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CMS issues FAQ on Medicaid plan marketing rules

Posted on January 20, 2015 | No Public Comments

The Centers for Medicare and Medicaid Services (CMS) posted a document which clarifies whether Medicaid managed care plans can market their private qualified health plans (QHP) to potential enrollees. CMS says federal rules do not prohibit Medicaid plans from providing information about QHPs to potential enrollees who might enroll in such a plan as an alternative to the Medicaid plan. However, CMS recommends that plans consult contracts and their state Medicaid agencies for more information on what is allowed.

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White paper outlines potential King v. Burwell scenarios

Posted on January 14, 2015 | No Public Comments

Consulting firm Leavitt Partners released a white paper outlining several scenarios that Congress, the states, and the administration could take should the Supreme Court rule against the administration in the King v. Burwell case. Under the first scenario Congress could amend the Affordable Care Act (ACA) in a way that establishes the subsidies were meant for all Americans regardless of who establishes the exchange. In the second proposed scenario Congress would pair a fix to the ACA with “material concessions”, such as the employer mandate or premium tax credit thresholds. In the third scenario outlined in the white paper, Congress would take no action regarding the Court’s decision, leaving it up to states to create their own contingency plans. The Leavitt white paper also suggests several fall-back ideas that may be under consideration by the administration as well as potential state reactions.

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Studies examine impact of possible King v. Burwell decision

Posted on January 13, 2015 | No Public Comments

Two studies by the Robert Wood Johnson Foundation (RWJF) and the RAND Corporation came up with similar findings regarding the Supreme Court’s potential decision in the King v. Burwell case. RWJF speculates that a ruling in favor of King, eliminating subsidies in federal exchanges, would shrink the nongroup insurance market by 9.7 million nonelderly adults and increase the number of uninsured Americans by 8.2 million in 2016. The RAND study also predicts that a ruling in favor of King could cause a 47 percent increase in premiums in federally facilitated marketplaces (FFM). The implications of the court’s decision could ricochet beyond those directly losing subsidies, affecting higher income individuals and even people who obtain coverage outside of the marketplaces.

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HHS issues proposed rule on summary of benefits and coverage

Posted on January 5, 2015 | No Public Comments

The U.S. Department of Health and Human Services (HHS) issued a proposed rule, simultaneously released by the Internal Revenue Service (IRS) and the Department of Labor (DOL), regarding the summary of benefits and coverage (SBC) and the uniform glossary for health insurance coverage in the group and individual markets under the Affordable Care Act (ACA). The proposed rule would change disclosure requirements to help plans and individuals better understand their health coverage and allow for informed comparisons of coverage options. The proposed regulation also makes amendments to the template for the SBC, instructions, sample language, guides for coverage example calculations, and the uniform glossary.

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IRS issues proposed rule on excepted benefits

Posted on January 5, 2015 | No Public Comments

The Internal Revenue Service (IRS) issued a proposed rule, simultaneously released by the Department of Labor (DOL) and the U.S. Department of Health and Human Services (HHS), amending the conditions under which wraparound coverage can be considered an excepted benefit. The proposed regulation sets forth five requirements under which limited benefits provided through a group health plan that wrap around either eligible individual insurance or coverage under a Multi-State Plan constitute excepted benefits. These conditions include coverage of additional benefits, quantity limits, nondiscrimination, and plan eligibility and reporting requirements. The proposed rule also includes a pilot program that would allow limited wraparound coverage to be offered as excepted benefits to coverage for a limited time.

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CMS issues 2016 draft guidance on federal exchange participation

Posted on December 21, 2014 | No Public Comments

The Centers for Medicare and Medicaid Services published a draft letter to insurers who want to offer qualified health plans (QHP) in the federally run exchanges in 2016. The letter outlines key requirements that insurers must follow, including provider network and patient safety standards. It also explains how CMS plans to review plan rate increases and conduct oversight of marketing, agents, and brokers. The initial submission window for 2016 QHP applications would be from March 16 to April 15 2015. Certification notices and agreements with insurers would be sent between Aug. 17 and Sept. 15, according to the draft guidance.

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CMS releases monthly Medicaid and CHIP enrollment report

Posted on December 20, 2014 | No Public Comments

The Centers for Medicare and Medicaid Services released a report showing state Medicaid and Children’s Health Insurance Program (CHIP) enrollment and growth. The data shows that Medicaid and CHIP grew by 9.7 million enrollees between the beginning of the first Affordable Care Act (ACA) open enrollment period and October 2014- that’s a 17 percent growth in average monthly enrollment, compared to the July-September 2013 period. Additionally, the report finds that enrollment in states that expanded Medicaid increased by 24 percent since first open enrollment, compared to 7 percent in states that did not expand. In total, Medicaid and CHIP had 68.5 million enrollees in October, an increase of about 400,000 over the previous month.

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Study examines coverage disparities under the ACA

Posted on December 18, 2014 | No Public Comments

A study by the Urban Institute finds that the Affordable Care Act (ACA) may reduce, but not eliminate health care coverage disparities. The report projects that under the ACA uninsurance rates will fall for each racial/ethnic group, narrowing coverage differences between whites and each minority group, except for blacks. If, however, all states were to expand their Medicaid programs, researchers predict that uninsurance rates would fall further for all racial/ethnic groups, with blacks experiencing a marked reduction.

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New report details health spending in 2013

Posted on December 5, 2014 | No Public Comments

The Centers for Medicare and Medicaid Services (CMS) Office of the Actuary published its annual health care spending report in the policy journal, Health Affairs. The report shows that total health care spending in the U.S. increased 3.6 percent in 2013. However, this increase was slower than that of 4.1 percent in 2012, and the share of GDP devoted to health care spending has remained at 17.4 percent since 2009. The deceleration in health care spending growth can be attributed to a slower growth in private health insurance and Medicare spending. Slower growth in spending for hospital care, investments in medical structures and equipment, and spending for physician and clinical care may also contribute to the low overall increase.

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CMS issues final rule on Medicaid DSH

Posted on December 3, 2014 | No Public Comments

The Centers for Medicare and Medicaid Services issued a final rule addressing the hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments. Under this limitation, DSH payments to a hospital cannot exceed the uncompensated costs of furnishing services to individuals who are Medicaid-eligible or uninsured. The final rule defines “uninsured” as those who have “no health insurance for the services furnished during the year.” The rule also provides that determinations of funding limits will be made on a service-specific basis rather than at the individual level. CMS says the regulation gives states and hospitals more flexibility in terms of which hospital costs can be considered uninsured costs than what had been in place under a final rule from 2008.

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