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Commonwealth Fund study finds most states unprepared for 2014 implementation

Posted on February 1, 2013 | No Comments

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An issue brief recently released by the Commonwealth Fund examines state action on a subset of Affordable Care Act provisions, including guaranteed access to coverage and a ban on preexisting condition exclusions. These protections go into effect in 2014. The analysis finds that, to date, only one state passed new legislation on all of these protections, and an additional 10 states and the District of Columbia passed new legislation or issued a new regulation on at least one of the two. The analysis also finds that some states face limitations in fully enforcing these reforms. According to the report, these findings suggest an acute need for states to take action in 2013 to help ensure that consumers are fully protected by and benefit from the ACA’s most significant reforms.

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CMS releases Exchange outreach timeline
April 22, 2013
In response to concerns expressed by the US Senate regarding the slow outreach efforts for the Exchanges, the Centers for Medicare and Medicaid Services (CMS) released the "Consumer Outreach Timeline." This succinct outline divides the outreach and education efforts into 4 phases: Preparation, Basic Education, Anticipation and Act Now. CMS is currently in the Preparation and Basic Education phases, which includes the continued development of infrastructure and raising awareness amongst consumers and stakeholders. A narrative version of the timeline has also been released by the Center for Consumer Information and Insurance Oversight.
CMS releases final Letter to Issuers on Exchanges
April 9, 2013
On April 5th, the Centers for Medicare and Medicaid Services (CMS) released a final letter regarding Federally-facilitated and State Partnership Exchanges. The draft version of this letter was made public at the beginning of March. The Letter to Issuers reaffirms that states will be, for the most part, responsible for qualified health plan (QHP) certification, including network adequacy. Below are significant points discussed in the final letter:
  • Plans that do not meet the minimum requirements for Essential Community Provider inclusion may still be considered a QHP.
  • The letter gives a more specific interpretation of what constitutes a "meaningful difference" between QHPs.
  • Large and small group QHPs have an additional year to comply with the single out-of-pocket limit for all services, and mental health services are not included in the major medical out-of-pocket limit.
  • In non-partnership states, there is no deadline by which CMS must review state evaluations of QHP certification.
  • CMS will create technology that allows individuals to enroll into the Exchange through an issuer's website or a web-broker.
  • Ancillary plans cannot be sold on the Exchange, but may be sold on non-Exchange programs within the same infrastructure.
 
CMS issues guidance on exchange participation
March 27, 2013
The Centers for Medicare and Medicaid Services (CMS) released a draft letter to issuers regarding Federally-facilitated and State Partnership Exchanges. This guidance letter offers technical and operational guidance that will permit Qualified Health Plan (QHP) issuers to operate successfully in Federally-facilitated Exchanges and Federally-facilitated SHOPs, including State Partnership Exchanges. One specific resource addressing requirements presented in this letter is a database of essential community providers (ECPs). ECPs treat low-income individuals in medically underserved areas. Although non-exhaustive, this database is designed to provide CMS an estimate regarding the number of ECPs in a QHP's service area.
HHS issues Q&A on new policy barring pre-existing condition exclusions for children under 19
July 28, 2010
The Department of Health and Human Services's Office of Consumer Information and Insurance Oversight has issued a questions and answers sheet about the policy published June 28 barring pre-existing condition exclusions on policies issued after September 23, 2010 for children under the age of 19.
HHS issues statement clarifying abortion coverage in Pre-Existing Condition Insurance Plans
July 15, 2010
Department of Health and Human Services spokesperson Jenny Backus has released the following statement clarifying abortion coverage in the Pre-Existing Condition Insurance Plans:
HHS opens Pre-Existing Condition Plan
June 30, 2010
On July 1, the Department of Health and Human Services will open a new "Pre-Existing Condition Insurance Plan" available to those who have been denied insurance, which the federal government will operate in 21 states. Twenty-nine states and the District of Columbia are operating their own high risk pools, all of which will be operational by the end of August. A link at Healthcare.gov allows those seeking coverage to find out how the plan works in their state.
UPDATE: Federal Health Insurance Marketplaces: A Conversation with CCIIO Director Gary Cohen
February 7, 2013
This Update begins with a summary of federal policy guidance on health insurance Marketplaces that has been issued to date. It then presents in its entirety an interview with Gary Cohen, conducted by Professor Sara Rosenbaum of GW on January 29, 2013. The Update concludes with some observations about key issues that will arise as implementation of the federal Marketplace proceeds.
UPDATE: Federal Health Insurance Marketplaces: A Conversation with CCIIO Director Gary Cohen
February 7, 2013
This Update begins with a summary of federal policy guidance on health insurance Marketplaces that has been issued to date. It then presents in its entirety an interview with Gary Cohen, conducted by Professor Sara Rosenbaum of GW on January 29, 2013. The Update concludes with some observations about key issues that will arise as implementation of the federal Marketplace proceeds.
High Risk Pools for Uninsured Persons with Pre-Existing Conditions
April 22, 2010
Provides funding for a temporary high-risk health insurance pool for individuals with pre-existing conditions.
GAO releases report on medical underwriting and pre-existing conditions
April 27, 2012
Individuals who buy coverage directly from a health insurer are often denied coverage due to a pre-existing condition during a process called medical underwriting, which assesses an applicant’s health status and other risk factors. Beginning January 1, 2014, the Affordable Care Act (ACA) prohibits health insurers in the individual market from denying coverage, increasing premiums, or restricting benefits because of a pre-existing condition. The Government Accountability Office (GAO) examined the effect of this provision on adults who are 19-64 years old in a new report released today. GAO examined (1) the most common medical conditions that would cause an insurance company to restrict or deny insurance coverage for adults and the average annual costs associated with these conditions, (2) estimates of the number of adults with pre-existing conditions, and (3) the geographic and demographic profile of adults with pre-existing conditions. To address these three issues...
Commonwealth Fund releases report on Pre-Existing Condition Insurance Program
October 4, 2010
The Commonwealth Fund has released a report analyzing state-to-state variations in the Pre-Existing Condition Insurance Programs established by the health reform law.
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