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CMS issues proposed rule on Medicare ACOs

Posted on December 2, 2014 | Comments Off

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule, which addresses changes to the Affordable Care Act’s (ACA) Medicare Shared Savings Program, including provisions relating to the payment of Accountable Care Organizations (ACO) participating in the Program.  The proposed rule includes several changes to eligibility requirements, definitions of an ACO participant, and how “pioneer” ACOs transition into the Medicare Shared Savings Program.  Notably, the rule would allow ACOs an extra three years without risk of penalties for poor performance, albeit with smaller shared savings for good performance. CMS also is considering making it easier for ACOs to meet spending targets by comparing them to providers in their region, instead of national comparisons, and by gradually making benchmarks less dependent on past ACO performance.

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HHS releases proposed rule on open enrollment

Posted on November 22, 2014 | Comments Off

The U.S. Department of Health and Human Services (HHS) issued a proposed rule that would set future annual exchange open enrollment periods so that they begin October 1 and end December 15. Consumers selecting a plan during this time period would gain coverage starting January 1, 2016. HHS says this time period will be long enough for consumers to pick or change their plan, but not crossing calendar years will reduce consumer confusion. The proposed rule also touches on key aspects of the Affordable Care Act (ACA), including risk corridors, user fees for the federal exchange, essential health benefits, and network adequacy.

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OPM issues proposed rule for Multi-State Plan Program

Posted on November 22, 2014 | Comments Off

The U.S. Office of Personnel Management (OPM) issued a proposed rule to implement modifications to the Multi-State Plan (MSP) Program. The MSP Program is a provision of the Affordable Care Act (ACA) designed to offer at least two federally administered plans in all 50 states. The proposed rule would revise sections of a final 2013 rule, adjusting the requirements on multi-state plans and the insurers that offer them, based on OPM’s experience since the final rule was issued.

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GAO issues report on SHOP exchanges

Posted on November 14, 2014 | Comments Off

A new Government Accountability Office (GAO) report reveals that only only 76,000 people enrolled in the 18 states running their own Small Business Health Options Program (SHOP) exchanges as of June 1. While GAO did not have data for the federal-run SHOP exchanges, CMS told the office that it expected similar enrollment trends for the small business marketplaces it is operating. A number of factors may be contributing to the low enrollment numbers such as a lack of interest in the Affordable Care Act’s (ACA) small business health tax credits, misconceptions about SHOP availability by employers, and the ability of employers to renew pre-ACA plans. GAO noted that these factors may also affect future growth.

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CMS issues letter to Medicaid directors

Posted on November 13, 2014 | Comments Off

In a recent letter to Medicaid directors, the Centers for Medicare and Medicaid Services (CMS) revealed plans to issue new regulations that will codify the availability of the 90/10 federal matching funds under the Affordable Care Act (ACA) for Medicaid eligibility and enrollment systems on a permanent basis. The letter also announces CMS’s intention to provide a three-year extension of the A87 waiver authority, allowing states to use their federal funds to help integrate Medicaid eligibility and enrollment through other social services through December 2018.

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AMA adopts new policy to increase insurance coverage

Posted on November 12, 2014 | Comments Off

A new American Medical Association (AMA) policy encourages policymakers of all levels to focus their efforts on working together to identify realistic coverage options for adults currently in the coverage gap, especially in states that are not expanding Medicaid under the Affordable Care Act (ACA). Given their concern with the high number of low-income adults who remain uninsured in states that have opted not to expand their Medicaid programs, the AMA suggests that these states consider using waivers to expand coverage. The organization also urges states to publicly report annually on efforts to cover the uninsured.

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IRS issues guidance on coverage of hospital services

Posted on November 5, 2014 | Public Comment (1)

New guidance issued by the Internal Revenue Service (IRS) states that employers must provide substantial coverage for in-patient hospitalization services in order to meet minimum Affordable Care Act (ACA) standards. Plans that fail to provide this coverage do not provide the minimum value intended by the minimum value requirement of the ACA. According to the guidance, any employer that has contracted with such a plan before this guidance was issued will be excluded from the requirement in 2015 if its plan year begins on or before March 1.

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CRS publishes report on ACA repeal legislation

Posted on November 3, 2014 | Comments Off

The Congressional Research Service issued a report summarizing legislative actions to repeal, defund, delay, or amend the Affordable Care Act (ACA). The report compiles legislation that has been approved by both chambers and enacted into law, legislation passed in the House not considered by the Senate, and ACA-related provisions in enacted annual appropriations acts for each of FY2011 through FY2014. Also included is a brief overview of all the ACA-related provisions added to appropriations bills considered, and in most cases reported, by the House and Senate Appropriations Committees since FY2011.

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Report finds state differences in EHBs

Posted on October 23, 2014 | Comments Off

A new report from University of Pennsylvania researchers, funded by the Robert Wood Johnson Foundation, finds that significant state variation exists in the Affordable Care Act (ACA) essential health benefits (EHB), which insurers must cover to offer plans on the exchanges. 45 states consider chiropractic care an EHB, 26 states include autism spectrum disorder services in their EHB package, and only five states considered weight loss programs and acupuncture as EHBs. The report states that the variation in EHB requirements is mostly a result of allowing states to determine their own essential health benefit package by using a “benchmark plan” already offered in the state as a model.

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CMS issues Basic Health Program information for 2016

Posted on October 22, 2014 | Comments Off

The Centers for Medicare and Medicaid Services (CMS) issued a proposed notice on how the federal government will determine payment amounts for 2016 for states that decide to establish a Basic Health Program. The Basic Health Program is a voluntary option under the Affordable Care Act (ACA), which provides insurance to individuals between 133 and 200 percent of poverty through a separate program rather than having them go to the exchanges. The proposed notice says that states that establish the program will receive federal funding equal to 95 percent of the amount of premium tax credits and cost-sharing subsidies that would have otherwise been provided to those individuals for exchange plans. However, the funding does not cover states’ ongoing administrative or operational costs.

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