Archive: November 2010
Agency Profile: Office of Consumer Information and Insurance Oversight
Posted on November 29, 2010
The responsibilities for implementing the Affordable Care Act are spread across several federal departments and the offices within them. This is the latest in a series of briefs developed by HealthReformGPS describing the implementing agencies and their roles.
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IRS issues guidance, solicits comments on branded drug annual fees
Posted on November 29, 2010
The Internal Revenue Service (IRS) issued guidance and requested comments on annual fees paid by drug companies under the Affordable Care Act (ACA). The fees apply to covered entities who sell branded drugs to publicly-financed health care programs, such as Medicare & Medicaid, TRICARE, and the Veterans Administration (VA). The guidance includes a proposed methodology for calculating the fee. Public comments are due by June 2, 2011.
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CMS issues final rule on Prospective Payment System for hospitals
Posted on November 24, 2010
CMS issued a final rule on the Medicare Outpatient Prospective Payment System (OPPS) for hospitals. The rule aligns Medicare payments with new provisions in the Affordable Care Act and describes factors used to determine payment rates for Medicare hospital outpatient services.
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Update: Medical Loss Ratio and Rebates in Private Health Insurance
Posted on November 23, 2010
This is an updated version of a brief originally published on August 25, 2010. This brief is current as of November 22, 2010.
A medical loss ratio (MLR) is the proportion of premium dollars that an insurer spends on health care services relative to health insurance premium paid by subscribers. Prior to the enactment of the health reform law, the federal government required Medicare supplemental insurance (or Medigap policies) to meet minimum federal loss ratio requirements, but did not establish federal standards to define how insurers should categorize losses, nor did those requirements apply to other types of private insurance policies.
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CRS issues memo marking key deadlines in first year of health reform
Posted on November 23, 2010
The Congressional Research Service (CRS) issued a Congressional Distribution Memorandum summarizing all deadlines that require specific federal action within the first year of the Affordable Care Act (ACA). The memo focuses on provisions in the law that require action be taken by a specific date falling between March 23, 2010 and March 23, 2011.
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AHIP issues summary highlighting key provisions of recent IFR related to MLR
Posted on November 23, 2010
America’s Health Insurance Plans (AHIP) released a summary document highlighting key provisions of the interim final rule (IFR) relating to MLR requirements under the Affordable Care Act (ACA). The document summarizes reporting requirements and activities, MLR calculation, and enforcement rules.
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HHS announces new funds to help address primary care workforce shortages
Posted on November 22, 2010
Today, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced $290 million in new funding from the Affordable Care Act (ACA) for the National Health Service Corps (NHSC) Loan Repayment Program to help increase the number of primary care providers in medically underserved areas. These funds will allow $60,000 in loan debt forgiveness to medical, dental, and mental health primary care providers who commit to practicing 2 years in an NHSC-designated service area. Additionally, the ACA allows for more leeway in administering NHSC funds, such as the opportunity to work full-time or half-time, as well as total loan forgiveness for a commitment of six years.
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HRSA announces $8 million in new funds to modernize community health centers
Posted on November 22, 2010
On November 19, 2010, the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services (HHS) announced $8 million in grant money to community-based organizations that support community health centers. These grants are funded out of the Affordable Care Act (ACA), and are designed to pay for enhanced training and technical assistance to help modernize community health centers.
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HHS releases Medical Loss Ratio Interim Final Rule
Posted on November 22, 2010
The Department of Health and Human Services Office of Consumer Information and Insurance Oversight (OCIIO) has released an interim final rule with request for comment implementing the medical loss ratio requirements for health insurance issuers under the health reform law. Along with the regulation, OCIIO released a fact sheet and Regulatory Impact Analysis Technical Appendix.
For more, visit our updated Medical Loss Ratio Implementation Brief.
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Update: Health Insurance Exchanges
Posted on November 22, 2010
The Affordable Care Act establishes “American Health Benefit Exchanges” (serving individuals) and “SHOP” Exchanges (serving small employer groups), to be operated by states that elect to establish exchanges for individuals and employer groups through which they can buy “qualified health plans.”
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Most Popular Content
- State Health Insurance Exchange Navigators posted on February 28, 2011
- The QHP Certification Process in Federally-Facilitated Exchanges: Network Adequacy and Essential Community Providers posted on March 27, 2013
- Summary of the U.S. Supreme Court decision in the case of National Federation of Independent Businesses et al. v. Sebelius, Secretary of Health and Human Services, et al. posted on June 28, 2012
- Update: Essential Health Benefits Final Rule posted on March 13, 2013
- Reform Overview posted on April 12, 2010
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Recent Posts
- CA releases proposed premium rates for 2014
- NEJM article correlates decline in health spending to recession
- EBRI study explores trends in part-time health coverage
- CO releases 2014 Exchange rates
- CMS State Resources FAQ: Medicaid Eligibility Determinations, Medicaid/Exchange Interactions, and §1115 Demonstrations that Use Enrollment Caps
- CMS letter addresses enrollment strategies for Medicaid and CHIP
- WA releases Exchange premiums
- CMS rule requires MA and Medicare Part D to comply with MLR
- CMS sets PCIP payment at Medicare rates
- CCIIO provides additional guidance on Navigators and Marketplace assistance
