Key Developments
CMS awards $639 million in loans to nonprofit health insurers
Posted on February 22, 2012
The Centers for Medicare & Medicaid Services (CMS) announced a total of $638.7 million in federal loans to seven nonprofit health insurance co-operatives. The groups are the first to receive loan funds under the Affordable Care Act (ACA). The purpose of these funds will be to improve quality, benefits, and premium affordability for subscribers. The creation of Consumer Operated and Oriented Plans (known as CO-OPs) is a provision under the ACA . CO-OPs are intended to be directed by their customers to offer individuals and small businesses more affordable, consumer-friendly health insurance.
CMS issued a final rule establishing the CO-OP program in December 2011 (237 HCDR, 12/9/11).
The groups receiving the awards Feb. 21 were…
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Supreme Court grants request for more time
Posted on February 21, 2012
The Supreme Court justices announced that they would lengthen the time allotted to hear the Anti-Injunction Act issue from 60 to 90 minutes. This issue surrounds whether the justices have the authority to decide whether the Affordable Care Act’s (ACA’s) minimum coverage provision is constitutional. This will bring the case to a total of six hours, making it the longest Supreme Court case in modern history. For the Anti-Injunction Act, the court will hear from a third-party attorney for 40 minutes, the Justice Department for 30 minutes, and the NFIB and the states will get 20 minutes. Next, the justices will hear two hours regarding whether the insurance mandate is constitutional. This issue of the severability of the individual mandate from the rest of the ACA will receive two and a half hours. The court will finally spend an hour on the states’ challenges to Medicaid expansion.
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Senate passes payroll-tax cut extension
Posted on February 17, 2012
In a vote of 60 to 36, the Senate passed a $150 billion economic package to extend the payroll tax holiday, unemployment compensation, Medicare physician payment, provide for the consideration of the Keystone XL pipeline, and for other purposes. The package will extend a payroll tax holiday for 160 million workers and unemployment benefits for the rest of the year. The bill passed in the House earlier today. The legislation will now go to President Obama, awarding him a victory on a portion of the jobs bill he presented to Congress in the fall.
The package will take the first significant…
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HHS releases fact sheet regarding MLR waiver requests
Posted on February 17, 2012
The Obama administration denied Wisconsin’s request for a waiver from the health law’s medical loss ratio, but partially approved North Carolina’s. These two decisions conclude the review the Department of Health and Human Service (HHS) has conducted of the 17 states that have requested a waiver from the law’s requirement that individual market health plans spend at least 80 percent of premiums on medical care or give customers rebates. In total, HHS has rejected 10 requests (North Dakota, Delaware, Texas, Kansas, Oklahoma, Florida, Indiana, Louisiana, Michigan and Wisconsin) and approved modified applications from seven states (Maine, New Hampshire, Kentucky, Nevada, Iowa, Georgia and North Carolina).
Wisconsin wanted a lower ratio of…
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HHS releases FAQs on EHB
Posted on February 17, 2012
On December 16, 2011, the Department of Health and Human Services (HHS) released a Bulletin describing the approach it intends to take in future rulemaking to define the essential health benefits (EHB) under the Affordable Care Act. This document of frequently asked questions (FAQs) is intended to provide additional guidance on HHS’s intended approach to defining EHB. This bulletin describes a comprehensive, affordable and flexible proposal and informs the public about the approach that HHS intends to pursue in rulemaking to define EHB. HHS intends to propose that EHB are defined using a benchmark approach. Under the department’s intended approach, states would have the flexibility to select a benchmark plan that reflects the scope of services offered by a “typical employer plan.” This approach would give states the flexibility to select a plan that would best meet the needs of their citizens.
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HHS releases white paper on EHB
Posted on February 14, 2012
The Affordable Care Act (ACA) identified ten categories of services and items to be included in essential health benefits (EHBs), and specified that the scope of EHBs must be equal to the scope of benefits provided under a typical employer plan. The ten categories include: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
A white paper issued in December by the Department of Health and Human Services’s Office of the Assistant Secretary for Planning and Evaluation (ASPE) found…
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FY2013 budget targets Medicare and Medicaid
Posted on February 13, 2012
Today, President Obama released the fiscal year 2013 (FY2013) budget. The budget totals $940.9 billion, and outlays $76.7 billion for the Department of Health and Human Services: 56 percent for Medicare, 30 percent for Medicaid and 8 percent for discretionary programs. The department will use these funds to invest in health care, disease prevention, social services, and scientific research.
The budget seeks $358.5 billion in savings in Medicare and Medicaid…
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Obama announces contraception compromise
Posted on February 11, 2012
On Friday, President Obama announced that the administration would compromise on the preventive services final rule. The final rule, an update to the interim final rule released in August, would have required religiously affiliated entities to cover contraceptive care without any cost-sharing requirements. The new final rules mandate that nonprofit organizations affiliated with religious institutions that do not cover contraception based on their beliefs will not have to include it in their coverage. However, health insurers that provide the policies used by those nonprofit religious affiliates, which include educational institutions, hospitals, and charities, are required to offer separate insurance policy “riders” that cover contraceptive care at no additional cost. The announcement came after many Catholic organizations and Republicans had strongly objected to the original final rule that the Department of Health and Human Services had announced on January 20th.
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IRS and Treasury release FAQs about ACA automatic enrollment, employer shared responsibility, and waiting periods
Posted on February 10, 2012
The Internal Revenue Service answered frequently asked questions related to automatic enrollment, employer shared responsibility payments, and waiting periods under the Affordable Care Act (ACA). The notice addressed employers’ questions and invited comments on proposals that the Treasury, Labor, and Health and Human Services departments expect to include in future guidance or rulemaking under the ACA.
The notice included the following information…
Final rule released requiring insurers to use plain language in describing benefits, coverage
Posted on February 9, 2012
Today the Department of Health and Human Services, the Department of Treasury, and the Department of Labor released a final rule requiring insurers to use plain language in describing health plan benefits and coverage under the Affordable Care Act (ACA). The regulations mandate health insurers and group health plans to provide concise and comprehensible information about health plan benefits and coverage to Americans with private health coverage. The new rules will also facilitate easier plan comparison for individuals and employers. The new explanations, available on or soon after September 23, 2012, will be a critical resource for the roughly 150 million Americans with private health insurance. Specifically, these rules will ensure consumers have access to two key documents that will help them understand and evaluate their health insurance choices…
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- The Center for Medicare and Medicaid Innovation: A Year’s Progress posted on January 26, 2012
- Chronic Disease Management posted on February 23, 2011
- Constitutional Challenges Update: Florida et al. v United States Department of Health and Human Services posted on January 4, 2012
- Hospital Readmissions Reduction Program posted on November 1, 2011
- State Health Insurance Exchange Navigators posted on February 28, 2011
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Recent Posts
- Supreme Court grants request for more time
- Senate passes payroll-tax cut extension
- HHS releases fact sheet regarding MLR waiver requests
- HHS releases FAQs on EHB
- Health Affairs and RWJF release report examining SHOP exchanges
- RAND Corporation releases report on ACA without individual mandate
- Challenges to the Affordable Care Act: Highlights from the Supreme Court Briefs (updated weekly)
- IOM summarizes workshop on facilitation of State Health Exchange communication
- Gallup survey shows fewer Americans received employer health insurance in 2011
- NEJM article addresses federalism and EHB
