Health Insurance
WA releases Exchange premiums
Posted on May 20, 2013
The Washington State Office of the Insurance Commissioner (OIC) recently released proposed premium rates for their state-based health insurance Exchange, Washington Health Plan Finder. Fears of rate increases were assuaged, as the plans presented ultimately indicated more coverage at a reduced cost, attributable to Washington’s already competitive insurance market. The proposed rates must be evaluated by OIC prior to being issued on the Exchange.
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CMS sets PCIP payment at Medicare rates
Posted on May 20, 2013
In an Interim Final Rule released Friday, the Centers for Medicare and Medicaid Services (CMS) stated that as of June 15th, payment rates for the federal Pre-Existing Condition Insurance Plan (PCIP) will be set to those of Medicare. Until the passage of the Affordable Care Act (ACA), many Americans with pre-existing conditions were denied insurance coverage or charged exorbitantly high premiums. PCIP, which was created under the ACA, was allocated $5 billion to enable those with pre-existing conditions to obtain insurance prior to 2014. 135,000 otherwise uninsured individuals with pre-existing conditions were granted coverage under PCIP, with claims averaging $32,108 per enrollee. Changes in PCIP payments were authorized in order to ensure program solvency until 2014. One specific example is the provision in which payments to skilled nursing facilities may be reduced by 50% as of June 15, 2013.
Enrollment in federal PCIP programs was capped in February due to funding concerns. Enrollment in the 27 state-operated PCIP programs was suspended several weeks later. As of now, 17 of the state-operated PCIP programs will be administered by the US Department of Health and Human Services (HHS) for the duration of the year.
Enrollment in federal PCIP programs was capped in February due to funding concerns. Enrollment in the 27 state-operated PCIP programs was suspended several weeks later. As of now, 17 of the state-operated PCIP programs will be administered by the US Department of Health and Human Services (HHS) for the duration of the year.
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CCIIO provides additional guidance on Navigators and Marketplace assistance
Posted on May 17, 2013
The Center for Consumer Information and Insurance Oversight (CCIIO) issued additional information on navigators and other consumer assistance and outreach programs provided by the Affordable Care Act (ACA). The document expands upon the standards with which these assistors must comply, available grant funding, and the differences between the assistance programs.
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CCIIO releases Marketplace FAQ
Posted on May 17, 2013
The Center for Consumer Information and Insurance Oversight (CCIIO), a division of the Centers for Medicare and Medicaid Services (CMS), recently posted new guidance concerning federally-facilitated and state-based Exchanges (Marketplaces) established under the Affordable Care Act (ACA). The guidance purports that if states do not adhere to and enforce the requisite standards for health insurance issuers in federally-facilitated Exchanges, then CMS intends to coerce enforcement through civil penalties and plan decertification. CMS does not believe that decertification will be a common occurrence. In addition, the guidance stated that qualified health plans (QHP) paired with health savings accounts (HSA) must meet the cost-sharing reduction standards that apply to low income-individuals.
CCIIO published additional guidance that expands upon which activities, in both federally-facilitated and state-based Marketplaces, that qualify for grant funding under ACA Section 1311. For instance, state-based Marketplaces are not permitted to use this funding for navigator outreach and education, yet they are allowed to use Section 1311 funds for “in-person assistance programs.”
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Update: Frequently Asked Questions on Patient Cost-Sharing Under the ACA – Set 12
Posted on May 16, 2013
The ACA contains numerous provisions affecting patient cost-sharing, both generally and in relation to specific services. Some of the provisions (such as those related to preventive services and annual limits on out-of-pocket cost-sharing) apply across multiple coverage markets (i.e., to health insurance products sold in both the individual and group markets as well as to self-insured plans). Other provisions, such as those governing deductibles applicable to the essential health benefit (EHB) package, apply only to those markets that are subject to the EHB requirement, i.e., health plans sold in the individual and small group (under 100 full-time employees) market. In general, the cost-sharing rules exempt grandfathered health plans.
CBO releases new report describing budgetary impact of the ACA
Posted on May 15, 2013
The Congressional Budget Office (CBO), in conjunction with the Joint Committee on Taxation (JCT), issued updated budget projections for fiscal years 2014-2023, which include updated impact estimates of the insurance provisions in the Affordable Care Act (ACA). Slower than anticipated growth in health care spending, particularly in programs such as Medicare and Medicaid, is one of several factors that influenced the revised estimates…
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CMS publishes FAQ on ECP
Posted on May 14, 2013
In a set of FAQ’s released yesterday, the Centers for Medicare and Medicaid Services (CMS) addressed the basics of Essential Community Providers (ECPs) within the Affordable Care Act (ACA). ECPs are health care providers that typically cater to medically needy, low-income individuals. Pursuant to the ACA, issuers that wish to offer qualified health plans (QHP) in health insurance Exchanges must have a sufficient number of ECPs geographically distributed throughout their networks. The FAQ set from CMS provides a basic outline of ECP criteria, including a link to a non-exhaustive list of ECPs and clarification on what CMS deems an “available” ECP.
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IRS updates guidance with MLR proposed rule
Posted on May 14, 2013
According to a proposed rule released by the Internal Revenue Service (IRS), “activities that improve health quality” can not be used to determine Blue Cross and Blue Shield’s Medical Loss Ratio (MLR) in regards to obtaining their tax-exempt status. According to the Affordable Care Act (ACA), insurance companies lose their tax privilege under tax code Section 833 and the MLR if they do not spend 85% of their premium revenue on enrollee medical services. Until this proposed rule was released, interim guidance permitted insurance companies to count health care quality activities toward their 85%.
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CCIIO will amend Exchange regulations for Utah
Posted on May 10, 2013
In a letter addressed to the governor of Utah, Center for Consumer Information and Insurance Oversight (CCIIO) Director Gary Cohen stated that CCIIO will release updated regulations that will permit Utah to operate their small business health option program (SHOP) while the federal government runs the individual Exchange. The letter addresses how Utah and the federal government will divvy up responsibilities concerning navigators and plan management, as well as data reporting requirements for their SHOP. In addition, the letter purports that other states may also pursue a similar Exchange model.
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Urban assesses impact of capping tax exemption for employer-sponsored coverage
Posted on May 10, 2013
According to a study recently released by the Urban Institute, capping the tax exemption for employer-sponsored coverage could generate $264 billion in revenue by 2023. Limiting the Tax Exclusion of Employer-Sponsored Health Insurance Premiums: Revenue Potential and Distributional Consequences, funded by the Robert Wood Johnson Foundation, recommends capping the top 25% most expensive health benefits to raise this amount. The study finds such an option would lead to a 16% tax increase for those who file taxes in 2014, and a 20% increase for those who file in 2023.
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- 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
- Reform Overview posted on April 12, 2010
- 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
- Navigators and Application Counseling and Assistance posted on April 24, 2013
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Recent Posts
- 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
- CCIIO releases Marketplace FAQ
- Update: Frequently Asked Questions on Patient Cost-Sharing Under the ACA – Set 12
- CBO releases new report describing budgetary impact of the ACA
- CMS publishes FAQ on ECP
- IRS updates guidance with MLR proposed rule
