MCN and the Changing Face of Health Care Reform

PPACA

The Patient Protection and Affordable Care Act (PPACA) is a federal statute signed into law in on March 23, 2010. The law includes numerous health-related provisions to take effect over a four-year period, including prohibiting denial of coverage/claims based on pre-existing conditions, expanding Medicaid eligibility, subsidizing insurance premiums, providing incentives for businesses to provide health care benefits, establishing health insurance exchanges, and providing support for medical research.

The PPACA addresses the external review process through which denial of a claim/coverage is appealed. MCN, as an Independent Review Organization (IRO), provides Utilization Reviews (Internal and External Appeal Reviews).

FMLA

The Family and Medical Leave Act (FMLA) is a federal law with mandates on paid and unpaid leave, job-protection status, and the provision of group health benefits to those on leave, with special requirements for military family leave. The U.S. Department of Labor (DOL) has issued detailed regulations interpreting the FMLA.

The FMLA provides challenges for human resource administrators when determining the ability of an employee to return to the workplace in their current or a different position. Working with MCN is an efficient, cost-effective way for employers to ensure compliance with the law. By ordering appropriate medical assessments, administrators are assured of compliance federal regulations and are ensured that each case meets proper medical criteria on an evidence basis.

ERISA

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for retirement and health benefit plans in private industry.

Understanding the intricacies of ERISA law is a cornerstone of the medical evaluation process. MCN's network of physicians can provide examinations which help define the financial risk of employee disability on a post-employment basis. Through the use of medical assessments upon an employee's leaving the workforce, as well as post-retirement assessments, managers can better assess their exposure on any specific case.