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

IRS releases regulations on information disclosure for Health Insurance Affordability Program eligibility requirements

Posted on April 30, 2012

Today, the Federal Register published the Internal Revenue Service’s (IRS) proposed rules on the disclosure of return information under Internal Revenue Code to carry out Affordable Care Act (ACA) eligibility requirements. The proposed regulations define certain terms and prescribe certain items of return information in addition to those items prescribed by statute that will be disclosed, upon written request, under section 6103(l)(21) of the Internal Revenue Code. The IRS will disclose to the Department of Health and Human Services (HHS) certain items of return information for any relevant taxpayer—meaning any individual listed, by name and Social Security number or adoption taxpayer identification number, on the application whose income may bear upon a determination of the eligibility of an individual for an insurance affordability program, according to the proposed rules.

IRS and the Treasury Department are requesting comments by July 30 on the proposed rules and have a public hearing scheduled at 10 a.m. Aug. 31 at the IRS Building.

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Categories: Department of the Treasury, Internal Revenue Service, Key Developments

House passes student loan bill

Posted on April 27, 2012

The House passed H.R. 4628: Interest Rate Reduction Act 215-195 to hold subsidized student loan interest rates at 3.4 percent for one year. House Republicans attached a Democratically unfavorable rider to the bill. The rider would tap into the Prevention and Public Health Fund, the Affordable Care Act (ACA) provision designated to improve public health efforts such as screening programs. The White House has threatened to veto such a bill, arguing that further slashing the Prevention Fund would cause harm to those in need of preventive services.

The Senate will debate its own student loan interest rate freeze bill on May 7. While the House bill pays for the bill through cuts to the Prevention and Public Health Fund, Senate Democrats will fund the bill through tax increases on certain corporations.

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Categories: 112th Congress, Congressional Action, Legislation, Public Health

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

CMS releases final rule addressing Medicare fraud

Posted on April 24, 2012

The Centers for Medicare & Medicaid Services (CMS) published a final rule today addressing three provisions under the Affordable Care Act (ACA): 1) Medicare and Medicaid Programs; 2) Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and 3) Changes in Provider Agreements. This final rule follows up on the May 5, 2010 interim final rule with comment period. It requires all providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted under the Medicare and Medicaid programs. In addition, it requires physicians and other professionals who are permitted to order and certify covered items and services for Medicare beneficiaries to be enrolled in Medicare. Finally, it mandates document retention and provision requirements on providers and supplier that order and certify items and services for Medicare beneficiaries.

The final rule intends to prevent fraud in Medicare…

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

CMS posts correction to Stage 2 meaningful use proposed rule

Posted on April 18, 2012

The Centers for Medicare & Medicaid Services recently posted an 11-page list of corrections to its Stage 2 proposed rule on meaningful use. The CMS notice amends technical and typographical errors in the proposed rule entitled “‘Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 2.” The proposed rule was made public in February and a final rule is expected to be issued this summer. Many of corrections are semantic, although some involved actual errors (the proposed rule incorrectly identified the National Committee for Quality Assurance as the National Council on Quality Assurance, for example).

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

IRS releases NPRM on Patient-Centered Outcomes Research Trust Fund

Posted on April 16, 2012

The Affordable Care Act (ACA) includes provisions that promote research to evaluate and compare health outcomes and the clinical effectiveness, risks, and benefits of medical treatments, services, procedures, drugs, and other strategies or items that treat, manage, diagnose, or prevent illness or injury. One provision relates to the establishment of the private, nonprofit corporation, the Patient-Centered Outcomes Research Institute. The Institute will assist, through research, patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence-based medicine through the synthesis and dissemination of comparative clinical effectiveness research findings. The Internal Revenue Service (IRS) released a notice of proposed rulemaking (NPRM) regarding fees on health insurance policies and self-insured plans for the patient-centered outcomes research trust fund. The NPRM contains proposed regulations that implement and provide guidance on the fees imposed by the Affordable Care Act (ACA) on issuers of certain health insurance policies and plan sponsors of certain self-insured health plans to fund the Patient-Centered Outcomes Research Trust Fund. These proposed regulations affect the issuers and plan sponsors that are directed to pay those fees.

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Categories: Department of the Treasury, Internal Revenue Service, Key Developments

CMS releases final rule on Medicare Part C and D regulations

Posted on April 12, 2012

Today, the Centers for Medicare & Medicaid released a final rule with comment period, which revises the Medicare Advantage (MA) program (Part C) regulations and prescription drug benefit program (Part D) regulations. The final rule implements new statutory requirements strengthens beneficiary protections, excludes plan participants that perform poorly, improves program efficiencies, and clarifies program requirements. It also responds to public comments regarding the long-term care facility conditions of participation pertaining to pharmacy services.

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