Key Developments

HHS awards Affordable Insurance Exchange grants to 13 states and releases new FAQs

Posted on November 30, 2011

The Department of Health and Human Services (HHS) awarded nearly $220 million in Affordable Insurance Exchange grants to 13 states (Alabama, Arizona, Delaware, Hawaii, Idaho, Iowa, Maine, Michigan, Nebraska, New Mexico, Rhode Island, Tennessee, and Vermont) to booster Exchange creation. The grants will provide the states with more flexibility and resources to implement the Exchange provisions under the Affordable Care Act (ACA). To date, forty-nine states and the District of Columbia have received planning grants, and 45 states have consulted with consumer advocates and insurance companies. Thirteen states have passed legislation to create an Exchange.

The Department also released several new Frequently Asked Questions, which provide information states may need as they begin creating the Exchange marketplaces. Critical among this new information is that states that run Exchanges have more options than originally proposed regarding eligibility determination for tax credits and Medicaid. States also have more time to apply for “Level One” Exchange grants.

To read more about the Exchanges, click here.

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Categories: Department of Health and Human Services, Health Insurance, Key Developments

CMS announces new deadlines for Advance Payment Model

Posted on November 30, 2011

The Advance Payment Accountable Care Organization (ACO) Model is an initiative developed by the Centers for Medicare and Medicaid (CMS) Innovation Center designed for organizations participating as ACOs in the Medicare Shared Savings Program (Shared Savings Program). Through the Advance Payment Model, selected participants in the Shared Savings Program will receive advance payments that will be recouped from the shared savings they earn. CMS released a notice today announcing the new application deadline for participation in the Advance Payment Model for certain ACOs. Applications for the performance period beginning on April 1, 2012 will be accepted from January 3, 2012 through February 1, 2012. The period during which applications will be accepted for the performance period beginning on July 1, 2012 will remain identical to the period for the Medicare Shared Savings Program.

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

Departments release FAQs on ACA, Mental Health Parity

Posted on November 22, 2011

According to a set of frequently asked questions (FAQs) recently released by the Departments of Health and Human Services (HHS), Treasury (DOT), and Labor (DOL), the final rule under an Affordable Care Act (ACA) provision, which requires health care insurers and group health plans to make available to consumers a standardized summary of the benefits and coverage for each plan they offer, will be released “as soon as possible.” The FAQs pertain to implementation of ACA market reform provisions and mental health parity requirements. Until this final rule is released, plans are not required to comply with the proposed rule’s provisions. The ACA requires plans to provide consumers with a standardized form containing definitions of benefits and information on coverage. Along with the benefits and coverage summary, the departments also included several FAQs addressing the implementation of the Mental Health Parity and Addiction Equity Act of 2008, which mandates equal treatment for medical and surgical care and mental health and substance use disorder care in areas such as out-of-pocket costs and benefit limits and practices.

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Categories: Department of Health and Human Services, Department of Labor, Department of the Treasury, Key Developments

HHS announces release of tool for small businesses to compare health insurance plans

Posted on November 18, 2011

The U.S. Department of Health and Human Services announced the release of a greatly expanded website to give small business owners a venue to review health insurance plan choices. The tool enables small business owners to compare the benefits and costs of health plans and choose those that are best for their employees. Small businesses will be able to research locally available products in an unbiased manner. The aim of the tool is to foster a more transparent and competitive marketplace. At present, the market is often difficult to analyze and small businesses do not fare as well as their large employer counterparts when negotiating health care prices. Ideally, the new tool will help ensure insurance companies will compete for business on the basis of price and quality.

The tool was created under requirements contained in the Affordable Care Act (ACA). The Centers for Medicare & Medicaid Services collected information from insurers across the country to develop the site.

Information on the website includes:

Insurance product choices for a given ZIP code, sorted by out-of-pocket limits, average cost per enrollee, or other factors.
A summary of cost and coverage for small group products that shows the available deductibles, range of co-pay options, included and excluded benefits, and benefits available for purchase at additional cost.
The ability to filter product selection based on whether the plans are Health Savings Account eligible, have prescription drug, mental health, or maternity coverage, or allow for domestic partner or same sex coverage.

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

CHIP open to children of low-income State employees

Posted on November 7, 2011

Prior to passage of the Affordable Care Act (ACA), section 2110(b) of the Social Security Act excluded children who were eligible for health benefits coverage under a State health benefits program from CHIP. Over time, however, it became clear that in some States, children of State employees do not have access to affordable, comprehensive coverage options. Many of these children were within the income eligibility level of their State’s CHIP program. Section 10203(b)(2)(D) of the ACA amends the definition of a targeted low-income child by permitting States to extend CHIP eligibility to children of State employees who are otherwise eligible under the State child health plan. At least six states have taken advantage of the new provision.

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

HHS releases final standards to measure health care disparities

Posted on October 31, 2011

On October 31st, The U.S. Department of Health and Human Services (HHS) released final standards to measure health care disparities based on race, ethnicity, sex, primary language, and disability status, as required by the Affordable Care Act (ACA). Making these data standards consistent will help identify significant health disparities that often exist between and within ethnic groups. For example, a study showed that the diabetes-related mortality rate for Mexican Americans (251 deaths per 100,000) and Puerto Ricans (204 deaths per 100,000) was twice as high as the diabetes-related mortality rate for Cuban Americans (101 deaths per 100,000). However, these data would have remained unexamined had only the umbrella terms of “Hispanic” or “Latino” been used. By adding different ethnic origins as explicit categories on all HHS-sponsored health surveys, the government hopes to better capture and track the health differences and thus target interventions more appropriately.

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Categories: Department of Health and Human Services, Disparities, Health Care Quality and Delivery System Reform, Key Developments

CMS selects 500 FQHCs for Advanced Primary Care Practice demonstration project

Posted on October 24, 2011

The Centers for Medicare and Medicaid Services (CMS) announced today that 500 Federally Qualified Health Centers (FQHCs) have been selected to participate in the Advanced Primary Care Practice demonstration project. These 500 centers will receive $42 million over three years to improve quality and coordination of health care delivery. The project is designed to evaluate the patient-centered medical home model. The goal of the model is to improve patient health and the quality of health care delivery while lowering the cost of of care. HRSA and the Center for Medicare and Medicaid Innovation Center developed the demonstration, which will be conducted from November 1, 2011 through October 31, 2014.

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Categories: Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Disparities, Health Care Quality and Delivery System Reform, Health Resources & Services Administration, Key Developments, Medicaid and CHIP, Uncategorized

CMS releases ACO final rule, others agencies weigh-in

Posted on October 20, 2011

The Centers for Medicare and Medicaid Services (CMS) released the much anticipated Accountable Care Organization (ACO) final rule, implementing section 3022 of the Affordable Care Act (ACA), which contains provisions relating to Medicare payments to providers of services and suppliers participating in ACOs under the Medicare Shared Savings Program. The rule on Medicare ACOs relaxes eligibility requirements for doctors and hospitals to participate by halving the number of performance measurements (65 to 33), removing the electronic medical records (EMR) requirement, and eliminating some financial risks. CMS also extended the deadline for ACO applications through 2012. As enticement to rural doctors and physician-owned practices, CMS said it would dedicate $170 million to said providers to start ACOs. Regulators estimate that between 50 and 270 ACOs will be established in the next 3 years, which will affect the care of 4% of Medicare beneficiaries.

Multiple federal agencies also released rules and guidance on fraud & abuse and antitrust issues related to ACOs. The HHS Office of Inspector General (OIG) issued an interim final rule (IFR) on the waiver of certain fraud and abuse provisions and the Department of Justice (DOJ) issued a statement on health care antitrust enforcement policies.

To read more about ACOs, click here.

For the ACO final rule fact sheet, click here.

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Categories: Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Department of Justice, Health Care Quality and Delivery System Reform, Health Insurance, Key Developments, Medicare, Office of Inspector General, Rulemaking, Rules, and Guidance

CMS releases proposed rules to save health care system about $1.1 billion per year

Posted on October 18, 2011

The Centers for Medicare & Medicaid Services (CMS) released new proposed rules today that would save hospitals and health care providers nearly $1.1 billion each year. The US Department of Health and Human Services (HHS) Secretary Kathleen Sebelius explained that the proposals “eliminate unnecessary and obsolete standards and free up resources,” thus allowing providers and hospitals to focus on patient care. One proposed rule would update the Medicare Conditions of Participation, the rules for hospitals that treat Medicare and Medicaid patients. Another NPRM would eliminates redundant, outdated, and conflicting regulatory requirements for health care providers and suppliers. These efforts are part of the wider-ranging reforms that the Obama Administration hopes to implement. The goal is to improve the quality of health care delivery and lower the associated costs for Americans.

For a summary of the rules, click here.

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Health Care Quality and Delivery System Reform, Health Insurance, Key Developments, Medicaid and CHIP, Medicare, Rulemaking, Rules, and Guidance

HHS Secretary Sebelius announces drop of CLASS Act

Posted on October 14, 2011

The U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius wrote a letter to Congress earlier today announcing that the Obama administration has given up on the Community Living Assistance Services and Supports (CLASS) program. The goal of the CLASS initiative was to improve long-term care insurance options for Americans. The CLASS Act was championed by the late Senator Edward M. Kennedy and Republicans have opposed the initiative since its introduction as part of last year’s health care law.

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Categories: Department of Health and Human Services, Health Care Quality and Delivery System Reform, Health Insurance, Key Developments, Long Term Care, Office of the Secretary