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CMS issues 2016 draft guidance on federal exchange participation

Posted on December 21, 2014 | Comments Off

The Centers for Medicare and Medicaid Services published a draft letter to insurers who want to offer qualified health plans (QHP) in the federally run exchanges in 2016. The letter outlines key requirements that insurers must follow, including provider network and patient safety standards. It also explains how CMS plans to review plan rate increases and conduct oversight of marketing, agents, and brokers. The initial submission window for 2016 QHP applications would be from March 16 to April 15 2015. Certification notices and agreements with insurers would be sent between Aug. 17 and Sept. 15, according to the draft guidance.

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CMS releases monthly Medicaid and CHIP enrollment report

Posted on December 20, 2014 | Comments Off

The Centers for Medicare and Medicaid Services released a report showing state Medicaid and Children’s Health Insurance Program (CHIP) enrollment and growth. The data shows that Medicaid and CHIP grew by 9.7 million enrollees between the beginning of the first Affordable Care Act (ACA) open enrollment period and October 2014- that’s a 17 percent growth in average monthly enrollment, compared to the July-September 2013 period. Additionally, the report finds that enrollment in states that expanded Medicaid increased by 24 percent since first open enrollment, compared to 7 percent in states that did not expand. In total, Medicaid and CHIP had 68.5 million enrollees in October, an increase of about 400,000 over the previous month.

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Study examines coverage disparities under the ACA

Posted on December 18, 2014 | Comments Off

A study by the Urban Institute finds that the Affordable Care Act (ACA) may reduce, but not eliminate health care coverage disparities. The report projects that under the ACA uninsurance rates will fall for each racial/ethnic group, narrowing coverage differences between whites and each minority group, except for blacks. If, however, all states were to expand their Medicaid programs, researchers predict that uninsurance rates would fall further for all racial/ethnic groups, with blacks experiencing a marked reduction.

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New report details health spending in 2013

Posted on December 5, 2014 | Comments Off

The Centers for Medicare and Medicaid Services (CMS) Office of the Actuary published its annual health care spending report in the policy journal, Health Affairs. The report shows that total health care spending in the U.S. increased 3.6 percent in 2013. However, this increase was slower than that of 4.1 percent in 2012, and the share of GDP devoted to health care spending has remained at 17.4 percent since 2009. The deceleration in health care spending growth can be attributed to a slower growth in private health insurance and Medicare spending. Slower growth in spending for hospital care, investments in medical structures and equipment, and spending for physician and clinical care may also contribute to the low overall increase.

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CMS issues final rule on Medicaid DSH

Posted on December 3, 2014 | Comments Off

The Centers for Medicare and Medicaid Services issued a final rule addressing the hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments. Under this limitation, DSH payments to a hospital cannot exceed the uncompensated costs of furnishing services to individuals who are Medicaid-eligible or uninsured. The final rule defines “uninsured” as those who have “no health insurance for the services furnished during the year.” The rule also provides that determinations of funding limits will be made on a service-specific basis rather than at the individual level. CMS says the regulation gives states and hospitals more flexibility in terms of which hospital costs can be considered uninsured costs than what had been in place under a final rule from 2008.

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CMS issues guidance on re-enrollment in the FFM

Posted on December 2, 2014 | Comments Off

The Centers for Medicare and Medicaid Services (CMS) announced in guidance that it will create an “Enrollee Switched List” that allows issuers participating in federally facilitated exchanges to identify enrollees who actively re-enrolled in coverage with another issuer. However, enrollees who completed an active selection to change plans with the same issuer will not be included on the list because the issuer will be aware of the plan change via the active enrollment transaction. The guidance comes in response to issuer concerns that CMS’s decision to not send termination notices to issuers when members select other plans could result in duplicate billings and other problems.

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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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