Tag: Exchanges
Treasury issues final rules on premium tax credits
Posted by mmcdowell on May 21, 2012
The Affordable Care Act (ACA) established American Health Benefit Exchanges (the Exchange or Exchanges), a marketplace where consumers can choose a private health insurance plan to fit their health needs. The Exchanges will provide Americans with access to the same health insurance choices as members of Congress. Today, the Treasury Department issued final regulations implementing the premium tax credit that will give middle-class Americans unprecedented tax benefits to make the purchase of health insurance affordable.
Premium tax credits will, first and foremost, make…
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HHS awards more Exchange establishment grants
Posted by mmcdowell on May 17, 2012
The U.S. Department of Health and Human Services (HHS) awarded another $181 million in health insurance exchange establishment grants yesterday, bringing the total amount allotted to such grants to $1 billion. The six recipients of the grants, Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington, will use the grants to establish Affordable Insurance Exchanges, which will help consumers and small businesses choose a private health insurance plan. These comprehensive health plans will ensure consumers have the same kinds of insurance choices as members of Congress. Including the most recent awards, 34 states and the District of Columbia have received Establishment grants to fund their progress toward building Exchanges.
States must indicate by the beginning of 2013 whether they will operate an Exchange on their own or in partnership with the federal government. Otherwise, HHS will fully oversee the establishment of the state’s Exchange.
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HHS publishes Exchange guidance and draft blueprint
Posted by mmcdowell 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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New report explores federal plan management of the Exchanges
Posted by mmcdowell on May 10, 2012
Health insurance exchanges are a provision under the Affordable Care Act (ACA) and must engage in five core functions: 1) determine eligibility for federal subsidies or public coverage, 2) enroll consumers and employees into qualified health coverage (or connect eligible individuals with Medicaid and CHIP), 3) conduct plan management, 4) provide consumer assistance, and 5) perform financial management. The Center on Health Insurance Reforms at Georgetown University Health Policy Institute and the National Academy of Social Insurance (NASI), with funding from the Robert Wood Johnson Foundation (RWJF) recently released a paper focuses on one of these core functions: the series of oversight activities that federal officials have called “plan management.” States face three choices: establish their own exchange and exercise control over plan management functions, allow the federal government to establish a federally facilitated exchange (FFE) but enter into a partnership arrangement to perform plan management, or cede all plan management functions to the FFE. With the latter two approaches, the state will essentially turn over to the federal government some of its traditional authority to regulate its private health insurance markets. However, through a partnership arrangement, state regulators can recapture that authority and oversight.
The U.S. Department of Health and Human Services (HHS) has defined plan management to…
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Three federal agencies release request for information on stop-loss coverage
Posted by mmcdowell 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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Commonwealth paper explores preventive health services expansion
Posted by mmcdowell on April 23, 2012
The Commonwealth Fund recently published a paper in Medscape Public Health regarding preventive health services under the Affordable Care Act (ACA). The law has already extended coverage to dependents through age 26. By 2014, Medicaid will expand to cover most low-income adults and the exchanges will extend insurance to many small business and individuals. This eminent expansion of health insurance coverage will greatly increase in the use of preventive services in the United States. ACA provisions also eliminate cost sharing associated with the provision of preventive services, which will also likely impact use. Finally, the movement toward medical homes will also augment the use of preventive services. The paper discusses these relationships in the context of delivery system reforms.
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New GW/Commonwealth paper examines multi-state plans
Posted by mmcdowell on April 16, 2012
A new paper titled, “Multi-State Plans under the Affordable Care Act,” was recently released by the George Washington University School of Public Health and Health Services. Authored by Trish Riley and Jane Hyatt Thorpe of the GW Department of Health Policy and funded by The Commonwealth Fund, the paper examines key issues related to the development of multi-state plans (MSPs), a new type of insurance coverage created by a provision of the Affordable Care Act (ACA). MSPs will be administered through the federal Office of Personnel Management (OPM) and offered across state lines through the new state health insurance exchanges. The findings in this paper are based on interviews with federal and state policy makers and other stakeholders, and are intended to inform the development and implementation of MSPs.
A primary goal of the ACA is to…
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Commonwealth Fund releases findings from the 2011 Health Insurance Tracking Survey of U.S. Adults
Posted by mmcdowell on April 14, 2012
The Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults finds that one-quarter of adults ages 19 to 64 experienced a gap in their health insurance in 2011, with a majority remaining uninsured for one year or more. Losing or changing jobs was the primary reason people experienced a gap. Compared with adults who had continuous coverage, those who experienced gaps were less likely to have a regular doctor and less likely to be up to date with recommended preventive care tests, with rates declining as the length of the coverage gap increases. According to Commonwealth, early provisions of the Affordable Care Act (ACA) are already helping bridge gaps in coverage among young adults and people with preexisting conditions. Beginning in 2014, new affordable health insurance options through Medicaid and state insurance exchanges will enable adults and their families to remain insured even in the face of job changes and other life disruptions.
Update: Exchanges Establishment and Eligibility Final Rule
Posted by mmcdowell on April 10, 2012
The Department of Health and Human Services (HHS), Center for Medicare and Medicaid Services (CMS) has issued a final rule[1] addressing two previous proposed rules: “Establishment of Exchanges and Qualified Health Plans”[2] and “Exchange Functions in the Individual Market: Eligibility Determinations and Exchange Standards for Employers.”[3] The final rule addresses 1) minimum federal standards that States must meet to establish and operate exchanges, 2) the minimum standards that health insurance issuers must meet as Qualified Health Plans (QHPs), and 3) basic standards employers must meet to participate in the Small Business Health Options Program (SHOP) Exchange. CMS indicates that certain portions of the rule will be considered interim final, and the agency will accept comments on certain sections.[4] CMS also indicates in the Preamble that additional details will be made available in future guidance and rulemaking, where appropriate. For information on the proposed rules, click here. This Update describes major changes made by CMS in the final rule.
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Editor’s Comment: Two Years and Counting
Posted by mmcdowell on March 29, 2012
March 23, 2012, marked the two-year anniversary of the Affordable Care Act (ACA), and the Administration’s two years worth of implementation efforts that span the full scope of the law. Major areas of implementation encompass the range of reforms under the Act: improving performance in the private insurance and employer-sponsored health plan markets; strengthening Medicare, Medicaid and CHIP; improving health care access and building a stronger health workforce; improving health care quality and accountability; increasing investments in public health; strengthening health care fraud and abuse controls; and reforming federal policies applicable to tax-exempt hospitals.
Health Reform GPS reported on the first year of implementation efforts here. This updated table includes both year-one and year-two key agency implementation actions. Year-two actions appear in italics.
ACA implementation efforts in Year Three can be expected to reach more deeply into the core of the reforms. Among other topics…
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Most Popular Content
- Update: Essential Health Benefits FAQs posted on May 9, 2012
- Update: Exchanges Establishment and Eligibility Final Rule posted on April 10, 2012
- Contraception Coverage under the ACA’s Preventive Services Coverage Requirements, and Employer Implementation: An Update posted on April 20, 2012
- State Health Insurance Exchange Navigators posted on February 28, 2011
- Update on the Final Rule: Standards Related to Reinsurance, Risk Corridors and Risk Adjustment posted on April 4, 2012
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- Treasury issues final rules on premium tax credits
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