Tag: HHS

Departments of Labor, HHS, and Treasury issue summary of benefits and coverage FAQs

Posted by mmcdowell on May 17, 2012

The departments of Labor, Health and Human Services, and Treasury issued a set of 14 frequently asked questions (FAQs) and answers regarding implementation of the summary of benefits and coverage (SBC) provisions of the Affordable Care Act (ACA). Importantly in the FAQs, the departments announced that they would not take enforcement action against insurers in a number of circumstances for failure to fully comply with requirements that they provide a standardized SBC during the first year of applicability of the new rules.

The departments issued a final rule in February requiring insurers to use plain language in describing benefits and coverage. With the final rule, the departments released a uniform glossary of terms.

The guidance is the ninth set of FAQs posted regarding ACA compliance. This set of FAQs also addresses when plans and issuers can provide SBC electronically, circumstances that will trigger the requirement for an issuer to provide an SBC, and whether issuers are required to provide SBCs to group health plans or their sponsors that are shopping for coverage but have yet to submit an application.

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CCIIO announces potential plans for risk adjustment

Posted by mmcdowell on

The Center for Consumer Information and Insurance Oversight (CCIIO) recently announced that the U.S. Department of Human Services (HHS) may use a a concurrent model for risk adjustment. The overall goals of the risk adjustment model are to mitigate impacts of adverse selection and stabilize premiums in the individual and small group markets.

HHS will use the Hierarchical Condition Category (HCC) classification system as a basis for the HHS risk adjustment model. This model utilizes diagnoses from all physician and hospital encounters, and profiles beneficiary medical problems with diagnostic categories (HCCs) that are not mutually exclusive. HCC classification provides a diagnostic framework for developing a risk adjustment model to predict medical spending and plan accordingly.

The concurrent risk adjustment model, if implemented, will use diagnoses in the current year to predict expenditures for that same year. Importantly, HHS plans to select a different set of HCCs for the Federal risk adjustment methodology than those used in Medicare to reflect the differences in population.

HCC was originally developed for CMS to do risk adjustment for Medicare Advantage and Part D prescription drug plans. The model will have to be adapted for the Affordable Care Act’s (ACA’s) risk adjustment due to the presence of the private insurance market.

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HHS awards more Exchange establishment grants

Posted by mmcdowell on

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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HHS releases web-based search tool to track health care system performance

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Health and Human Services (HHS) announced the launch of a new web-based tool to track how the nation’s health care system is performing. The tool, known as the Health System Measurement Project, will enable policymakers, providers, and the public to develop consistent data-driven views regarding changes in critical U.S. health system indicators. The tool brings together data sets from across the federal government that span topical areas, such as access to care, cost and affordability, prevention and health information technology. It presents these indicators by population characteristics, such as age, sex, income level, insurance coverage, and geography. The measures included in the tool were developed by the HHS Office of the Assistant Secretary for Planning and Evaluation. They are aligned with the HHS Strategic Plan, the National Quality Strategy, and other departmental strategic planning efforts.

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Update: Medical Loss Ratio Requirements

Posted by Mark Dorley on May 15, 2012

On May 11, 2012, the United States Department of Health and Human Services (HHS) issued a final rule that revises previous medical loss ratio (MLR) rules to establish consumer notification requirements with which insurers must comply when meeting applicable MLR requirements. In a previous December, 2011 final rule governing other aspects of the MLR amendments, HHS had required notification only when insurers did not …

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HHS announces funding for school-based health centers

Posted by mmcdowell on May 10, 2012

Health and Human Services (HHS) Secretary Kathleen Sebelius recently announced the availability of funding for the construction and renovation of school-based health centers. These new investments, totaling up to $75 million, are part of the School-Based Health Center Capital (SBHCC) Program, created by provisions under the Affordable Care Act (ACA).

School-based health centers are an important component of…

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HHS releases two rules to streamline regulations for hospitals and providers

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Today, the Centers for Medicare & Medicaid Services (CMS) released two final rules. The first rule revises the Medicare Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs). CMS estimates that annual savings to hospitals and CAHs will be approximately $940 million per year. The second, the Medicare Regulatory Reform rule, will produce savings of $200 million in the first year by promoting efficiency. This rule eliminates duplicative, overlapping, and outdated regulatory requirements for health care providers.

Among other changes, the final rules will…

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CMS releases proposed rule to increase Medicaid payments

Posted by mmcdowell on May 9, 2012

Today the Centers for Medicare & Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services (HHS), released a proposed rule on Medicaid payments. The proposed rule would implement Medicaid payment for primary care services furnished by certain physicians in years 2013 and 2014 at rates not less than Medicare rates in effect in that time period. The rule would apply to physicians who practice family medicine, general internal medicine, or pediatric medicine, and to services paid through Medicaid managed plans. The proposal also permits providers to charge higher rates for vaccinations under the federally backed Vaccines for Children program. CMS estimated the provision will cost the government $5.5 billion the first year, and $5.6 billion in the second.

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HHS announces first 26 Health Care Innovation Awards

Posted by mmcdowell on May 8, 2012

Health and Human Services (HHS) Secretary Kathleen Sebelius today announced the first batch of organizations for Health Care Innovation awards. The awards, a provision under the Affordable Care Act (ACA), will support 26 new innovation projects. The goals of the projects are to lower health care costs, improve quality of care, and enhance the provider workforce. The preliminary awardees announced today expect to reduce health spending by $254 million over the next 3 years.

Projects include…

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