A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

CBO and JCT revise mandate penalty estimation

Posted on June 5, 2014 | Comments Off

An updated analysis released by the Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) estimates that 2 million fewer individuals are anticipated to pay the shared responsibility payment in 2016. Under the Affordable Care Act (ACA), most individuals not receiving minimum essential coverage through their insurance plans are expected to pay a fine for not complying with the individual mandate. The last estimate released by the analysts in 2012 postulated that 6 million individuals way pay the fine in 2016. CBO and JCT cite the expected increase in the number of individuals receiving exemptions from the individual mandate as the main reason for the estimated drop.

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Article discusses likelihood of funding gaps for safety-net hospitals

Posted on June 2, 2014 | Comments Off

A new article published in Health Affairs finds that some safety-net hospitals will still face funding issues, even after implementation of the Affordable Care Act (ACA). The article cites rising healthcare costs, the number of Americans still without insurance, and the disproportionate share hospital payment reductions within the ACA as reasons contributing to the continuation of funding gaps for many safety-net hospitals. States that did not expand Medicaid may be particularly impacted by these funding gaps, as they will not be receiving federal expansion money to offset the cuts in the safety-net funds.

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Report discusses use of narrow networks

Posted on May 30, 2014 | Comments Off

Under the Affordable Care Act (ACA), many insurers have been creating plans with narrower provider networks. A new report discusses how to use narrow networks as a means to contain costs, but not compromise patient access to care. The report, published by the Urban Institute and The Center on Health Insurance Reforms at Georgetown University, suggests that the appropriate balance between consumer choice and containing costs can be achieved through regulations, transparency, and oversight.

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IRS Q&A clarifies employer payment plans

Posted on May 27, 2014 | Comments Off

According to a Q&A document recently released by the Internal Revenue Service (IRS), employers that do not offer health insurance but reimburse premiums for employees that purchase private insurance may be hit with a financial penalty. The Q&A states that employers utilizing this approach are effectively creating employer payment plans, which are beholden to the same rules and requirements as other group health plans under the Affordable Care Act (ACA). The IRS states that this arrangement does not comply with the ACA market reforms, and offering this option to employees may result in a $100/day excise tax per applicable employee for the employer.

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CMS issues Medicare Advantage and Part D final rule for 2015

Posted on May 21, 2014 | Comments Off

The Centers for Medicare and Medicaid Services (CMS) issued the final rule for Medicare Advantage (Part C) and the Medicare prescription drug benefit program (Part D) for contract year 2015. The rule aims to clarify program provisions, enact statute requirements, and improve payment accuracy. One specific provision provided in the rule said CMS will not open up preferred networks to permit any willing pharmacy to offer preferred cost-sharing. CMS indicated they would continue to study preferred cost-sharing practices to address stakeholder reactions and concerns to the proposed policy.

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HHS releases final Marketplace rule

Posted on May 16, 2014 | Comments Off

The US Department of Health and Human Services (HHS) issued a final rule entitled Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond. Some specific provisions in the rule include:

  • Raising the administrative costs and profits ceiling under the risk corridor formula by 2%.
  • Providing information on how to include ICD-10 costs under the medical loss ratio (MLR).
  • Requiring qualified health plans (QHP) on the ACA Marketplace to have a more efficient and effective method for enrollees to acquire medications not covered on the plan. This specifically applies to enrollees on a course of treatment in which absence of the medication would substantially impact the individual’s life and health.
  • Requiring insurers to annually report plan changes to beneficiaries.
  • Beginning in 2016, Marketplaces will have to display quality data on all plans for public viewing. The data will be based on a five-star system and enrollee satisfaction surveys.
  • Enumerating state requirements that may prohibit Navigators or other assistors from performing their roles. For example, Navigators may go door-to-door for enrollment assistance and outreach. They may not, however, provide gifts to entice enrollment.
  • Delaying the “employee choice” option in the small business health options program (SHOP) to 2016.

The final rule is largely unchanged from the proposed version. An FAQ addressing market reforms and Marketplace standards can also be accessed here.

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Exemptions and Special Enrollment Periods under the ACA

Posted on May 14, 2014 | Comments Off

Below are three tables that describe the exemptions and SEPs in the ACA. The first table enumerates the exemptions and the method by which an individual may claim them. The second table focuses specifically on one type of exemption pathway- hardships. This table lists several specific events that will qualify as a hardship exemption and how to claim them. The third table describes the SEPs, including the rationale behind them and who is affected.

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Update: State Medicaid, Marketplace and Navigator Law Status

Posted on May 12, 2014 | Comments Off

This post provides the most updated map concerning state status on Medicaid expansion, Marketplace operation, and passage of Navigator laws.

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RWJF and Urban report discusses repealing employer mandate

Posted on May 12, 2014 | Comments Off

A new report released by the Urban Institute and the Robert Wood Johnson Foundation stated that aside from costs, there would be a minimal impact if the administration removed the Affordable Care Act’s (ACA) employer mandate. The report, Why Not Just Eliminate the Employer Mandate?, stated that repealing the provision would result in 200,000 fewer individuals being covered in 2016, 500,000 fewer receiving employer-sponsored coverage, and 300,000 more qualifying for Medicaid or health insurance subsidies. Repealing the employer mandate, which the report states is not pivotal in expanding coverage under the ACA, would remove the business industry’s main issue with the ACA. The biggest challenge with removing the employer mandate would be finding a pay-for to account for the $130 billion the provision was anticipated to generate in fines and the costs of providing more subsidies.

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New CMS rule reduces burden and promotes efficiency

Posted on May 8, 2014 | Comments Off

A final rule released by the Centers for Medicare and Medicaid Services (CMS) is designed to loosen policies that could save hospitals up to $3.2 billion over the next five years. One policy addressed removes the requirement that a physician must be present at a rural health center every two weeks, which was implemented to help combat the shortage of rural health providers. The rule also relaxes supervision requirements for some providers, such as dieticians. Easing regulations under this rule follows suit with the administration’s “regulatory lookback” that began in 2012.

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