Implementation Briefs
The Center for Medicare and Medicaid Innovation: A Year’s Progress
Posted on January 26, 2012
Improving the quality of care delivery and reducing explosive growth in healthcare costs is a cornerstone of The Patient Protection and Affordable Care Act (ACA). It reflects the shared understanding that the current silo-based approaches to care delivery that focus on settings of care (e.g., physician office, hospital) rather than care delivery across multiple providers and setting (e.g., episodic) are not working. Costs are increasing at an unsustainable pace, and evidence from leading researchers collectively points to serious deficiencies in health care quality and the disconnect between high spending and health care quality.
To foster the development of more collaborative and…
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Update to Consumer Operated and Oriented Plan (CO-OP) Program: Final Rule
Posted on January 18, 2012
The Centers for Medicare and Medicaid Services (CMS) issued its final rule implementing the Consumer Operated and Oriented Plan (CO-OP) Program on December 13, 2011. This rule finalizes the notice of proposed rulemaking (NPRM) issued by CMS on July 20, 2011, and takes into consideration the numerous comments received during the public notice and comment period ending September 16, 2011. Established by §1322 of the Affordable Care Act (ACA), the CO-OP program develops and creates new private, non-profit health insurance issuers to offer qualified health plans (QHPs) through state Exchanges as an alternative for consumers to traditional, for-profit plans. CO-OP plans are consumer-run, and accountable to their individual membership in a way that most traditional for-profit health plans typically are not. The ACA requires HHS to award funds for start-up loans and solvency grants to eligible CO-OP applicants in order to enable each state to have at least one CO-OP. In making these awards, HHS must take into account recommendations from the Advisory Board created by ACA §1322(b)(2). Two previous Implementation Briefs provided an overview of the CO-OP program and set forth the key provisions of the proposed rule; this update describes significant changes to the proposed rule as codified in the final rule.
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Independent Payment Advisory Board (IPAB)
Posted on January 13, 2012
Section 3403 of the Affordable Care Act (ACA) established the Independent Payment Advisory Board (IPAB), a 15-member panel of appointed experts that will recommend cost-saving measures for Medicare. In the face of controversy about its structure and powers, legislation has been introduced in the 112th Congress to repeal its establishment.
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Constitutional Challenges Update: Florida et al. v United States Department of Health and Human Services
Posted on January 4, 2012
On November 14, 2011 the United States Supreme Court agreed to hear oral arguments on issues that have arisen as a result of more than two dozen legal challenges to the Affordable Care Act (ACA) that were filed upon or immediately following the March 2010 enactment of the health reform law. The Court will consider four constitutional issues related to the ACA: (1) whether Congress has the power under Article I of the Constitution to enact the coverage requirement; (2) if the coverage requirement is found unconstitutional, whether it is severable from the remainder of the ACA; (3) whether the ACA’s requirement that states expand Medicaid eligibility or risk losing federal funds is unduly coercive in violation of the Tenth Amendment; and (4) whether the individual coverage requirement is a tax for purposes of the Anti-Injunction Act, meaning that plaintiffs seeking to challenge the requirement must wait until it takes effect in 2014.
Oral arguments are set for March 26-28, 2012, and a decision is expected by the end of the Court’s term in late June of 2012.
Update: Essential Health Benefits
Posted on December 20, 2011
On December 16, 2011, the HHS Center for Consumer Information and Insurance Oversight (CCIIO) released an Essential Health Benefits Bulletin, whose purpose is to “provide information and solicit comments on the regulatory approach that the Department of Health and Human Services (HHS) plans to propose to define essential health benefits under section 1302 of the Affordable Care Act.” Comments on the Bulletin can be sent directly to EssentialHealthBenefits@cms.hhs.gov and will be accepted until January 31, 2011
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Update: Racial and Ethnic Disparities in Health and Health Care
Posted on December 1, 2011
This post serves as an Implementation Update to our previous Implementation Brief on racial and ethnic disparities, originally posted April 15, 2010. The Update reflects changes made by HHS in their recently-released health survey standards.
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Employer Responsibilities under the Affordable Care Act
Posted on November 21, 2011
Under federal law, employers are not required to offer health insurance coverage to their employees; however, most do voluntarily. In fact, employer-sponsored health insurance is the primary source of health care coverage for most Americans, with roughly 60 percent of the non-elderly receiving health coverage through the workplace. Initially offered as a way to attract workers during wartime wage freezes and price controls, health insurance coverage is still used as a way to recruit and retain workers, and as a means of improving employees’ health and productivity. However, not all workers have health insurance. Indeed, three-fourths of the approximately 50 million uninsured Americans are working people and their dependents.
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Update: Medicare Shared Savings Program for Accountable Care Organizations
Posted on November 8, 2011
While a primary aim of the Affordable Care Act (ACA) was to increase access to affordable health insurance coverage, a critical, although less publicized, component of the law is a series of provisions designed to improve health care quality and efficiency and to advance the concept of “value-based purchasing.” The Agency for Health Care Research and Quality (AHRQ) defines the concept of value-based purchasing as holding “providers of health care accountable for both the cost and quality of care.” AHRQ notes that “value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. This strategy can be contrasted with more limited efforts to negotiate price discounts, which reduce costs but do little to ensure that quality of care is improved.”
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Hospital Readmissions Reduction Program
Posted on November 1, 2011
Hospitals in the United States readmit an average of 20% of Medicare patients within thirty days of their initial discharge. These readmissions cost the Medicare program an estimated 12 billion dollars each year and may be an indicator of poor quality of care where the readmission was potentially preventable. In its June 2007 Report to Congress, the Medicare Payment Advisory Commission (MedPAC) classified many hospital readmissions as potentially preventable. Based on these recommendations, Congress included the Hospital Readmissions Reduction Program (HRRP or Program) in the Affordable Care Act. CMS issued the final rule implementing the HRRP on August 18, 2011, although CMS will continue to clarify additional details of the program through future rulemaking.
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Update on Essential Health Benefits: The Institute of Medicine Report
Posted on October 21, 2011
Under the Affordable Care Act (ACA) beginning January 1, 2014, state insurance Exchanges become operational and comprehensive insurance market reforms take effect. One of the most significant market reforms is the requirement that all health insurance plans sold in the individual and small group (100 employees or fewer) markets – whether sold outside or inside state insurance Exchanges – cover “essential health benefits” (EHBs). The definition of EHBs also will apply to Medicaid “benchmark” plans, the specified coverage standard for individuals made newly eligible by the ACA’s Medicaid expansions.
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Most Popular Content
- Constitutional Challenges Update: Florida et al. v United States Department of Health and Human Services posted on January 4, 2012
- The Center for Medicare and Medicaid Innovation: A Year’s Progress posted on January 26, 2012
- Chronic Disease Management posted on February 23, 2011
- Hospital Readmissions Reduction Program posted on November 1, 2011
- Update to Consumer Operated and Oriented Plan (CO-OP) Program: Final Rule posted on January 18, 2012
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