1. Any insurer, as defined in section 383.105, that fails to timely report
2 claims information as required by sections 383.100 to 383.125 shall be subject to the
3 penalties applicable to insurance companies under section 374.215, RSMo.
4 2. For purposes of sections 383.100 to 383.125, any guarantee association paying
5 claims on behalf of an insolvent insurer shall be subject to the same reporting requirements
6 as the insolvent insurer.
383.160. 1. All association policies of insurance shall be written so as to apply to injury
2 which results from acts or omissions occurring during the policy period. No policy form shall
3 be used by the association unless it has been filed with the director and approved [or thirty days
4 have elapsed and he has not delivered to the board written disapproval of it as misleading or not
5 in the public interest]. The director shall have the power to disapprove any policy form
6 previously approved if found by him after hearing to be misleading or not in the public interest.
7 2. Cancellation of the association's policies shall be governed by law.
8 3. The rates, rating plans, rating rules, rating classifications and territories applicable to
9 the insurance written by the association and statistics relating thereto shall be subject to the
10 casualty rate regulation law giving due consideration to the past and prospective loss and expense
11 experience in medical malpractice insurance of all of the insurers, trends in the frequency and
12 severity of losses, the investment income of the association, and such other information as the
13 director may require. All rates shall be actuarially sound and shall be calculated to be
14 self-supporting.
15 4. In the event sufficient funds are not available for the sound financial operation of the
16 association, additional funds shall be raised by making an assessment on all member companies.
17 Assessments shall be made against members in the proportion that the net direct premiums for
18 the preceding calendar year of each member for each line of insurance requiring it to participate
19 in said plan bear to the net direct premiums for the preceding calendar year of all members for
20 such line of insurance; provided that, assessments made pursuant to sections 383.150 to 383.195
21 shall not exceed in any calendar year one percent of each member's net direct premiums
22 attributable to the line or lines of insurance the writing of which requires it to be a member.
23 5. All members shall deduct the amount of any assessment from past or future premium
24 taxes due but not yet paid the state.
25 6. Any funds which result from policyholder premiums and other revenues received in
26 excess of those funds required for reserves, loss payments and expenses incurred and accrued
27 at the end of any calendar year shall be paid proportionately to the general fund to the extent that
28 credit against premium tax liability has been granted pursuant to subsection 5 of this section and
29 to members which have been assessed but have not received tax credits as provided in subsection
30 5 of this section.
H.B. 1087 6
383.165. Each policyholder shall pay to the association in the first policy year, in
2 addition to the premium payment due for insurance through the association, an amount equal to
3 said premium payment. Such charge shall be separately stated in the policy. Such charge shall
4 be paid in the form of cash or cash equivalent and not in the form of a promissory note.
383.300. 1. As used in sections 383.300 to 383.316, the term "insurer" or "insurers"
2 means any insurance company, mutual insurance company, medical malpractice
3 association, any entity created under this chapter, or other entity providing any insurance
4 to any health care provider, as defined in section 538.205, RSMo, practicing medicine in
5 the state of Missouri, against claims for malpractice or professional negligence; provided,
6 however, that the term "insurer" or "insurers" shall not mean any surplus lines insurer
7 operating under chapter 384, RSMo, or any entity to the extent it is self-insuring its
8 exposure to medical malpractice liability.
9 2. Notwithstanding any other provision of law, no insurer shall, with regards to
10 medical malpractice insurance, as defined in section 383.150:
11 (1) Charge an assessment or surcharge, or increase the premium charges, by more
12 than ten percent for such insurance without first providing written notice by United States
13 mail to the insured at least sixty days prior to the effective date of such actions; provided,
14 however, such notice is not required if the premium change is due to the request of the
15 insured;
16 (2) Fail or refuse to renew such insurance without first providing written notice by
17 United States mail to the insured at least sixty days prior to the effective date of such
18 actions, unless such failure or refusal to renew is based upon a failure to pay sums due or
19 a termination or suspension of the health care provider's license to practice medicine in the
20 state of Missouri, termination of the insurer's reinsurance program, or a material change
21 in the nature of the insured's health care practice; or
22 (3) Cease the issuance of such policies of insurance in the state of Missouri without
23 first providing written notice by United States mail to the insured and to the Missouri
24 department of insurance at least one hundred eighty days prior to the effective date of such
25 actions.
26 3. Any insurer that fails to provide the notice required under subdivisions (1) and
27 (2) of subsection 2 of this section shall, at the option of the insured, continue the coverage
28 in accordance with the provisions of subdivision (2) of subsection 6 of section 379.321,
29 RSMo.
383.302. The department of insurance shall, prior to October 1, 2006, establish
2 health care provider classification codes and risk-reporting categories for medical
3 malpractice insurance premiums, as defined in section 383.150, and shall establish
H.B. 1087 7
regulations for the reporting of all premiums 4 charged by such categories and/or codes. The
5 department of insurance shall consider the available history or prior court judgments for
6 claims under this chapter, in each county and any city not within a county in this state and
7 the current risk categories in use by insurers in establishing the risk reporting categories.
383.304. All insurers shall, with regards to medical malpractice insurance as
2 defined in section 383.150, provide to the department of insurance, beginning on January
3 1, 2007, and not less than annually thereafter, an accurate report as to the actual rates,
4 including assessments levied against members, excluding members whose practice is part5
time, charged by such company for such insurance, for each of the risk-reporting
6 categories and/or codes established in section 383.302.
383.306. Not later than June 1, 2007, and at least annually thereafter, the
2 department of insurance shall, utilizing the information provided under section 383.304
3 establish and publish, a market rate reflecting the median of the actual rates charged for
4 each of the risk-reporting categories for the preceding year by all insurers.
383.308. For purposes of sections 383.308 to 383.316, the following terms mean:
2 (1) "Base rate", the premium rate designed to reflect the average aggregate
3 experience of a particular health care provider classification prior to adjustment for
4 individual risk characteristics;
5 (2) "Schedule rating or individual risk rating credits or debits", rating factors or
6 adjustments applied to an insurer's base rates to increase or decrease the premium of an
7 individual insured or unit or exposure to adjust the base rate to account for individual risk
8 characteristics not reflected in the base rate.
383.310. 1. The department of insurance shall establish reporting standards for
2 insurers by which the insurers shall report their base rates and schedule of rating or
3 individual risk rating credits or debits for the health care provider classifications and/or
4 codes designated by the department, in whatever categories the department determines to
5 be actuarially appropriate.
6 2. The department shall collect the information required in subsection 1 of this
7 section and shall create a database to be made available to the public that compares the
8 base rates and schedule of rating or individual risk rating credits or debits charged by each
9 insurer actively writing a particular health care provider classification code. Such
10 database may distinguish between base rates for different types of coverage.
383.312. 1. The department of insurance shall establish reporting standards for
2 insurers by which the insurers, or an advisory organization designated by the department,
3 shall annually report such Missouri medical malpractice insurance actual premium, actual
4 premium deviation from the base rate, loss, exposure, and other information as the
H.B. 1087 8
department may require for the purpose 5 of compiling a Missouri medical malpractice
6 ratemaking database. The reports shall be in a format determined by the department.
7 Such information shall be considered confidential information and shall be a closed record
8 under chapter 610, RSMo.
9 2. The department shall collect the information required in subsection 1 of this
10 section and compile it in a manner appropriate for assisting Missouri medical malpractice
11 insurers in developing their future base rates, schedule rating or individual risk rating
12 factors, and other aspects of their rating plans. In compiling the information and making
13 it available to Missouri insurers and the public, the department shall remove any
14 individualized information that identifies a particular insurer or provider as the source or
15 subject of the information. The department may combine such information with similar
16 information obtained through insurer examinations so as to cover periods of more than one
17 year.
383.314. After August 28, 2006, when evaluating the base rates of any medical
2 malpractice insurer, including any insurer newly admitted to write medical malpractice
3 insurance in Missouri or any insurer entering such line, in order to determine whether
4 such rates are excessive, inadequate, or unfairly discriminatory, the director of insurance
5 shall, in addition to any other methods of evaluation, use the base rates collected under
6 section 383.310 as a basis for comparison.
383.316. 1. If the director finds that any insurer or filing organization has violated
2 any provision of sections 383.300 to 383.316, the director may impose a penalty of not more
3 than five hundred dollars for each violation, but if the director finds the violation to be
4 willful, the director may impose a penalty of not more than five thousand dollars for each
5 violation. Such penalties may be in addition to any other penalty provided by law.
6 2. The director may suspend the license of any rating organization or insurer that
7 fails to comply with an order of the director relating to sections 383.300 to 383.316 within
8 the time limited by such order, or any extension thereof which the director may grant. The
9 director shall not suspend the license of any rating organization or insurer for failure to
10 comply with an order until the time prescribed for an appeal therefrom has expired or if
11 an appeal has been taken, until the order has been affirmed. The director may determine
12 when a suspension of license shall become effective and it shall remain in effect for a period
13 fixed by the director, unless the director modifies or rescinds such suspension or until the
14 order upon which such suspension is based is modified, rescinded, or reversed.
15 3. No penalty shall be imposed or no license shall be suspended or revoked except
16 upon a written order of the director, stating the director's findings, made after a hearing
H.B. 1087 9
held upon not less than ten days' written notice 17 to such person or organization specifying
18 the alleged violation.
383.330. The department of insurance shall promulgate rules defining the term
2 "claim" as it applies to claims made for medical malpractice. Any rule or portion of a rule,
3 as that term is defined in section 536.010, RSMo, that is created under the authority
4 delegated in this section shall become effective only if it complies with and is subject to all
5 of the provisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. This
6 section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the
7 general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date, or
8 to disapprove and annul a rule are subsequently held unconstitutional, then the grant of
9 rulemaking authority and any rule proposed or adopted after August 28, 2006, shall be
10 invalid and void.
383.335. By January 1, 2011, all insurers writing medical malpractice insurance in
2 this state shall offer medical malpractice policies of insurance which are written so as to
3 apply to injury which results from acts or omissions occurring during the policy period,
4 regardless of the timing of the filing of a claim based on such acts and omissions.
HOUSE BILL NO. 1087
93RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVES SCHAAF (Sponsor), TILLEY, MOORE, SMITH (118),
WHORTON, FISHER, PAGE, THRELKELD AND COOPER (155) (Co-sponsors).
Pre-filed December 8, 2005 and copies ordered printed.
STEPHEN S. DAVIS, Chief Clerk
3749L.01I
AN ACT
To repeal sections 383.035, 383.079, 383.105, 383.160, and 383.165, RSMo, and to enact in lieu
thereof seventeen new sections relating to insurance for health care providers in
Missouri.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Sections 383.035, 383.079, 383.105, 383.160, and 383.165, RSMo, are
2 repealed and seventeen new sections enacted in lieu thereof, to be known as sections 383.035,
3 383.079, 383.105, 383.111, 383.160, 383.165, 383.300, 383.302, 383.304, 383.306, 383.308,
4 383.310, 383.312, 383.314, 383.316, 383.330, and 383.335, to read as follows:
383.035. 1. Any association licensed pursuant to the provisions of sections 383.010 to
2 383.040 shall be subject to the provisions of the following provisions of the revised statutes of
3 Missouri:
4 (1) Sections 374.010, 374.040, 374.046, 374.110, 374.115, 374.122, 374.170, 374.210,
5 374.215, 374.216, 374.230, 374.240, 374.250 and 374.280, RSMo, relating to the general
6 authority of the director of the department of insurance;
7 (2) Sections 375.022, 375.031, 375.033, 375.035, 375.037 and 375.039, RSMo, relating
8 to dealings with licensed agents and brokers;
9 (3) Sections 375.041 and 379.105, RSMo, relating to annual statements;
10 (4) Section 375.163, RSMo, relating to the competence of managing officers;
H.B. 1087 2
11 (5) Section 375.246, RSMo, relating to reinsurance requirements, except that no
12 association shall be required to maintain reinsurance, and for insurance issued to members who
13 joined the association on or before January 1, 1993, an association shall be allowed credit, as an
14 asset or as a deduction from liability, for reinsurance which is payable to the ceding association's
15 insured by the assuming insurer on the basis of the liability of the ceding association under
16 contracts reinsured without diminution because of the insolvency of the ceding association;
17 (6) Section 375.390, RSMo, relating to the use of funds by officers for private gain;
18 (7) Section 375.445, RSMo, relating to insurers operating fraudulently;
19 (8) Section 379.080, RSMo, relating to permissible investments, except that limitations
20 in such section shall apply only to assets equal to such positive surplus as is actually maintained
21 by the association;
22 (9) Section 379.102, RSMo, relating to the maintenance of unearned premium and loss
23 reserves as liabilities, except that any such loss reserves may be discounted in accordance with
24 reasonable actuarial assumptions;
25 (10) Sections 383.100 to 383.111 relating to reports from medical malpractice
26 insurers;
27 (11) Sections 383.300 to 383.316 relating to notification, data reporting, and rating
28 requirements.
29 2. [Any association which was licensed pursuant to the provisions of sections 383.010
30 to 383.040 on or before January 1, 1992, shall be allowed until December 31, 1995, to comply
31 with the provisions of this section as they relate to investments, reserves and reinsurance.
32 3.] Any association licensed pursuant to the provisions of sections 383.010 to 383.040
33 shall file with its annual statement a certification by a fellow or an associate of the Casualty
34 Actuarial Society. Such certification shall conform to the National Association of Insurance
35 Commissioners annual statement instructions unless otherwise provided by the director of the
36 department of insurance.
37 [4.] 3. The director of the department of insurance shall have authority in accordance
38 with section 374.045, RSMo, to make all reasonable rules and regulations to accomplish the
39 purpose of sections 383.010 to 383.040, including the extent to which insurance provided by an
40 association may be extended to provide payment to a covered person resulting from a specific
41 illness possessed by such covered person; except that no rule or regulation may place limitations
42 or restrictions on the amount of premium an association may write or on the amount of insurance
43 or limit of liability an association may provide.
44 [5.] 4. Other than as provided in this section, no other insurance law of the state of
45 Missouri shall apply to an association licensed pursuant to the provisions of this chapter, unless
46 such law shall expressly state it is applicable to such associations.
H.B. 1087 3
47 [6.] 5. If[, after August 28, 1992, and] after its second full calendar year of operation, any
48 association licensed under the provisions of sections 383.010 to 383.040 shall file an annual
49 statement which shows a surplus as regards policyholders of less than zero dollars, or if the
50 director of the department of insurance has other conclusive and credible evidence more recent
51 than the last annual statement indicating the surplus as regards policyholders of an association
52 is less than zero dollars, the director of the department of insurance may order such association
53 to submit, within ninety days following such order, a voluntary plan under which the association
54 will restore its surplus as regards policyholders to at least zero dollars. The director of the
55 department of insurance may monitor the performance of the association's plan and may order
56 modifications thereto, including assessments or rate or premium increases, if the association fails
57 to meet any targets proposed in such plan for three consecutive quarters.
58 [7.] 6. If the director of the department of insurance issues an order in accordance with
59 subsection [6] 5 of this section, the association may, in accordance with chapter 536, RSMo, file
60 a petition for review of such order. Any association subject to an order issued in accordance with
61 subsection [6] 5 of this section shall be allowed a period of three years, or such longer period as
62 the director may allow, to accomplish its plan to restore its surplus as regards policyholders to
63 at least zero dollars. If at the end of the authorized period of time the association has failed to
64 restore its surplus to at least zero dollars, or if the director of the department of insurance has
65 ordered modifications of the voluntary plan and the association's surplus has failed to increase
66 within three consecutive quarters after such modification, the director of the department of
67 insurance may allow an additional time for the implementation of the voluntary plan or may
68 exercise his powers to take charge of the association as he would a mutual casualty company
69 pursuant to sections 375.1150 to 375.1246, RSMo. Sections 375.1150 to 375.1246, RSMo, shall
70 apply to associations licensed pursuant to sections 383.010 to 383.040 only after the conditions
71 set forth in this section are met. When the surplus as regards policyholders of an association
72 subject to subsection [6] 5 of this section has been restored to at least zero dollars, the authority
73 and jurisdiction of the director of the department of insurance under subsections 5 and 6 [and
74 7]of this section shall terminate, but this subsection may again thereafter apply to such
75 association if the conditions set forth in subsection [6] 5 of this section for its application are
76 again satisfied.
77 [8.] 7. Any association licensed pursuant to the provisions of sections 383.010 to
78 383.040 shall place on file with the director of the department of insurance, except as to excess
79 liability risks which by general custom are not written according to manual rates or rating plans,
80 a copy of every manual of classifications, rules, underwriting rules and rates, every rating plan
81 and every modification of the foregoing which it uses. Filing with the director of the department
82 of insurance within ten days after such manuals, rating plans or modifications thereof are
H.B. 1087 4
83 effective shall be sufficient compliance with this subsection. [Any rates, rating plans, rules,
84 classifications or systems in effect or in use by an association on August 28, 1992, may continue
85 to be used by the association.] Upon written application of a member of an association, stating
86 his reasons therefor, filed with the association, a rate in excess of that provided by a filing
87 otherwise applicable may be used by the association for that member.
383.079. The director shall compile a statistical summary of all data submitted and shall
2 issue a public report to the Missouri Bar and the supreme court of the state of Missouri.
3 Beginning not later than December 31, 2006, and annually thereafter, the director shall
4 report to the general assembly an accurate report as to the actual rates charged for
5 malpractice insurance and any changes in those rates from the previous year.
383.105. 1. Every insurer providing medical malpractice insurance to a Missouri health
2 care provider and every health care provider who maintains professional liability coverage
3 through a plan of self-insurance shall submit to the director of the department of insurance a
4 report of all claims, both open claims filed during the reporting period and closed claims filed
5 during the reporting period, for medical malpractice made against any of its Missouri insureds
6 during the preceding three-month period.
7 2. The report shall be in writing and contain the following information:
8 (1) Name and address of the insured and the person working for the insured who
9 rendered the service which gave rise to the claim, if the two are different;
10 (2) Specialty coverage of the insured;
11 (3) Insured's policy number;
12 (4) Nature and substance of the claim;
13 (5) Date and place in which the claim arose;
14 (6) Name, address and age of the claimant or plaintiff;
15 (7) Within six months after final disposition of the claim, the amounts paid, if any, and
16 the date and manner of disposition (judgment, settlement or otherwise);
17 (8) Expenses incurred; and
18 (9) Such additional information as the director may require.
19 3. As used in this section, "insurer" includes every insurance company authorized to
20 transact insurance business in this state, every unauthorized insurance company transacting
21 business pursuant to chapter 384, RSMo, every risk retention group, every insurance company
22 issuing insurance to or through a purchasing group, every entity operating under this chapter,
23 and any other person providing insurance coverage in this state[. With respect to any insurer
24 transacting business pursuant to chapter 384, RSMo, filing the report required by this section
25 shall be the obligation of the surplus lines broker or licensee originating or accepting the
26 insurance], including self-insured health care providers.
H.B. 1087 5
383.111. 1. Any insurer, as defined in section 383.105, that fails to timely report
2 claims information as required by sections 383.100 to 383.125 shall be subject to the
3 penalties applicable to insurance companies under section 374.215, RSMo.
4 2. For purposes of sections 383.100 to 383.125, any guarantee association paying
5 claims on behalf of an insolvent insurer shall be subject to the same reporting requirements
6 as the insolvent insurer.
383.160. 1. All association policies of insurance shall be written so as to apply to injury
2 which results from acts or omissions occurring during the policy period. No policy form shall
3 be used by the association unless it has been filed with the director and approved [or thirty days
4 have elapsed and he has not delivered to the board written disapproval of it as misleading or not
5 in the public interest]. The director shall have the power to disapprove any policy form
6 previously approved if found by him after hearing to be misleading or not in the public interest.
7 2. Cancellation of the association's policies shall be governed by law.
8 3. The rates, rating plans, rating rules, rating classifications and territories applicable to
9 the insurance written by the association and statistics relating thereto shall be subject to the
10 casualty rate regulation law giving due consideration to the past and prospective loss and expense
11 experience in medical malpractice insurance of all of the insurers, trends in the frequency and
12 severity of losses, the investment income of the association, and such other information as the
13 director may require. All rates shall be actuarially sound and shall be calculated to be
14 self-supporting.
15 4. In the event sufficient funds are not available for the sound financial operation of the
16 association, additional funds shall be raised by making an assessment on all member companies.
17 Assessments shall be made against members in the proportion that the net direct premiums for
18 the preceding calendar year of each member for each line of insurance requiring it to participate
19 in said plan bear to the net direct premiums for the preceding calendar year of all members for
20 such line of insurance; provided that, assessments made pursuant to sections 383.150 to 383.195
21 shall not exceed in any calendar year one percent of each member's net direct premiums
22 attributable to the line or lines of insurance the writing of which requires it to be a member.
23 5. All members shall deduct the amount of any assessment from past or future premium
24 taxes due but not yet paid the state.
25 6. Any funds which result from policyholder premiums and other revenues received in
26 excess of those funds required for reserves, loss payments and expenses incurred and accrued
27 at the end of any calendar year shall be paid proportionately to the general fund to the extent that
28 credit against premium tax liability has been granted pursuant to subsection 5 of this section and
29 to members which have been assessed but have not received tax credits as provided in subsection
30 5 of this section.
H.B. 1087 6
383.165. Each policyholder shall pay to the association in the first policy year, in
2 addition to the premium payment due for insurance through the association, an amount equal to
3 said premium payment. Such charge shall be separately stated in the policy. Such charge shall
4 be paid in the form of cash or cash equivalent and not in the form of a promissory note.
383.300. 1. As used in sections 383.300 to 383.316, the term "insurer" or "insurers"
2 means any insurance company, mutual insurance company, medical malpractice
3 association, any entity created under this chapter, or other entity providing any insurance
4 to any health care provider, as defined in section 538.205, RSMo, practicing medicine in
5 the state of Missouri, against claims for malpractice or professional negligence; provided,
6 however, that the term "insurer" or "insurers" shall not mean any surplus lines insurer
7 operating under chapter 384, RSMo, or any entity to the extent it is self-insuring its
8 exposure to medical malpractice liability.
9 2. Notwithstanding any other provision of law, no insurer shall, with regards to
10 medical malpractice insurance, as defined in section 383.150:
11 (1) Charge an assessment or surcharge, or increase the premium charges, by more
12 than ten percent for such insurance without first providing written notice by United States
13 mail to the insured at least sixty days prior to the effective date of such actions; provided,
14 however, such notice is not required if the premium change is due to the request of the
15 insured;
16 (2) Fail or refuse to renew such insurance without first providing written notice by
17 United States mail to the insured at least sixty days prior to the effective date of such
18 actions, unless such failure or refusal to renew is based upon a failure to pay sums due or
19 a termination or suspension of the health care provider's license to practice medicine in the
20 state of Missouri, termination of the insurer's reinsurance program, or a material change
21 in the nature of the insured's health care practice; or
22 (3) Cease the issuance of such policies of insurance in the state of Missouri without
23 first providing written notice by United States mail to the insured and to the Missouri
24 department of insurance at least one hundred eighty days prior to the effective date of such
25 actions.
26 3. Any insurer that fails to provide the notice required under subdivisions (1) and
27 (2) of subsection 2 of this section shall, at the option of the insured, continue the coverage
28 in accordance with the provisions of subdivision (2) of subsection 6 of section 379.321,
29 RSMo.
383.302. The department of insurance shall, prior to October 1, 2006, establish
2 health care provider classification codes and risk-reporting categories for medical
3 malpractice insurance premiums, as defined in section 383.150, and shall establish
H.B. 1087 7
regulations for the reporting of all premiums 4 charged by such categories and/or codes. The
5 department of insurance shall consider the available history or prior court judgments for
6 claims under this chapter, in each county and any city not within a county in this state and
7 the current risk categories in use by insurers in establishing the risk reporting categories.
383.304. All insurers shall, with regards to medical malpractice insurance as
2 defined in section 383.150, provide to the department of insurance, beginning on January
3 1, 2007, and not less than annually thereafter, an accurate report as to the actual rates,
4 including assessments levied against members, excluding members whose practice is part5
time, charged by such company for such insurance, for each of the risk-reporting
6 categories and/or codes established in section 383.302.
383.306. Not later than June 1, 2007, and at least annually thereafter, the
2 department of insurance shall, utilizing the information provided under section 383.304
3 establish and publish, a market rate reflecting the median of the actual rates charged for
4 each of the risk-reporting categories for the preceding year by all insurers.
383.308. For purposes of sections 383.308 to 383.316, the following terms mean:
2 (1) "Base rate", the premium rate designed to reflect the average aggregate
3 experience of a particular health care provider classification prior to adjustment for
4 individual risk characteristics;
5 (2) "Schedule rating or individual risk rating credits or debits", rating factors or
6 adjustments applied to an insurer's base rates to increase or decrease the premium of an
7 individual insured or unit or exposure to adjust the base rate to account for individual risk
8 characteristics not reflected in the base rate.
383.310. 1. The department of insurance shall establish reporting standards for
2 insurers by which the insurers shall report their base rates and schedule of rating or
3 individual risk rating credits or debits for the health care provider classifications and/or
4 codes designated by the department, in whatever categories the department determines to
5 be actuarially appropriate.
6 2. The department shall collect the information required in subsection 1 of this
7 section and shall create a database to be made available to the public that compares the
8 base rates and schedule of rating or individual risk rating credits or debits charged by each
9 insurer actively writing a particular health care provider classification code. Such
10 database may distinguish between base rates for different types of coverage.
383.312. 1. The department of insurance shall establish reporting standards for
2 insurers by which the insurers, or an advisory organization designated by the department,
3 shall annually report such Missouri medical malpractice insurance actual premium, actual
4 premium deviation from the base rate, loss, exposure, and other information as the
H.B. 1087 8
department may require for the purpose 5 of compiling a Missouri medical malpractice
6 ratemaking database. The reports shall be in a format determined by the department.
7 Such information shall be considered confidential information and shall be a closed record
8 under chapter 610, RSMo.
9 2. The department shall collect the information required in subsection 1 of this
10 section and compile it in a manner appropriate for assisting Missouri medical malpractice
11 insurers in developing their future base rates, schedule rating or individual risk rating
12 factors, and other aspects of their rating plans. In compiling the information and making
13 it available to Missouri insurers and the public, the department shall remove any
14 individualized information that identifies a particular insurer or provider as the source or
15 subject of the information. The department may combine such information with similar
16 information obtained through insurer examinations so as to cover periods of more than one
17 year.
383.314. After August 28, 2006, when evaluating the base rates of any medical
2 malpractice insurer, including any insurer newly admitted to write medical malpractice
3 insurance in Missouri or any insurer entering such line, in order to determine whether
4 such rates are excessive, inadequate, or unfairly discriminatory, the director of insurance
5 shall, in addition to any other methods of evaluation, use the base rates collected under
6 section 383.310 as a basis for comparison.
383.316. 1. If the director finds that any insurer or filing organization has violated
2 any provision of sections 383.300 to 383.316, the director may impose a penalty of not more
3 than five hundred dollars for each violation, but if the director finds the violation to be
4 willful, the director may impose a penalty of not more than five thousand dollars for each
5 violation. Such penalties may be in addition to any other penalty provided by law.
6 2. The director may suspend the license of any rating organization or insurer that
7 fails to comply with an order of the director relating to sections 383.300 to 383.316 within
8 the time limited by such order, or any extension thereof which the director may grant. The
9 director shall not suspend the license of any rating organization or insurer for failure to
10 comply with an order until the time prescribed for an appeal therefrom has expired or if
11 an appeal has been taken, until the order has been affirmed. The director may determine
12 when a suspension of license shall become effective and it shall remain in effect for a period
13 fixed by the director, unless the director modifies or rescinds such suspension or until the
14 order upon which such suspension is based is modified, rescinded, or reversed.
15 3. No penalty shall be imposed or no license shall be suspended or revoked except
16 upon a written order of the director, stating the director's findings, made after a hearing
H.B. 1087 9
held upon not less than ten days' written notice 17 to such person or organization specifying
18 the alleged violation.
383.330. The department of insurance shall promulgate rules defining the term
2 "claim" as it applies to claims made for medical malpractice. Any rule or portion of a rule,
3 as that term is defined in section 536.010, RSMo, that is created under the authority
4 delegated in this section shall become effective only if it complies with and is subject to all
5 of the provisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. This
6 section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the
7 general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date, or
8 to disapprove and annul a rule are subsequently held unconstitutional, then the grant of
9 rulemaking authority and any rule proposed or adopted after August 28, 2006, shall be
10 invalid and void.
383.335. By January 1, 2011, all insurers writing medical malpractice insurance in
2 this state shall offer medical malpractice policies of insurance which are written so as to
3 apply to injury which results from acts or omissions occurring during the policy period,
4 regardless of the timing of the filing of a claim based on such acts and omissions.
Tuesday, December 20, 2011
Maintenance Manual Revisions
The Family Support Division announced Income Maintenance manual revisions based upon Social Security, Supplemental Security Income, CMS, and Railroad Retirement 2012 COLA's in IM # 72, dated 12/9/2011 to be effective January 1, 2012.
The Division will be doing mass system changes based on these Federally-derived numbers. Of course our penalty-divisor number that we must use in Missouri has not been announced yet (supposed to be based upon the semi-private room average cost of the cost of skilled nursing home care). Also some numbers are announced at other times such as July 1 of each year for the minimum monthly maintenance needs allowance and April 1 of each year for the Medical Assistance income limit (for non-vendor MO HealthNet).
Here is a summary of some of the changes (please look at the IM yourself for a complete report) found at http://www.dss.mo.gov/fsd/iman/memos_11/im72_11.html:
SSI single $698 (up from $674); couple $1,048 (up from $1,011).
Maximum Monthly Needs Allowance to Community Spouse, $2841 (up from $2,739) --Minimum Monthly Needs Allowance remains unchanged at $1,839 until July 1.
Minimum Community Spouse Resource Allowance, $22,728 (up from $$21,960); Maximum Community Spouse Resource Allowance, $113,640 (up from $109.560).
Maximum Home Equity (for single person), $525,000 (up from $505,000).
Home and Community Based Waiver Standard, $1,220 (up from $1,178).
Medicare Part B minimum premium, $99.90 (up from $96.40, and down for those who became eligible in 2009 and had to pay $110.50 and down for those who became Medicare eligible in 2010 and had to pay $115.40 when no COLA's were given to those receiving Social Security benefits--please note that higher income earners may have higher Medicare Part B premiums).
The Division will be doing mass system changes based on these Federally-derived numbers. Of course our penalty-divisor number that we must use in Missouri has not been announced yet (supposed to be based upon the semi-private room average cost of the cost of skilled nursing home care). Also some numbers are announced at other times such as July 1 of each year for the minimum monthly maintenance needs allowance and April 1 of each year for the Medical Assistance income limit (for non-vendor MO HealthNet).
Here is a summary of some of the changes (please look at the IM yourself for a complete report) found at http://www.dss.mo.gov/fsd/iman/memos_11/im72_11.html:
SSI single $698 (up from $674); couple $1,048 (up from $1,011).
Maximum Monthly Needs Allowance to Community Spouse, $2841 (up from $2,739) --Minimum Monthly Needs Allowance remains unchanged at $1,839 until July 1.
Minimum Community Spouse Resource Allowance, $22,728 (up from $$21,960); Maximum Community Spouse Resource Allowance, $113,640 (up from $109.560).
Maximum Home Equity (for single person), $525,000 (up from $505,000).
Home and Community Based Waiver Standard, $1,220 (up from $1,178).
Medicare Part B minimum premium, $99.90 (up from $96.40, and down for those who became eligible in 2009 and had to pay $110.50 and down for those who became Medicare eligible in 2010 and had to pay $115.40 when no COLA's were given to those receiving Social Security benefits--please note that higher income earners may have higher Medicare Part B premiums).
Monday, December 19, 2011
Occupational therapists launch new guidelines to help stop elder abuse before it starts
Canadian Association of Occupational Therapists /PRNewswire/ - The Canadian Association of Occupational Therapists (CAOT) is pleased to have officially launched "Strategies for occupational therapists to address elder abuse/mistreatment, " a resource tool developed for occupational therapists that will build health human resource capacity to address and manage elder abuse.
The project was made possible through funding from Human Resources and Skills Development Canada (HRSDC), who recognized the vital role occupational therapists play in managing elder abuse."
Occupational therapists are in a unique position to detect and manage elder abuse due to the strong working relationship they develop with an older adult through having an intimate knowledge of their daily life and routines," said Rosemary Lester, Chair of the Elder Abuse Committee of Newfoundland and Labrador and External Member of the CAOT Board of Directors. "This tool will support this relationship and be an important resource in the ongoing effort to combat elder abuse."
The resource tool provides a set of guidelines that strive to assist occupational therapists across Canada in understanding what to look for (indicators), first steps to follow when suspecting abuse (e.g. What do I ask? Look for?), and strategies for discussing the situation with the older adult.
The Minister of State for Seniors, the Honourable Alice Wong attended the event in support of the new documents and the positive impact occupational therapists have on managing and working to prevent elder abuse."
Our government is committed to support the well-being of seniors," said Minister Wong. "Elder abuse should be everyone's concern and that is why our government is ensuring that Canadians are aware of the issue and can take the necessary preventative action or seek support.
"This year the Government of Canada awarded nearly $567,000 to the National Initiative for the Care of the Elderly, to develop tools to measure elder abuse, which could support the development of strategies for prevention, detection and treatment. This initiative in addition to the release of the guidelines provides an optimistic future for seniors.
Strategies for occupational therapists to address elder abuse/mistreatment is available for download off the CAOT website by all practicing occupational therapists across Canada.
www.caot.ca/elderabuseCanadian Association of Occupational Therapists Canadian Association of Occupational Therapists - Strategies for Dealing with Elder Abuse SOURCE Canadian Association of Occupational Therapists
Read more here: http://www.bradenton.com/2011/11/23/v-print/3675497/occupational-therapists-launch.html#storylink=cpy
The project was made possible through funding from Human Resources and Skills Development Canada (HRSDC), who recognized the vital role occupational therapists play in managing elder abuse."
Occupational therapists are in a unique position to detect and manage elder abuse due to the strong working relationship they develop with an older adult through having an intimate knowledge of their daily life and routines," said Rosemary Lester, Chair of the Elder Abuse Committee of Newfoundland and Labrador and External Member of the CAOT Board of Directors. "This tool will support this relationship and be an important resource in the ongoing effort to combat elder abuse."
The resource tool provides a set of guidelines that strive to assist occupational therapists across Canada in understanding what to look for (indicators), first steps to follow when suspecting abuse (e.g. What do I ask? Look for?), and strategies for discussing the situation with the older adult.
The Minister of State for Seniors, the Honourable Alice Wong attended the event in support of the new documents and the positive impact occupational therapists have on managing and working to prevent elder abuse."
Our government is committed to support the well-being of seniors," said Minister Wong. "Elder abuse should be everyone's concern and that is why our government is ensuring that Canadians are aware of the issue and can take the necessary preventative action or seek support.
"This year the Government of Canada awarded nearly $567,000 to the National Initiative for the Care of the Elderly, to develop tools to measure elder abuse, which could support the development of strategies for prevention, detection and treatment. This initiative in addition to the release of the guidelines provides an optimistic future for seniors.
Strategies for occupational therapists to address elder abuse/mistreatment is available for download off the CAOT website by all practicing occupational therapists across Canada.
www.caot.ca/elderabuseCanadian Association of Occupational Therapists Canadian Association of Occupational Therapists - Strategies for Dealing with Elder Abuse SOURCE Canadian Association of Occupational Therapists
Read more here: http://www.bradenton.com/2011/11/23/v-print/3675497/occupational-therapists-launch.html#storylink=cpy
Monday, December 12, 2011
Elder Substance Abuse
(Co-authored with Kimberly A. Williams)
Gladys became a drug addict at the age of 82 when the pain of arthritis got to be too much for her and she became dependent on opiates to get through the day and to sleep at night.
Frank became a dangerous, problem drinker at 66 after he retired from his job as a maintenance man in a local school. Every day he drove to a bar where he hung out with a few buddies and drank a few too many beers before he drove home.
Samuel grew up during the era of drugs, sex and rock and roll. Throughout his adult life, he smoked marijuana after work without problems at work or at home. After he retired at 65 he smoked more often and getting high began to interfere with the life he had hoped for when he retired.
For most of her adult life, Joan had had two or three glasses of wine with dinner. In her mid-60s her physical tolerance for alcohol diminished. She drank no more than usual, but by the second glass she began to slur her words and to find it hard to think clearly. She frequently fell asleep right after dinner.
These are just a few of the faces of substance abuse or misuse among older adults. They are not the images that ordinarily come to mind when we think of substance abuse, and this is a major reason why these problems often go undetected in elders. Of course, there are older adults who are alcoholics and/or addicted to illegal drugs such as heroin, but fewer and fewer as people age, in part because so many people addicted to alcohol or drugs die prematurely and in part because some survivors turn their lives around.
For older adults, drinking too much and misusing medications are the major substance use problems, affecting as many as 20 percent of them (1). They are particularly vulnerable to the mental and physical effects of alcohol and drugs because of physiological and cognitive changes that take place with age. And, even if they are not addicted to alcohol or illegal substances, they are at risk for serious problems including:
- Adverse drug reactions, including fatal overdoses,
- Accidents -- including falls and traffic accidents,
- Exacerbation of health problems,
- Social isolation,
- Sleep disturbances,
- Inactivity,
- Loss of cognitive capacity and
- Suicide -- which is more likely among older adults than any other age group.
In general, substance abuse and misuse vastly limit the potential to live well in old age.
During the elder boom there will be tremendous growth of the number of older adults with substance use problems, in part because of the growth of the population of older adults, but also because baby boomers use substances -- including illegal substances -- much more commonly than their parents' generation.
For example, a study done by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) projects the growth of people 60 or over who need substance abuse treatment from about 700,000 in 2000 to about 2,300,000 in 2020 (2). Recent surveys (3) confirm that this is already happening, with marked growth of the use of marijuana.
In addition, the CDC recently released a report projecting a vast increase in addiction to prescription painkillers and in deaths due to overdoses, which already kill more Americans than heroin and cocaine combined (4).
Will you, a member of your family, or a close friend be among the older adults with serious substance use problems? Here are a few signs that should cause concern (5).
- Getting unusually high without an increase in use
- Use of alcohol or drugs to sleep and then finding it difficult to get going in the morning
- Reliance on opiates to manage pain in doses that exceed a doctor's prescription
- Going from doctor to doctor to get additional prescriptions
- Using over-the-counter drugs in amounts or in combinations of medicines that are not recommended
- Cognitive or memory impairments, difficulty concentrating, or confusion
- Slurred speech
- Increased isolation
- Difficulty participating in ordinary activities
- Weight loss and/or poor nutrition
- Increased fatigue and/or weakness
- Poor personal hygiene
- Unusual restlessness or agitation
- Persistent irritability or altered mood
- Balance problems and/or frequent falls
These symptoms can, of course, have causes other than substance abuse or misuse, but if a person is using alcohol or other drugs and has these symptoms, substance use may be a major cause.
You may be able to recognize substance use problems in yourself or a friend or family member. You may be able to cut back or help someone to cut back. But many people need professional help. Talk frankly with your physician. If you don't know where to turn for help, call 1-800-273-TALK. This is the National Suicide Prevention Lifeline, and it can connect you with mental health or substance abuse services near your home.
Michael B. Friedman and Kimberly Williams are the co-founders of the Geriatric Mental Health Alliance. He is now retired except for teaching at Columbia University. She is the Director of The Center for Policy, Advocacy and Education of the Mental Health Association of NYC.
(1) Blow, F. "Baby Boomers, Mental Health, and Aging: New Challenges and Opportunities." Keynote address to the Geriatric Mental Health Alliance Annual Conference, May 2011. http://www.mha-nyc.org/media/9736/fred%20blow%20keynote%20presentation%20[compatibility%20mode].pdf
(2) Gfroerer, J. et al. "Substance Abuse Treatment Need Among Older Adults in 2020: The Impact of the Baby Boom Generation" in Drug and Alcohol Dependence, 2003.http://johnstrogerhospital.org/cru/images/education/519cd99e959493c0c6ad6bf40b928794.pdf
(3)Substance Abuse and Mental Health and Services Administration. "Illicit Drug Use Among Older Adults." National Survey on Drug Use and Health, 2011.http://oas.samhsa.gov/2k11/013/WEB_SR_013_HTML.pdf
(4) Center for Disease Control. "Prescription Painkiller Overdoses At Epidemic Levels: Kill More Americans Than Heroin and Cocaine Combined." Press Release, November 1, 2011.http://www.cdc.gov/mmwr/pdf/wk/mm6043.pdf.
(5) Blow, F. "Substance Abuse Among Older Adults." SAMHSA TIP 26, 1998http://www.ncbi.nlm.nih.gov/books/NBK14467/?report=printable
Sunday, December 4, 2011
The Ups and Downs of Medicare Part B Premiums: Frequently Asked Questions
What will the Medicare Part B standard monthly premium be for 2012?
The U.S. Department of Health and Human Services (HHS) recently announced that the standard monthly Medicare Part B premium for 2012 will be $99.90. This premium is paid by, or on behalf of, beneficiaries who are enrolled in the Supplementary Medical Insurance part of the Medicare program (Part B), which covers physician and other outpatient services. The standard Part B premium amount is calculated to cover 25 percent of annual Part B spending, although higher‐income enrollees pay a greater share of costs, ranging from 35 percent to 80 percent, depending on their income. Medicare Part B premiums are typically deducted from most beneficiaries’ Social Security payments.1
The 2012 standard Part B premium amount represents a $15.50 decrease from the 2011 standard amount of $115.40 (and $6.70 less than actuaries had projected for 2012 earlier this year). According to HHS, the decrease in Part B premiums is due to the Social Security cost‐of‐living adjustment (COLA) that Part B enrollees will receive in 2012, and to lower‐than‐expected Part B spending in 2011. The 3.6 percent COLA for Social Security recipients in 2012 is the first COLA since 2009, following two years of no cost‐of‐living increase, which affected the Medicare Part B premium amount in 2010 and 2011, as explained below. Moreover, the COLA increase for 2012 is larger than was previously projected in the 2011 Social Security Trustees report.
How does the Social Security COLA affect the Medicare Part B premium?
In a year where the Social Security COLA is insufficient to cover the amount of the Medicare Part B premium increase for an individual, the law prohibits an increase in the Part B premium that would otherwise result in a reduction in that individual’s monthly Social Security payments. This is known as the “hold‐harmless” provision. In 2010 and 2011, with no Social Security COLA, the hold‐harmless provision prevented the majority of Medicare beneficiaries from paying any increase in Part B premiums. Thus, in both 2010 and 2011, the majority of Medicare beneficiaries paid monthly premiums of $96.40, which was the standard Part B premium amount in 2009.2
Roughly one‐quarter of all Part B enrollees were not held harmless in 2010 and 2011, including new Medicare enrollees (3 percent); higher‐income beneficiaries (5 percent); and Medicare beneficiaries who do not have their Part B premium deducted from their Social Security benefit payment (19 percent) – this group consists mainly of beneficiaries dually eligible for Medicare and Medicaid, for whom Medicaid pays the monthly Part B premium (17 percent).3 These beneficiaries were subject to a higher Part B premium than those who were protected by the hold‐harmless provision to ensure that Part B enrollee premium contributions continued to cover 25 percent of program costs. The standard monthly premium for these beneficiaries was $110.50 in 2010 and $115.40 in 2011.
With an increase in the Social Security COLA scheduled for 2012, fewer beneficiaries will be affected by the hold‐ harmless provision, and the beneficiary portion of annual Part B expenditures will be spread across a greater share of Part B enrollees than in 2010 and 2011. This results in a monthly Part B premium of $99.90 in 2012 – an increase for the majority of beneficiaries who have been protected by the hold‐harmless provision in 2010 and 2011 who were paying $96.40, and a decrease for all others who were paying the standard amount in both years – including states, which pay the standard premium amounts on behalf of dual eligibles.
How will Part B premiums change for Medicare beneficiaries who were protected by the
hold‐harmless provision for both 2010 and 2011?
For Medicare beneficiaries who have been protected by the hold‐harmless provision since 2009, the Part B premium will increase by $3.50, or 3.6 percent, from $96.40 to $99.90. Some of these beneficiaries – generally those with a relatively low Social Security benefit payment – might experience another year of being held harmless from the Part B premium increase if the dollar amount by which their Social Security payment increases is less than the increase in the Part B premium.
1 Or from Railroad Retirement payments, if applicable. Certain individuals are exempt from this requirement, including beneficiaries enrolled in both Medicare and Medicaid (“dual eligibles”). See Section 1840 of the Social Security Act. 2 For more details on the relationship between the Social Security COLA and the Medicare Part B premium, see “The Social Security COLA and Medicare Part B Premium: Questions, Answers, and Issues,” Kaiser Family Foundation, December 2010.
3 Centers for Medicare & Medicaid Services, “Medicare Premiums, Deductibles for 2011,” November 4, 2011.KAMILY F
How will Part B premiums change for Medicare beneficiaries who were not protected by the
hold‐harmless provision in 2010 and/or 2011?
The monthly Medicare Part B premium for those who have been paying the 2011 standard Part B premium (i.e., not protected by the hold‐harmless provision this year) will decrease by $15.50 per month, from $115.40 to $99.90 (a 13.4 percent decrease). For those who have been paying the 2010 standard Part B premium (e.g., beneficiaries who enrolled in Medicare in 2010), the monthly Part B premium will decrease by $10.60 per month, from $110.50 to $99.90 (a 9.6 percent decrease).
How will Part B premiums change for higher‐income Medicare beneficiaries?
Approximately 5 percent of Part B enrollees pay the income‐related Part B premium. Beneficiaries are required to pay the higher Part B premium if their income is equal to or greater than $85,000 for an individual and $170,000 for a couple. For 2011, the income‐related Part B premium amounts range from $154.70 to $353.60, based on income. For 2012, these amounts will range from $139.90 to $319.70, a decrease of 13.4 percent – the same percentage decrease at each level as for the standard Part B premium amount.
How does the Medicare Part B premium amount affect state Medicaid spending for dual
eligibles?
Medicaid spending is also directly affected by changes in the Part B premium because Medicaid pays premiums on behalf of the roughly 9 million Medicare beneficiaries who are also covered by Medicaid, known as “dual eligibles.” Therefore, changes in the Medicare Part B premium contribute to changes in state Medicaid spending on dual eligibles. The majority of those who were not held harmless from higher Part B premiums in 2010 and 2011 are low‐income beneficiaries dually eligible for both Medicare and Medicaid, for whom the states are responsible for paying Part B premiums.
This publication (#7912-04) is available on the Kaiser Family Foundation’s website at www.kff.org. ThE hEnRy J. KaISER FamIly FoUndaTIon
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