Centers for Medicare & Medicaid Services

HHS publishes Exchange guidance and draft blueprint

Posted on May 16, 2012

The US Department of Health and Human Services (HHS) published guidance today on the implementation of the federally-run fallback exchange that the government will run in states that are not ready to operate a state-run exchange. In addition to the higher level operational approach, the paper also discusses how states can partner with HHS to implement selected functions in a Federally-facilitated Exchange (FFE), key policies organized by Exchange function, and how HHS will consult with a variety of stakeholders to implement an FFE. HHS also released a draft blueprint for approval of state-based or state-federal partnership exchanges. State exchanges must be certified by HHS by the beginning of 2013.

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Health Insurance, Key Developments, Office of Consumer Information and Insurance Oversight

CMS releases final rule on MLR requirements

Posted on May 12, 2012

The Centers for Medicare & Medicaid Services (CMS), a department within the U.S. Department of Health and Human Services (HHS), released final rules on Friday May 11th requiring insurers to notify subscribers when the medical loss ratio (MLR) provision of the Affordable Care Act (ACA) is met or exceeded for spending on medical claims or quality improvements. The December 2011 interim final rule and final rule on MLR only required that notices be sent to policyholders when insurers did not meet the MLR requirements.

The ACA requires both individual and small group plans to meet the MLR requirements by spending at least 80 percent of premiums on medical claims or quality improvements. Large plans are required to spend at least 85 percent. Beginning in August of 2012, insurers must refund the difference to consumers.

The goal of the notice is to educate consumers regarding the MLR measures and to help consumers know that the majority of premium payments go towards health care, as opposed to advertising, executive bonuses, or administrative overhead costs.

HHS said the rule is not expected to have an economic impact of more than $100 million a year.

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Categories: Centers for Medicare & Medicaid Services, Key Developments

HHS releases two rules to streamline regulations for hospitals and providers

Posted on May 10, 2012

Today, the Centers for Medicare & Medicaid Services (CMS) released two final rules. The first rule revises the Medicare Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs). CMS estimates that annual savings to hospitals and CAHs will be approximately $940 million per year. The second, the Medicare Regulatory Reform rule, will produce savings of $200 million in the first year by promoting efficiency. This rule eliminates duplicative, overlapping, and outdated regulatory requirements for health care providers.

Among other changes, the final rules will…

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Key Developments, Medicaid and CHIP, Medicare

CMS releases proposed rule to increase Medicaid payments

Posted on May 9, 2012

Today the Centers for Medicare & Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services (HHS), released a proposed rule on Medicaid payments. The proposed rule would implement Medicaid payment for primary care services furnished by certain physicians in years 2013 and 2014 at rates not less than Medicare rates in effect in that time period. The rule would apply to physicians who practice family medicine, general internal medicine, or pediatric medicine, and to services paid through Medicaid managed plans. The proposal also permits providers to charge higher rates for vaccinations under the federally backed Vaccines for Children program. CMS estimated the provision will cost the government $5.5 billion the first year, and $5.6 billion in the second.

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Key Developments, Medicaid and CHIP

HHS announces first 26 Health Care Innovation Awards

Posted on May 8, 2012

Health and Human Services (HHS) Secretary Kathleen Sebelius today announced the first batch of organizations for Health Care Innovation awards. The awards, a provision under the Affordable Care Act (ACA), will support 26 new innovation projects. The goals of the projects are to lower health care costs, improve quality of care, and enhance the provider workforce. The preliminary awardees announced today expect to reduce health spending by $254 million over the next 3 years.

Projects include…

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Categories: Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Key Developments

CMS issues final and proposed rules on Medicaid and community-based services

Posted on May 7, 2012

The Centers for Medicare & Medicaid Services (CMS) issued final and proposed rules on April 26 giving states more flexibility regarding community-based services and support for Medicaid enrollees. The regulations were published in today’s Federal Register.

The final rule implements section 2401 of the Affordable Care Act (ACA), which establishes a new State option to provide home and community-based attendant services and supports. These services and supports are known as Community First Choice (CFC). The regulation provides an incentive for states to expand Medicaid coverage for home and community-based services by boosting the federal match rate. To qualify for this improved federal match rate, a state must agree to develop its Community First Choice benefit, maintain a quality assurance system, and collect and report information to CMS. Additionally, during the first 12 months of Community First Choice benefit implementation, the state must maintain or exceed the level of expenditures for home and community-based services provided under the state plan, waivers or demonstration for the preceding 12 months. While this final rule sets forth the requirements for implementation of CFC, it does not finalize the section concerning the CFC setting. CMS estimated that the final rule would have an impact of $1.3 billion in FY 2012.

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Key Developments

CMS takes steps to improve transparency of demonstration waiver process

Posted on April 30, 2012

The Centers for Medicare & Medicaid Services (CMS) issued guidance on Friday, April 27 regarding the process the agency will use to review and approve state demonstration projects under Medicaid and the Children’s Health Insurance Program (CHIP). The guidance outlines how CMS plans to implement requirements for improving public input and transparency with regard to the demonstration projects. These “1115 Waivers” authorize states to test new coverage and delivery models after obtaining appropriate waivers from CMS.

The guidance, accompanied by a letter to state Medicaid directors, also introduces the user guide that CMS is providing for stakeholder organizations.

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Key Developments

Three federal agencies release request for information on stop-loss coverage

Posted on April 30, 2012

On April 27, 2012, the Department of the Treasury’s Internal Revenue Service (IRS), the Department of Labor’s Employee Benefits Security Administration, and the Department of Health and Human Services’ (HHS) Centers for Medicare & Medicaid Services (CMS) issued a request for information (RFI) regarding the use of stop loss insurance by group health plans and their plan sponsors, with a focus on the prevalence and consequences of stop loss insurance at low attachment points, or the point at which excess insurance or reinsurance limits apply.

Concerns have circulated that the practice could lead to higher costs in small group health insurance exchanges. Stop-loss insurance protects self-insured companies against claims above the attachment point. Employers and plans that purchase stop-loss insurance generally are not subject to state health insurance laws regarding coverage, rating policies, and other state and federal consumer protections, and thus could prove financially risky in the exchange market. Specifically, if the practice is widespread, it could worsen the risk pool and increase premiums in the insured small group market, including the Small Business Health Options Program (SHOP) exchanges.

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Department of Labor, Department of the Treasury, Employee Benefit Security Administration, Internal Revenue Service, Key Developments

CCIIO and IRS release simultaneous info bulletins on premium tax credits

Posted on April 27, 2012

Yesterday, the Center for Consumer Information and Insurance Oversight (CCIIO), a branch of the Centers for Medicare and Medicaid Services (CMS), released a bulletin outlining how government will verify access to employer-sponsored coverage. This is a necessary part of the process for determining eligibility for advance payments of the premium tax credit available to support the purchase of qualified health plans (QHPs) through Affordable Insurance Exchanges. The purpose of the bulletin is to request comment from the public on a proposed interim strategy and potential regulatory approach for verification of an applicant’s access to qualifying coverage in an employer-sponsored plan under section 1411 of the Affordable Care Act (ACA). The Department of Health and Human Services (HHS) also solicits comments on the development of a long-term verification strategy.

Also yesterday, the Internal Revenue Service (IRS)…

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Department of the Treasury, Internal Revenue Service, Key Developments

CMS releases bulletin providing MLR guidance

Posted on April 25, 2012

The Center for Consumer Information and Insurance Oversight (CCIIO), a division of the Centers for Medicare and Medicaid Services (CMS) recently released a bulletin providing medical loss ratio (MLR) guidance. Section 2718 of the Public Health Service Act (PHS Act), as added by the Affordable Care Act (ACA), requires health insurance issuers to submit a MLR report to the Secretary. The PHS Act also requires issuers to provide a rebate to enrollees if the issuer’s MLR is less than the applicable percentage established in the PHS Act. The CCIIO bulletin covers the following topics:

Applicability of the Medical Loss Ratio to Certain Types of Plans
Employer Groups of One
Counting Employees for Determining Market Size
Individual Association Policies
Offering Policyholders a “Premium Holiday”
Reinsurance and Reporting
Exchange User Fees
States With a Higher Medical Loss Ratio Standard
“Mini-Med” Experience – Application of the Adjustment
Form of Rebate

CMS issued a final rule implementing MLR requirements and an interim final rule implementing MLR rebate requirements in December 2011.

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Key Developments