Supreme Court Decision Regarding ERISA Self-Insured Plans
On March 1, 2016, the Supreme Court made a 6-2 ruling in the Gobeille vs. Liberty Mutual case stating that ERISA preempts Vermont's APCD statute pertaining to self-insured employer claims. The decision prohibits states from mandating the submission of claims data from self-insured ERISA plans to All Payer Claims Databases (APCD). Accordingly, the Colorado APCD rule has been amended to comply with Federal law with an effective data of July 30th, 2016.
It is important to note that the Supreme Court decision DOES NOT prohibit voluntary submission of claims information from self-insured ERISA plans, and CIVHC and HCPF are strongly encouraging employers to continue to submit data to the CO APCD. Including self-insured ERISA plans will help employers identify ways to save costs and improve the health of their employees and enhances health care transparency for the benefit of all Coloradans.
- Learn more about the importance of including self-insured claims in APCDs from the APCD Council.
- Please click here for Colorado FAQs and to learn more.
- Read more about the Supreme Court ruling and CIVHC's statement here.
History of Self-Insured Claims in the CO APCD
Original legislation enacting the CO APCD did not include self-insured plans as a payer type required to submit claims data to the database. On June 29th, 2015, the Colorado Department of Health Care Policy and Financing promulgated a rule change that included self-insured plans in the definition. The rule went into effect August 30, 2015.
Why Does Colorado Need Self-Insured Claims In the CO APCD?
Created by legislation in 2010, the CO APCD currently includes health insurance claims from 33 commercial payers, Medicaid and Medicare with the goal to improve care and lower costs. However, due to the way the initial legislation was written, and with the new Supreme Court decision, ERISA self-insured employer claims are not fully represented in the database.
Self-insured employer claims represent approximately 25 percent of insured lives across the state and pose a significant gap in the market when it comes to analyzing the data in the CO APCD. Adding this important segment of the market will allow for a more complete picture of Colorado’s health care landscape and opportunities for positive change.
Current Outreach and Self-Insured Employer Engagement
CIVHC is conducting outreach to ERISA self-insured employers to raise the awareness importance of voluntarily submitting self-insured claims to the CO APCD. We help them understand the Supreme Court decision, answer any questions and outline the benefits for employers and their employees of having their data submitted to the CO APCD.
We would like your support connecting with self-insured employers in Colorado. We would like to meet with them, learn how health care costs are affecting their business and hear their suggestions and/or concerns about having self-insured health care claims data included in the CO APCD.
Please contact Amy Andrews McMaster, Stakeholder Relations, at email@example.com with any questions or to connect us with employers in your network.