Since the early 1900’s the U.S. health system has endeavored to standardize disease classification systems to ensure appropriate payments for healthcare. In 1975, the World Health Organization published the International Classification of Diseases system Ninth Revision (ICD-9). Since that release, there has been significant pressure to add specificity in diagnosis coding; hence developers added a fourth and fifth digit to the codes. Providers have long been aware of claims denials due to “fifth digits.”

Pursuant to provisions of the Health Insurance Portability and Accountability Act (HIPAA), the Department of Health and Human Services (HHS) published a Final Rule on January 16, 2009 that mandated nationwide conversion to ICD-10. Thus, for any healthcare service that occurs on or after October 1, 2014, providers must use ICD-10 codes.1 This mandate applies to healthcare reimbursement, research, and reporting services. CMS has confirmed that they will offer no grace period and no additional delays for the transition.

ICD-10 promises a number of advantages. The American Medical Association cites ICD-10’s potential for identifying trends in diagnosis, pinpointing public health needs and epidemic outbreaks, and even managing bioterrorism events.2  Additionally, ICD-10 has the capability to identify ways to curb healthcare costs by more precisely and efficiently describing a patient’s illness using advanced information tools. ICD-10’s detailed coding may help to increase efficiency of electronically approved claims as ICD-10 can help to reduce the need for supporting documentation.3  This could eventually lead to lower administrative costs. It could also help to reduce the claims cycle by minimizing delays and rejections resulting from insufficient information. Properly implemented and adopted, ICD-10’s new code sets could help providers improve their first pass submission rates, thereby eliminating many common obstacles to prompt payment.3  While new to the U.S. health system, ICD-10 has been in development since the release of ICD-9. Today, 99 countries use the ICD-10 diagnosis coding system.4  Despite ICD-10′s international maturity, it very much represents a significant shift for U.S. providers. This transition affects almost every aspect of service delivery, billing, claims processing, and reimbursement. ICD-10 will require testing changes in practice management (PM) and electronic medical record (EMR) systems, billing reporting packages, and decision and analytics tools. In addition, all coders and providers will need retraining.5  Conjecture surrounding the impact that ICD-10 will have on healthcare providers and the industry as a whole abounds. According to the Centers for Disease Control and Prevention (CDC), while ICD-10 builds on concepts with which ICD-9 users are very familiar, “ICD-10 does represent an enormous change.”6

To view full report, see link below:

ICD-10 A Dose of Reality

EXECUTIVE SUMMARY

Applicable pharmaceutical and medical device manufacturers could face fines up to $1.15 million annually for failing to correctly report payments made to physicians, as mandated in the Transparency Reports and Reporting of Physician Ownership or Investment Interests section of the Patient Protection and Affordable Care Act, commonly referred to as the “Physician Payment Sunshine Act.” Although the Act’s writers and prominent figures within the healthcare industry have urged for swift adoption, final approval was just released February 1, 2013 – one full year after the public comment period closed. The industry has been abuzz, trying to identify best practices in aiming their processes and technologies for what is finally a confirmed, albeit ambiguous, target. Pharmaceutical and medical device manufacturers recognize that compliance with the Sunshine Act will require strict, granular accounting of the payments and other transfers of value (TOV) to physicians and teaching hospitals. As public companies scrambled to comply with the Sarbanes-Oxley Act via electronic discovery in the early 2000s, pharmaceutical companies and medical device manufacturers are scrambling to find a solution that will not require undue burden or expense. This paper discusses the outstanding questions and possible solutions for streamlining the transfer of value reporting while improving the accounting and verification processes.

To download and view full report, see link below:

http://www.ombud.com/corporate/featured-report-sunshine-act?utm_source=MARKETING&utm_medium=OMBUD_BLOG&utm_campaign=RESEARCH&utm_term=REDIRECTID_2099&utm_content=RDRECORDID_33050

A couple of weeks ago I had the opportunity to moderate a panel discussion on lessons learned from Superstorm Sandy. I was participating in the Independent Insurance Agents and Brokers of New JerseyTechnology Day program.

The panel consisted of four independent insurance agents as well as a representative from the New Jersey Department of Insurance. Each panel member shared their own stories of how they were affected by the storm and how they were able to respond to the devastation brought by the storm.

Insurance is something most people don’t think about — until they need it. In a widespread disaster like Hurricane Sandy, it is vitally important that insurance organizations be as well prepared as possible so they are available and ready to help their clients.

Each of the insurance agents on the panel had hundreds of insurance claims reported by their clients. Listening to each of the participants talk about their own story, four lessons emerged that the insurance industry — along with every business — should learn from Hurricane Sandy.

Lesson #1: Be Prepared

Every business needs to take the necessary steps to be prepared for any type of disaster. Weather patterns are changing. “Unusual” weather is becoming common. Think through the potential problems your organization could face. Create a checklist of what needs to be done and by whom.

For a disaster you can see coming (like Sandy) take information you will likely need to a secure off site location. For insurance agents print out a list of clients with contact information and policy numbers. Make sure you have the physical forms you will need in case you will not be able to access the electronic versions.

Your first responsibility is to take care of your employees. In a wide spread disaster your employees will likely be affected. Create a way to communicate with them so you can determine if they are OK and will need help.

The NJ Department of Insurance considered being prepared so important they required insurance organization licensed by the state to submit their disaster preparedness plans as part of their annual review process. The department realized that the insurance industry was a vital resource in helping consumers recover from a disaster.

Lesson #2: Hosted systems work better

Three of the four insurance agents on the panel had Policy Management database systems that were hosted by third parties off-site. The information contained in these systems are accessed through an Internet connection.

Policy Management systems hosted by third parties can be accessed wherever an employee can find Internet access. As part of their disaster recovery plan, one agency purchased two mobile MiFi hotspots that provided Internet access through the cellular data network.

The agent who had their system and servers located within their office was not able to physically get to their office for a week because of the effects of the storm. This lack of access to client policy information complicated the process of taking claim information from clients. After this experience, the agency owner said he will be moving the database to a third-party hosted service.

In addition to Policy Management systems, telephone systems should be hosted off-site with telephone service provided through Internet connections. It is much easier to manage access to an organization’s telephone network when the physical equipment is not located within the office.

Lesson #3: Communication is vital

Any and all forms of communication should be incorporated into an organization’s disaster recovery plan. Just be careful to not make the assumption that cellular towers will be functional so that mobile phones will be able to actually make a connection. Using SMS text messaging is a very viable option as often text messages will go through on a cellular connection when voice will not.

Social platforms can also be a great way to get information to those people who need it. This is another reason every organization should have a presence on various social platforms. Again, with an Internet connection, people can use these sites as a way to communicate.

Lesson #4: Power is key

When wrapping up the session I asked each panel member to share with the audience in one sentence their major lesson. Each, in one form or another, talked about the importance of having access to power. It’s great to have cell phones, MiFi devices, and laptops. But, none of those devices will work without power. Making sure the agency and staff had access to a power source is key to being able to effectively help your clients when they need you most.

At a low point in the movie Apollo 13, the NASA Director says to Gene Krantz (the Flight Director), “I know what the problems are. This could be the worst disaster NASA’s ever experienced.” Gene Krantz responds with, “With all due respect, sir. I believe this is gonna be our finest hour.”

The finest hour for the insurance industry is when we can effectively and rapidly fulfill the promise we made when we sold an insurance policy. A key to fulfilling that promise is being prepared ourselves. My hope is that you will take these lessons to heart and make sure your organization is fully prepared for any disaster that might come your way.

What lessons have you learned from Hurricane Sandy or any other disaster you have experienced?

http://www.linkedin.com/today/post/article/20130327132624-5214630-4-lessons-every-business-should-learn-from-superstorm-sandy

Canada, Feb. 28 — A new survey published by the Business Continuity Institute (BCI) in association with BSI has revealed that 65 per cent of organizations are extremely concerned or concerned about a cyber-attack in 2013.

The survey also reveals that 71 per cent see the use of the Internet for malicious attacks as a major trend that requires a business continuity response with 42 per cent seeking to manage the prevalence and high adoption of Internet-dependent services, such as the cloud, within their preparedness activities.

The Horizon Scan 2013 Survey Report is based on a survey of respondents from 730 organizations in 62 countries including USA, UK, India, China, South Africa, Egypt and Brazil. It concludes that the level of concern across sectors and geography over a cyber-attack is a major challenge for public policy makers and board rooms. More needs to be done to gain a better understanding of the threat and underlying trends that drive the vulnerability to ensure that a proportionate business continuity approach is in place.

The 730 organizations that participated in the survey were from sectors as diverse as financial services, public administration and defence, retail and manufacturing.

Further findings from the report, now in its second consecutive year, include:

The leading threat of concern in 2013 is unplanned IT and telecom outages with 70 per cent of organizations surveyed stating they were extremely concerned or concerned about this threat in 2013. This was followed in second place by concern over a data breach at 66 per cent.

Supply chain disruption and the underlying trend of increasing supply chain complexity figure prominently in the overall results and are lead concerns in manufacturing and retail sectors.

60 per cent of respondents see the influence of social media as a major trend affecting reputation management and crisis communications, the second highest rated trend in the survey.

Investment in business continuity is robust, in spite of difficult economic times, with 22 per cent seeing increased investment in 2013 and 54 per cent stating that investment will be maintained at appropriate levels. Fourteen per cent expected investment to be cut, thereby limiting the scope or effectiveness of the programme.

“For the first time, we see a study that brings together short-term threats with the underlying trends that drive disruption. This provides business managers with both an immediate term focus and insight into the longer term needs for capability development,” said Lyndon Bird FBCI, Technical Director at the Business Continuity Institute. “The dominance of technology and Internet-related threats and trends in this year’s survey mirrors events we have seen in the real world recently with for example PayPal, RIM, O2 and RBS. The high level of concern over a cyber-attack may well be misplaced but it demands a considered independent analysis of the threat to avoid hype and disillusionment and ensure a proportionate response is in place. The BCI is willing to bring its unique view on disruption and preparedness to the debate”.

“This latest report shows that businesses need to be more prepared than ever for every type of risk,” said Gary Robinson, Commercial Director, BSI Canada. “The top five threats highlight that the digital age is continuing to bring new challenges to organizations around the world. In order to counter this, cyber resilience must become part of an organization’s wider business resilience strategy. Businesses can benefit from an integrated implementation of standards in areas such as business continuity management (ISO/IEC 22301) and information security (ISO/IEC 27001) to identify, prioritise and manage these threats.”

A copy of the report is available on request to research@thebci.org or can be downloaded from the BCI website, www.thebci.org (registration required).

About the Business Continuity Institute

Based in Caversham, United Kingdom, the Business Continuity Institute (BCI) was established in 1994 to promote the art and science of business continuity management and to assist organizations in preparing for and surviving minor and large-scale man-made and natural disasters. The Institute enables members to obtain guidance and support from their fellow practitioners and offers professional training and certification programmes to disseminate and validate the highest standards of competence and ethics. It has over 8,000 members in more than 100 countries in an estimated 3,000 organizations in private, public and third sectors. Published by HT Syndication with permission from Business Review Canada. For any query with respect to this article or any other content requirement, please contact Editor at htsyndication@hindustantimes.com

(c) 2013 2011 – Business Review Canada

As communities begin to recover from the devastating effects of Hurricane Sandy, it is important to recognize lessons learned, and to employ mitigation actions that ensure structures are rebuilt stronger, safer, and are less vulnerable to future flooding events.

Prior to Hurricane Sandy, the Federal Emergency Management Agency (FEMA), charged with administering the National Flood Insurance Program (NFIP), was restudying areas of the New Jersey and New York coastlines to update Flood Insurance Rate Maps (FIRMs). These updated maps were set to be delivered to state and local officials in mid-2013. Because existing FIRMs for these areas were developed more than 25 years ago, and updated FIRMs are not finalized, FEMA determined it is vital to provide near-term Advisory Base Flood Elevations (ABFEs) to support reconstruction efforts.

ABFEs are developed using sound science and engineering derived from more recent data and improved study methodologies compared to existing FIRMs. The ABFEs will likely reflect higher flood elevations than the current regulatory FIRMs. Property and business owners should check with their local building officials to fully understand the requirements for using ABFEs in rebuilding efforts.

ABFEs will be available for all or portions of the following counties:

New Jersey Counties: Atlantic, Bergen, Burlington, Cape May, Essex, Hudson, Middlesex, Monmouth, Ocean, and Union.

New York Counties: Bronx, Kings, New York, Richmond, Queens, and Westchester.

To see the full extent of the locations where ABFEs will be issued, please visit: www.Region2Coastal.com.

To better explain the implications of the ABFEs, FEMA has prepared this document containing frequently asked questions.

1. GENERAL ADVISORY BASE FLOOD ELEVATION (ABFE) QUESTIONS

1.1 WHAT ARE ADVISORY BASE FLOOD ELEVATIONS (ABFEs)?

ABFEs are advisory in nature and more accurately reflect the true 1% annual chance flood hazard elevations in a given area. Following large storm events, such as Hurricane Sandy, FEMA performs an assessment to determine whether the 1% annual chance flood event, shown on the effective FIRMs adequately reflects the current flood hazard. In some cases, due to the age of the analysis and the science used to develop the effective FIRMs, FEMA determines there is a need to produce ABFEs. ABFEs are provided to communities as a tool to support them in recovering in ways that will make them more resilient to future storms.

1.2 HAS FEMA ISSUED ABFEs IN THE PAST? IF SO, WHERE, AND WAS IT SUCCESSFUL?

Yes, FEMA developed ABFEs after Hurricane Katrina in 2005. Many communities adopted the ABFEs in Louisiana and Mississippi, which resulted in home and business owners building higher and safer. This also meant lower flood insurance premiums once the flood elevations were adopted based on the revised FIRMs several years later.

1.3 FOR WHAT COUNTIES IN NEW JERSEY AND NEW YORK WILL ABFEs BE ISSUED?

ABFEs will be issued for all or portions of the following counties in New Jersey and New York:

New Jersey Counties: Atlantic, Bergen, Burlington, Cape May, Essex, Hudson, Middlesex, Monmouth, Ocean, and Union.

New York Counties: Bronx, Kings, New York, Richmond, Queens, and Westchester.

This information will be available in December 2012. To see the full extent of the locations where ABFEs will be issued, please visit: www.Region2Coastal.com.

1.4 HOW WILL THE ABFEs BE DEVELOPED FOR THE COUNTIES IMPACTED BY HURRICANE SANDY ?

FEMA will use updated coastal study methodologies and topographic data in coastal New Jersey and New York. These ABFEs will also build on the work already underway and reflect an updated coastal analysis.

1.5 WHAT INFORMATION WILL THE ABFEs INCLUDE THAT WILL BE AVAILABLE TO STAKEHOLDERS?

The ABFEs will include advisory coastal flood hazard elevations and associated advisory maps. This information will include the following:

Advisory Data Layers by County:

Geospatial layers depicting ABFEs and updated flood zones (including but not limited to Advisory Flood Hazard Zone A, Advisory Flood Hazard Zone V, Limit of Moderate Wave Action (LiMWA), and Area of Moderate Wave Action, also known as Coastal A Zone), high water marks collected reflecting Hurricane Sandy’s impact, and U.S. Fish and Wildlife Coastal Barriers Zones that communities can input into existing Geographic Information Systems (GIS) to help make decisions about zoning, building, and redevelopment.

Advisory Maps by County:

Paneled maps depicting the geospatial data layers referenced above. These advisory maps will reflect higher flood elevations and in some cases, more expansive coastal flood zones.

Methodology Report for ABFEs:

A report summarizing the methodologies, assumptions, and data sources used in developing the advisory data layers and maps.

1.6 WHEN WILL THE ABFEs BE AVAILABLE?

Work is currently underway to prepare the ABFEs. FEMA expects to release ABFEs in December 2012.

1.7 WHO SHOULD USE THE ABFEs?

Communities must use ABFEs for any FEMA Recovery or Mitigation activity (e.g. Public Assistance, Hazard Mitigation Grants). In addition, FEMA recommends that community officials including building and floodplain management officials, property owners, business owners, architects, builders, and engineers use this information because the ABFEs will more accurately depict the current flood hazards.

1.8 HOW CAN THE ABFEs BE ACCESSED?

The ABFEs will be available on the FEMA Region II Coastal Website at www.Region2Coastal.com. This site will also contain guidance to enable uses to make informed decisions regarding rebuilding communities.

1.9 HOW WILL THE IMPACTS OF HURRICANE SANDY BE FACTORED INTO THE ADVISORY INFORMATION?

The specific magnitude and track of Hurricane Sandy will not be factored into the updated coastal analysis for the ABFEs. FEMA uses statistical probabilities of historic storms as part of the updated coastal analysis, which does not include any individual event from past history. Historical storms of similar paths and magnitudes to Hurricane Sandy are accounted for within

the statistical analysis and the inclusion of Hurricane Sandy would not affect the outcomes of the ABFEs or the depiction of the advisory flood zones. FEMA will provide specific high water marks observed from Hurricane Sandy as point data on the advisory maps that were collected by the United States Geological Survey. Also, a range of surge elevations that occurred as a result of Hurricane Sandy will be provided in the informational section of each advisory map panel.

1.10 WHY ARE SOME ABFEs HIGHER THAN THE ELEVATIONS SHOWN ON THE EFFECTIVE FIRMS?

Flood risk can change over time due to changes in climate, population, development in and around the community, and other factors. The Base Flood Elevations (BFEs) shown on the current, effective FIRMs are based on studies that were performed more than 25 years ago. The ABFEs are based on information from the flood risk mapping studies that were already underway before Hurricane Sandy, and include an additional 25 years of flood data and updated topographic data. As a result, the ABFEs will reflect higher elevations than the BFEs shown on current, effective FIRMs.

1.11 WHY DO THE ABFEs SHOW SOME ELEVATIONS LOWER THAN HURRICANE SANDY FLOOD ELEVATIONS?

The ABFEs are based on the 1% annual chance flood event. In some areas, the ABFEs may show elevations lower than Hurricane Sandy because Sandy was a more extreme event than the 1% annual chance flood in certain areas. The elevations of the 1% annual chance flood are the NFIP standard for floodplain management. It is important to note that buildings constructed to this standard are still vulnerable to the effects of larger events like Hurricane Sandy.

2. FLOODPLAIN MANAGEMENT QUESTIONS ON THE USE OF ABFEs AND ADVISORY MAPS FOR RECONSTRUCTION

2.1 IS MY COMMUNITY REQUIRED TO ADOPT THE ADVISORY MAPS AND ABFEs FOR RECONSTRUCTION TO REMAIN ELIGIBLE TO PARTICIPATE IN THE NFIP?

No. A community participating in the NFIP is not required to use the advisory maps and ABFEs. Advisory Maps and ABFEs provide communities with an estimate of the minimum flood elevations and flood hazard areas that they can use during reconstruction to minimize future damages.

2.2 WHAT ARE THE BENEFITS TO MY COMMUNITY OF USING OR ADOPTING THE ABFEs AND ADVISORY MAPS?

Using the ABFEs for rebuilding can reduce the vulnerability of structures to flooding and flood damages. Constructing buildings to ABFEs may decrease the cost of flood insurance, as well as the cost to recover from future storm and flood events. While the initial cost to rebuild to ABFEs may be slightly higher, communities, and property and business owners will save money over the long term by having structures that are more resistant to costly flood damage. FEMA will provide technical assistance to communities in adopting and implementing the ABFEs and advisory maps.

2.3 IF MY COMMUNITY DECIDES TO ENFORCE THE ABFEs, WILL IT NEED TO AMEND ITS FLOODPLAIN MANAGEMENT REGULATIONS AND/OR THE INTERNATIONAL BUILDING CODES® TO REFLECT THE ABFEs?

Generally yes. The community will need to adopt the ABFEs and your floodplain administrator will need to enforce the amended regulations.

2.4 IN AREAS WHERE THE IMPACTS OF HURRICANE SANDY ELEVATIONS EXCEED ABFEs, SHOULD COMNMUNITIES BUILD HIGHER?

Yes. It is good practice to build higher. Some options that communities and property owners have to provide additional protection include:

Adopt or use freeboard on top of the ABFEs.

The use of pile or column foundations to elevate residential buildings is required in V zones. In addition, this may be required in existing AE zones.

2.5 CAN MY COMMUNITY ADOPT A FREEBOARD REQUIREMENT ON TOP OF ITS CURRENT BASE FLOOD ELEVATIONS (BFEs) AS AN ALTERNATIVE TO ADOPTING THE ABFEs?

Yes. However, communities should use caution in adopting BFEs plus freeboard if they are lower than the ABFEs. Structures constructed to the BFE plus freeboard will be more susceptible to flood damage than structures built to the ABFE or higher.

In addition, property owners and communities need to be aware that insurance rates will also be affected by the Biggert-Waters Flood Insurance Reform Act of 2012, which mandates eliminating flood insurance premium subsidies and discounts and increasing rates to reflect the actual risk. If the new effective FIRM has BFEs that are higher, residents whose buildings are below the new level could pay substantially higher premiums for flood insurance.

2.6 WHEN FEMA PROVIDES FINAL FIRMS THAT REPLACE THE ABFEs, WILL MY COMMUNITY BE REQUIRED TO ADOPT THE REVISED FIS AND FIRMs?

Yes. Any time that FEMA revises the effective FIRMs, the community must adopt or amend their floodplain management regulations to incorporate the new data and meet any additional floodplain management requirements. Additional information about adopting FIRMs can be found in FEMA’s brochure,

Adoption of Flood Insurance Rate Maps by Participating Communities (FEMA 495 – September 2005).

3. FLOOD INSURANCE IMPLICATIONS

3.1 IF COMMUNITIES ADOPT AND UTILIZE ABFEs, HOW WILL THAT AFFECT OWNERS’ FLOOD INSURANCE PREMIUMS AND POLICIES?

Adopting standards based on ABFEs will not change the zones or elevations currently in effect, and premiums will continue to be rated based on the map currently in effect and the lowest floor of the building. Flood insurance policies are rated using the zones and flood elevations on the current effective FIRM. Flood insurance premium rates may be affected by the Biggert-Waters Flood Insurance Reform Act of 2012 (see Section 3.2).

3.2 WHAT WILL HAPPEN TO RENEWAL RATES FOR EXISTING FLOOD INSURANCE POLICIES IF THE FIRMS ARE REVISED IN THE FUTURE TO REFLECT NEW, HIGHER ELEVATIONS?

As flood maps are updated, flood zones and associated premiums could change to reflect the new flood risk. Rates will also be affected by the Biggert-Waters Flood Insurance Reform Act of 2012, which mandates eliminating flood insurance premium subsidies and discounts and increasing rates to reflect the actual risk. If the new effective FIRM has BFEs that are higher, residents whose buildings are below the new level could be required to pay substantially higher premiums for flood insurance.

3.3. WILL INCREASED COST OF COMPLIANCE (ICC) BENEFITS BE AVAILABLE TO HELP COVER THE COSTS TO ELEVATE THE BUILDING?

ICC coverage is a standard coverage in most NFIP policies. The coverage provides up to $30,000 to help property owners reduce the risk of damage from future floods by elevating, flood proofing (for nonresidential structures), demolishing, or relocating their building or home to meet the requirements of a local community’s building ordinances. This coverage is in addition to the building coverage for the repair of the actual physical damages from flooding. However, the total claims payments cannot exceed statutory limits. Therefore, the maximum amount collectible for both ICC and physical damage from flood for a single family dwelling is $250,000.

3.4 IF A HOUSE WAS BUILT IN COMPLIANCE WITH THE CURRENT EFFECTIVE FIRM AND WAS SUBSTANTIALLY DAMAGED WOULD ICC COVER THE COST TO ELEVATE THE STRUCTURE TO THE BFE OR ABFE?

Yes, to whichever elevation the community has adopted and is enforcing throughout the community.

3.5 IF A SECOND FLOOR IS ADDED TO THE HOUSE AND THE LOWEST FLOOR IS CONVERTED TO PARKING, STORAGE, OR ACCESS, IS THIS ELEVATION TECHNIQUE ELIGIBLE FOR ICC?

No. ICC will only cover if the structure meets the insurance definition of an elevated structure.

3.6 IF A PROPERTY OWNER DEMOLISHES A HOUSE, IS THE PROPERTY OWNER ELIGIBLE FOR UP TO $30,000 TO ELEVATE A NEW HOUSE?

Yes, if the elevation is to the BFE, BFE plus freeboard, or the ABFE as required by the community and the structure is in a mapped floodplain on the current effective FIRM. ICC will cover up to $30,000 for any combination of the following activities:

 Elevation

 Flood proofing (non-residential buildings only)

 Relocation

 Demolition

3.7 IF A COMMUNITY IS DEMOLISHING DAMAGED HOMES, BUT NOT DEMOLISHING THE SLAB, WILL ICC COVER DEMOLISHING THE SLAB?

Yes. ICC will cover the demolition of the slab, but ICC will not cover the demolition cost that has already been paid for from another funding source.

3.8 CAN A RESIDENTIAL STRUCTURE BE ELEVATED FOR $30,000?

It depends. There are many factors that affect the costs associated with raising houses. Factors such as size of home, construction type including foundation type, condition and shape of home, condition of slab, elevating utilities, and most importantly the height of elevation should be considered.

3.9 WHAT OTHER RESOURCES ARE AVAILABLE ON ICC COVERAGE AND STRUCTURAL ELEVATION?

ICC Resources:

National Flood Insurance Program Increased Cost of Compliance Coverage, Guidance for State and Local Officials, FEMA 301/September 2003; http://www.fema.gov/library/viewRecord.do?fromSearch=fromsearch&id=1532

Increased Cost of Compliance, F-663/August 2002

http://www.fema.gov/library/viewRecord.do?fromSearch=fromsearch&id=3009

Information about Increased Cost of Compliance (ICC) can be found at:

http://www.fema.gov/national-flood-insurance-program-2/increased-cost-compliance-coverage

FEMA Publications:

 Principles and Practices of Retrofitting Floodprone Residential Structures, FEMA 259/January 1999 ; http://www.fema.gov/library/viewRecord.do?fromSearch=fromsearch&id=1645

 Homeowner’s Guide to Retrofitting, Six Ways to Protect Your House from Flooding, FEMA 312/June 1998; http://www.fema.gov/library/viewRecord.do?fromSearch=fromsearch&id=1420

USACE Flood Proofing Publications:

 Raising and Moving a Slab-on-Grade House with Slab, 1990

 Flood Proofing – How to Evaluate Your Options, 1993

 A Flood Proofing Success Story Along Dry Creek at Goodlettsville, Tennessee, 1993

These and other publications can be found on the following website:

http://www.usace.army.mil/Missions/CivilWorks/ProjectPlanning/nfpc.aspx

4. COMMUNITY RATING SYSTEM

4.1 CAN MY COMMUNITY GET CREDIT UNDER THE NFIP COMMUNITY RATING SYSTEM (CRS) FOR ADOPTING ABFEs OR FREEBOARD?

Yes. Several communities on the New Jersey and New York coast participate in the NFIP’s CRS. Policyholders in these communities receive discounts on their flood insurance premiums because their communities are implementing floodplain management programs that go beyond the minimum requirements of the NFIP. Communities could receive CRS credit for adopting and enforcing the ABFEs or for adopting and enforcing freeboard requirements. Credits for adopting the ABFEs would be in effect until a revised FIRM became effective.

Additional information on CRS can be found at: http://www.fema.gov/national-flood-insurance-program/community-rating-system

5. APPLICATION OF ABFEs TO FEMA DISASTER GRANTS AND ASSISTANCE PROGRAMS

5.1. WILL FEMA USE THE ABFEs FOR FEMA RECOVERY AND MITIGATION GRANT PROJECTS?

Yes. FEMA Recovery and Mitigation activities and programs must use the best flood hazard data available prior to obligation of Federal funds.

5.2 WHY MUST FEMA USE ABFEs FOR FEMA DISASTER GRANTS AND ASSISTANCE PROGRAMS?

FEMA is taking action to reduce the risks of flood loss, minimizing impacts of floods on human safety, health, and welfare, and restoring and preserving the natural and beneficial values served by floodplains in carrying out our programs. FEMA grants supporting construction, repair, rehabilitation, and/or improvements in or affecting floodplains are subject to Executive Order 11988, codified in 44 CFR Part 9. FEMA is required to follow an eight-step decision-making process for any action with potential to affect floodplains and must involve the public throughout the decision-making process. FEMA is providing significant investment to help communities recover from the impacts of Hurricane Sandy. FEMA’s responsibility is to ensure the Federal investment is wise, sound, and based on the best scientific information available. This will also increase community resilience related to recovery, siting and evaluation of critical facilities and other FEMA infrastructure restoration projects, and will help guide decisions regarding recovery and hazard mitigation in affected areas to reduce future damages.

5.3 HOW WILL FEMA USE ABFEs IN THE MITIGATION AND RECOVERY PROGRAMS?

FEMA will use the ABFEs to determine the flood zone boundaries and minimum flood elevations required for project design and performance standards. This includes the use of ABFEs to determine if a temporary housing activity is located in the floodplain. This applies to placement of temporary housing units (THUs) as well as development of group housing sites and non-traditional types of temporary housing.

5.4 IF LOCAL FLOODPLAIN MANAGEMENT ORDINANCES ARE MORE STRINGENT THAN THE FEMA ABFEs, WHICH STANDARD WILL FEMA USE FOR DISASTER ASSISTANCE AND GRANT DECISIONS?

FEMA funded grant activities and projects must be consistent with all Federal, State and local requirements, laws and ordinances. If the local codes and standards are more stringent than the ABFE, projects must be designed to the higher standard.

5.5 WHAT HAPPENS IF THE BEST AVAILABLE DATA CHANGES?

It should be expected that what constitutes best available data may change over the course of the recovery process. To be consistent with FEMA regulations (44 CFR 9.11(d)(6), no project shall be built to a floodplain management standard that is inconsistent with the NFIP or less restrictive community floodplain management regulations. That information must be considered when making recovery decisions.

Source: FEMA, December 2012

Nearly 10 years after major automobile insurance market reforms, New Jersey has instituted no-fault auto personal injury protection system changes. The new rules come despite several motions to stay their implementation by an array of opponents.

Ed Rogan, spokesman for the New Jersey Department of Banking and Insurance, said there were four appeals filed to prevent the new PIP regulations from going into place Jan. 4, which the department denied. Three of these denials were upheld by the state appeals court, with the fourth one pending, clearing the way for the new rules to go into effect. The injunctions filed by the New Jersey Coalition for Quality Healthcare, the New Jersey Association for Justice, the New Jersey Healthcare Coalition, and the United Acupuncture Society of New Jersey are part of a larger legal challenge to the new rules, Rogan said.

The new PIP rules include the creation of a new hospital outpatient surgical facility fee schedule separate from the ambulatory surgical center facility fee; amendments of the surgical center facility fee to eliminate an over-reimbursement for implantable devices; deletion of 117 fees from the physician’s fee schedule for spinal and neurosurgical procedures because of their infrequency and availability of coverage; deletion of references to workers’ compensation managed care organizations from the PIP protocols rule and removal of post-employment restriction on dispute relation professionals (Best’s News Service, Jan. 20, 2012). The new rules also establish rules for alternative dispute resolution for payment and benefit disputes.

The opponents of the new rules claim they are unlawful and invalid because the rules violate the legislatures specific mandate that the PIP fee schedule shall incorporate the reasonable and prevailing fees of 75% of the practitioners within the regions of the state, according to legal documents. They also hold the insurance commissioner exceeded his authority because the new rules state certain procedures will not be reimbursed unless they are performed in hospitals or hospital outpatient surgical facilities, and by adopting rules that impose restrictions on how PIP arbitrators may determine attorneys fee awards to successful claimants. The suit also claims the fee schedules provide for improperly low fees for ambulatory surgical centers.

The department holds it was well within its power in adopting the new rules, according to legal papers.

The industry welcomed the new rules.

“PIP costs are hard costs and drive 93% of all rate increase applications,” said Eric Goldberg, AIA vice president, Mid-Atlantic region, in an email. “We will work to preserve the cost savings associated with the latest round of PIP reforms.”

The department previously said changes to PIP coverage were necessary because it has driven up the cost of private passenger auto insurance rates in recent years (Best’s News Service, Aug. 3, 2011).

“There were some outliers who were abusing the system and forcing costs up,” Rogan said.

Last year, Rich Attanasio, vice president of property/casualty ratings at A.M. Best, called PIP costs and medical inflation “pressure points for the auto line” in New Jersey (Best’s News Service, Feb. 21, 2012). At the time, he said “it is having a negative impact on some companies’ results” and that insurers can try to handle the PIP costs by raising rates, but “it’s not sustainable to keep doing that given the magnitude of rate needs.”

Out of New Jersey’s 43 auto writers, 16 had no-fault adjusted loss ratios above 100 in 2011, according to BestLink, A.M. Best’s online financial database.

Rogan said the department reviews the PIP rules every two years, and called it an ongoing process.

Changes were made in 2003 to the state’s auto insurance laws but left no-fault PIP untouched. The existing PIP medical fees went into effect in 2009 thanks to a state court decision that upheld department-set limits on PIP coverage (Best’s News Service, Aug. 17, 2009). “What the 2003 reforms were about were availability,” Rogan said. “The PIP reforms are more about coverage. It’s another piece.”

Before the 2003 reforms, carriers, such as State Farm, were leaving the New Jersey market. The reforms reversed this trend and spurred competition and brought in new companies to the market, Rogan noted.

The top five writers of private passenger auto in New Jersey in 2011 were Berkshire Hathaway Insurance Group, with 15.33% market share; Allstate Insurance Group, with 15.4%; NJM Insurance Group, with 13.49%; State Farm Group, with 9.52%; and Palisades Group, with 9.42%, according to BestLink (www.ambest.com/bestlink).

(By Rick Cornejo, managing editor, BestWeek: rick.cornejo@ambest.com)                   

(c) 2013 A.M. Best Company, Inc.

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The American Council of Engineering Companies of New York (ACEC New York) is the voice of New York State’s engineering companies. Whether for sole proprietors or global companies, for young principals or industry leaders, ACEC New York has, since its formation in 1921, been true to its mission: To be the leading advocate in New York State for consulting engineers and to enhance the image and business practices of professional engineering companies.

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