Posted on May 29, 2013
On April 10, 2013, President Obama released his proposed FY 2014 budget, which includes $967.3 billion in outlays for the Department of Health and Human Services (HHS) and makes legislative proposals that would save an estimated $361.1 billion (net) over ten years. In conjunction with the release of the President’s budget, HHS published an overview of the budget provisions for HHS, which provides more detail on how the Department would allocate its budget in FY 2014 and describes its ongoing progress in meeting specific program goals and legislative requirements. Many of the proposals included in the President’s budget and HHS’ overview relate to the ongoing transformation of the health care delivery system to a value-based system that rewards quality and efficiency. Critical to the success of this transformation is the exchange of health information for activities such as quality measurement and reporting, value-based purchasing, consumer engagement, and comparative effectiveness research. Below are selected provisions of the HHS budget, the agency’s relevant legislative proposals for 2014, and progress reports for health care system reform efforts that require the use and exchange of health information. We also identify HHS’ stated priorities for 2014 that are related to health information…
Posted on April 29, 2013
The Center for Consumer Information and Insurance Oversight (CCIIO) released a set of eight questions on implementation of the Affordable Care Act (ACA). Specifically, this guidance clarifies the limitation provided in the Market Rule final rule stating that a plan issuer may have one geographic rating factor for each approved geographic rating area per single risk pool in a given state. The following topics are addressed in the FAQ to expand upon the meaning of this limitation:
- Withdrawal of non-grandfathered business
- Maintenance of alternative mechanisms
- Geographic rating areas
- Definition of association coverage
- Premium adjustment when coverage becomes secondary to Medicare
Issuers submitting plans to the federally-facilitated Exchanges may make necessary changes to their plans in order to comply with this new guidance.
Posted on April 26, 2013
According to a new survey released by the Commonwealth Fund, 84 million Americans were either uninsured or under-insured in 2012. In addition, 75 million Americans in 2012 were either actively paying or having difficulty paying their medical bills, indicating that medical debt is still a prominent issue. Findings were not bleak for all demographics, however, as the 2012 Biennial Health Insurance Survey also found that the proportion of uninsured individuals ages 19-25 decreased from 48% to 41% in 2012. This phenomenon is most attributable to the Affordable Care Act’s (ACA) provision that allows children to remain on their parents’ health insurance until age 26.
Posted on April 24, 2013
The US Department of Health and Human Services (HHS) Office of Minority Health released enhanced standards on Culturally and Linguistically Appropriate Services (CLAS) in health care settings. There are many determinants that inhibit the achievement of health equity, and the implementation of CLAS is one mechanism by which disparities can begin to be whittled away. Building upon the original 2000 standards, National Standards for Culturally and Linguistically Appropriate Standards in Health and Health Care: A Blueprint for Advancing and Sustaining CLAS Policy and Practice is designed to provide an organization with the information and tools necessary to mitigate health care disparities and achieve health equity by using CLAS. The enhanced standards aim to improve health equality within health care settings by addressing the categories of (1) governance, leadership, and workforce, (2) communication and language assistance, and (3) engagement, continuous improvement, and accountability.
A synopsis of the enhanced CLAS standards is also available.
Posted on April 23, 2013
By the end of September 2014, the Centers for Medicare and Medicaid Services (CMS) will launch a new website that publishes payments made to physicians and teaching hospitals by drug and device manufacturers. The website, OPEN PAYMENTS, is a product of the National Physician Payment Transparency Program required by Section 6002 of the Affordable Care Act (ACA). OPEN PAYMENTS will not only collect and aggregate data regarding potential conflicts of interests between manufacturers and providers, but it will also allow providers to access their data prior to public posting and enable them to address any data disputes.
Posted on March 13, 2013
State Health Reform Assistance Network, a program of the Robert Wood Johnson Foundation, released an issue brief detailing basic information regarding Navigators and In-Person Assistors (IPAs), two programs that will aid individuals enrolling in state insurance marketplaces. The brief specifically discusses policy and operational issues regarding the programs, as well as resources and ideas utilized by states designing their own Navigators and IPAs. This is one of several briefs intended to educate and assist state policy makers in implementing this facet of the Affordable Care Act (ACA).
Posted on March 7, 2013
US Department of Health and Human Services (HHS) released an RFI yesterday soliciting public input on policies to further advance standards-based health information exchange to support delivery system transformation. The RFI also sets out new potential policies under consideration by HHS to accelerate exchange of patient information across settings of care to facilitate more coordinated and affordable care. Comments are due by April 22, 2013.
Posted on February 11, 2013
The Centers for Medicare & Medicaid Services (CMS) issued a proposal to collect data on licenses and other information to register and monitor health insurance brokers and agents for the federal health insurance exchange. Health insurance brokers and agents would enter basic identifying information on the exchange portal during initial registration and when registration is complete, brokers and agents would be routed to CMS’s Learning Management System to complete required training and exams. CMS would use broker and agent usernames and ZIP codes to record training history and to communicate the results with the federally facilitated exchange (FFE). Under the Affordable Care Act (ACA), open enrollment in all exchanges begins Oct. 1 for plans that take effect in 2014.
Comments on the proposal are due April 8.
Posted on February 1, 2013
On January 17, 2013, the U.S. Department of Health and Human Services (HHS) issued an omnibus Final Rule, which modifies the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules, as required by the Health Information Technology for Economic and Clinical Health Act (HITECH). It also includes changes to the Privacy Rule requires by the Genetic Information Nondiscrimination Act (GINA).
The team at Health Information & the Law has written a detailed overview of the Final Rule, which highlights the key changes to the Privacy, Security, Enforcement, and Breach Notification Rules. A longer, more comprehensive analysis piece along with a comparative table of changes included in the Final Rule is forthcoming at their website, HealthInfoLaw.org.
Posted on January 29, 2013
The Centers for Medicare and Medicaid Services (CMS) has released a draft of the single, streamlined applications for both individual health insurance coverage and the SHOP applications, in preparation for the launch of the new Health Insurance Marketplace (formerly known as the Exchange) next fall. Model applications and documentation for individuals and for the small business health options program (SHOP) are now available for public comment via the paperwork reduction act (PRA).
The individual application is a single point of entry to purchase private insurance through the Marketplace and assess eligibility for assistance, including Medicaid, CHIP, and the Advanced Premium Tax Credits (PTCs). CMS has asked that people review the paper and online applications and provide feedback in the way of comments, which can be done by accessing the documents at the PRA website here.