Tag: Health and Human Services
HHS proposed rule covers a slew of ACA provisions
Posted by Nikki Hurt on June 14, 2013
Today, the US Department of Health and Human Services released a proposed rule addressing various facets of the Affordable Care Act (ACA). The 253 page document expands upon guidance previously released to states and stakeholders, covering topics ranging from financial integrity and additional oversight of Exchanges to options available under the Small Business Health Options Program (SHOP). Key provisions provided in the proposed rule include:
- Qualified health plans must accept a wide variety of payment options for premiums. A recent Jackson Hewitt study found a large number of uninsured Americans lack bank accounts, and restrictive payment policies excluding money orders and prepaid debit cards would impede the ability of these uninsured Americans to gain insurance access.
- Additional guidance was provided for federally-facilitated Exchange (FFE) states that choose to operate their own SHOP market while the federal government maintains oversight of their individual market, known as the Utah plan. The proposed rule states that data sharing requirements between SHOP and individual markets do not apply in these arrangements. Additionally, states operating their own SHOP Exchange can have their own set of Navigators, separate from the individual market, that perform outreach to small businesses.
CMS releases additional hospital spending data
Posted by Nikki Hurt on June 3, 2013
In an expansion to the hospital charges data released last month, the Centers for Medicare and Medicaid Services (CMS) provided data describing charges for 30 different outpatient procedures. The data include charge estimates for Ambulatory Payment Classification Groups, which are paid under the Medicare Outpatient Prospective Payment System. Presented data are hospital-specific and report charge values collected during calendar year 2011.
Administration released final rule on employee-sponsored wellness programs
Posted by Nikki Hurt on May 29, 2013
A joint rule released by the US Department of Labor (DoL), the US Department of the Treasury (DoT), and the US Department of Health and Human Services (HHS) addresses new provisions regarding participatory wellness programs in the workplace. Workplace wellness programs are designed to reduce the prevalence of chronic disease, stifle growing health care costs, and improve overall health by rewarding employees for participating in certain activities, such as educational classes or obtaining memberships to fitness centers. The final rule sets the maximum reword for completion of a nondiscriminatory health-contingent wellness program to 30% of coverage costs, up from the original 20%. Employees that successfully complete tobacco-related wellness programs are eligible for up to 50% of cost of coverage.
Health Information Implications of the 2014 HHS Budget
Posted by Nikki Hurt on
On April 10, 2013, President Obama released his proposed FY 2014 budget, which includes $967.3 billion in outlays for the Department of Health and Human Services (HHS) and makes legislative proposals that would save an estimated $361.1 billion (net) over ten years. In conjunction with the release of the President’s budget, HHS published an overview of the budget provisions for HHS, which provides more detail on how the Department would allocate its budget in FY 2014 and describes its ongoing progress in meeting specific program goals and legislative requirements. Many of the proposals included in the President’s budget and HHS’ overview relate to the ongoing transformation of the health care delivery system to a value-based system that rewards quality and efficiency. Critical to the success of this transformation is the exchange of health information for activities such as quality measurement and reporting, value-based purchasing, consumer engagement, and comparative effectiveness research. Below are selected provisions of the HHS budget, the agency’s relevant legislative proposals for 2014, and progress reports for health care system reform efforts that require the use and exchange of health information. We also identify HHS’ stated priorities for 2014 that are related to health information…
Jackson Hewitt explores issue of “unbanked” Americans gaining ACA insurance coverage
Posted by Nikki Hurt on May 24, 2013
A new study released by Jackson Hewitt Tax Service Inc. describes an issue that may arise when uninsured individuals without bank accounts enroll into the Affordable Care Act’s (ACA) health insurance Exchanges. Uninsured + Unbanked = Unenrolled= How Health Insurance Companies May Exclude 1 in 4 Eligible Americans from ACA Coverage- and What the Federal Government Can Do to Stop It finds that one quarter of Americans eligible for federal premium subsidies under the ACA, meaning their annual income falls between 100-400% of the federal poverty level, do not have a checking account. This presents an issue in regards to the types of premium payments insurers are willing to accept, as many insurers will not take debit or credit card as a payment form. The US Department of Health and Human Services (HHS) claimed they ameliorated this concern in their guidance letter issued last month by stating that insurance companies must “accept payment in ways that are non-discriminatory.”
CMS releases DSH payment proposed rule
Posted by Nikki Hurt on May 14, 2013
The Centers for Medicare and Medicaid Services (CMS) released a proposed rule concerning reductions to Disproportionate Share Hospital (DSH) payments. Pursuant to the Affordable Care Act (ACA), the federal government had intended to cut DSH payments beginning in 2014, as the law’s Medicaid expansion would negate the need for such payments. Since the Supreme Court’s decision rendered Medicaid expansion optional, the federal government has elected to delay the DSH payment reduction until 2015 when they have a more accurate assessment of the nation’s uncompensated care level after initial implementation of the ACA.
A fact sheet summarizing the rule can be found here.
CCIIO will amend Exchange regulations for Utah
Posted by Nikki Hurt on May 10, 2013
In a letter addressed to the governor of Utah, Center for Consumer Information and Insurance Oversight (CCIIO) Director Gary Cohen stated that CCIIO will release updated regulations that will permit Utah to operate their small business health option program (SHOP) while the federal government runs the individual Exchange. The letter addresses how Utah and the federal government will divvy up responsibilities concerning navigators and plan management, as well as data reporting requirements for their SHOP. In addition, the letter purports that other states may also pursue a similar Exchange model.
CMS releases data on hospital charges
Posted by Nikki Hurt on May 8, 2013
In an effort to increase health care affordability and transparency, the Centers for Medicare and Medicaid Services (CMS) published data pertaining to hospital charges for the 100 most common services provided during Medicare inpatient stays. With more than 163,000 entries, the data released by CMS indicated wide variation in costs, both across the country and within similar regions. For instance, a joint replacement procedure can cost $5,300 in Ada, Oklahoma, while a similar procedure may cost upwards of $223,000 in Monterey Park, California. Similarly, heart failure treatments can cost anywhere between $9,000 and $51,000 in Jackson, Mississippi. To further promote the spirit of the Affordable Care Act (ACA), the US Department of Health and Human Services (HHS) will also be offering grants for entities to collect and analyze medical pricing and reimbursement data to aid consumers in their health care decision-making and promoting cost-effective care.
Final Rule: Notice of Benefit and Payment Parameters for 2014
Posted by Nikki Hurt on
On March 11, 2013, the U.S. Department of Health and Human Services (HHS) released a final rule on the Notice of Benefit and Payment Parameters for 2014. This final rule addresses a variety of issues, including the specific payment parameters for the three premium stabilization programs – the permanent risk adjustment program, the transitional reinsurance program, and the temporary risk corridors program. In addition, the final rule also covers advance payments of the premium tax credit, cost-sharing reductions, and user fees for the federally-facilitated Exchanges, specific requirements related to the federally facilitated Small Business Health Option Program (SHOP), and the medical loss ratio program. This rule finalizes the provisions set forth in HHS’s proposed rule on these topics, December 7, 2012…
Interim Final Rule: Alternative Approaches to Cost-Sharing Reduction Payment and Risk Corridor Calculations
Posted by Nikki Hurt on
The temporary risk corridors program allows the federal government to share a QHP’s profits or losses among other QHP issuers due to inaccurate rate setting inside the Exchanges from 2014-2016. To determine whether a QHP issuer has inaccurately set premium rates that lead to an unjustified profit or loss, a QHP’s “allowable costs” must be calculated per the requirements in the Premium Stabilization Rule. The IFR modifies the definition of “allowable costs” such that a QHP’s allowable costs are to be determined based on its pro-rata share of the QHP issuer’s incurred claims for all non-grandfathered health plans within a state, and allocated to the QHP based on premiums earned by the issuer in the market…