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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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ACA health plan agreements include Halbig provision

Posted on October 21, 2014 | Comments Off

Insurers must sign Affordable Care Act (ACA) qualified health plan (QHP) agreements in order to offer their plans on for 2015. The 2015 agreements include a provision that takes into account the fact that the Supreme Court could issue a ruling on the Halbig v. Burwell case sometime next year that would make ACA subsidies illegal in federal exchange states. In the agreements, CMS reassures plans that if ACA premium tax credits and cost-sharing subsidies are no longer available to qualifying enrollees in the federal exchanges, the health plan could have cause to terminate the agreement subject to applicable state and federal law.

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Survey assesses impact of high deductibles

Posted on October 14, 2014 | Comments Off

A new poll conducted by the The Associated Press and the NORC Center for Public Affairs Research suggests that high deductibles remain a significant barrier to health care for many privately insured Americans. The survey finds that of privately insured adults under age 64, about one in five said they don’t go to a doctor when they are sick despite having health coverage. A similar number of survey respondents reported going without preventive care and cutting back on retirement savings, or having to use all their savings for care. These issues were particularly acute among the 26 percent of respondents with high deductible plans. Consequently, about half of those surveyed said they preferred higher premiums over higher out-of-pocket costs.

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CMS issues guidance on ACA health insurance tax

Posted on October 9, 2014 | Comments Off

Guidance issued by the Centers for Medicare and Medicaid Services (CMS) advises states that that their capitated payment rates for Medicaid managed care plans should cover the costs of the Affordable Care Act’s (ACA) health insurance tax, as it is considered a “reasonable business cost.” The tax starts at $8 billion in 2014 and increases every year, up to $14.3 billion in 2018. Starting in 2019, the amount of the tax will increase annually based on premium trends. CMS contends that this fee is not unlike other taxes and fees that actuaries must take into account when developing capitation rates.

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