HHS publishes Exchange guidance and draft blueprint

Posted on May 16, 2012 | No Public Comments

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

Posted on May 16, 2012 | No Public Comments

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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Heritage Foundation Recommends Eliminating Premium Subsidy for High Income Beneficiaries to Shore-Up Medicare

Posted on May 16, 2012 | No Public Comments

According to an issue brief recently published by the Heritage Foundation, wealthy seniors should pay more in Medicare premiums. Taxpayers spend an extra $4,897 per Medicare beneficiary beyond what is collected in taxes and premiums. Currently, Medicare beneficiaries pay a basic premium for Part B of $99.90 per month, which covers some costs while the remaining costs are covered by subsidies from the general revenue. The subsidy declines for married seniors with combined income above $170,000. When a senior’s income reaches $428,000, the premium tops out at $319.70 per month, leaving a 20 percent subsidy. According to the report, a retired couple with a $428,000 combined salary would have total financial assets worth more than $7.1 million, excluding the value of their home. In other words, this means that multimillionaire retiree seniors still qualify for a 20 percent Medicare subsidy. The report explores this issue and suggests eliminating premium subsidies for such high income Medicare beneficiaries.

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Implementation Brief Update: Medical Loss Ratio Requirements

Posted on May 15, 2012 | No Public Comments

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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CMS releases final rule on MLR requirements

Posted on May 12, 2012 | No Public Comments

The Centers for Medicare & Medicaid Services (CMS), a department within the U.S. Department of Health and Human Services (HHS), released final rules on Friday May 11th requiring insurers to notify subscribers when the medical loss ratio (MLR) provision of the Affordable Care Act (ACA) is met or exceeded for spending on medical claims or quality improvements. The December 2011 interim final rule and final rule on MLR only required that notices be sent to policyholders when insurers did not meet the MLR requirements.

The ACA requires both individual and small group plans to meet the MLR requirements by spending at least 80 percent of premiums on medical claims or quality improvements. Large plans are required to spend at least 85 percent. Beginning in August of 2012, insurers must refund the difference to consumers.

The goal of the notice is to educate consumers regarding the MLR measures and to help consumers know that the majority of premium payments go towards health care, as opposed to advertising, executive bonuses, or administrative overhead costs.

HHS said the rule is not expected to have an economic impact of more than $100 million a year.

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Report estimates impact of small business tax credit

Posted on May 11, 2012 | No Public Comments

Congress included in the Affordable Care Act (ACA) a significant new tax credit for small business owners who provide their workers with health insurance. Under this new tax credit, businesses that have fewer than 25 full-time workers and average wages of less than $50,000 are now eligible to receive a tax credit of up to 35 percent of the cost of the health insurance that they provide for their workers. To qualify for the tax credit, small businesses must cover at least 50 percent of each employee’s health insurance premiums. In 2014, the size of the credit will increase to cover up to 50 percent of the cost of health insurance provided to workers.

Families USA and Small Business Majority recently commissioned The Lewin Group to develop estimates of the number of small businesses that are eligible for this new tax break in tax year 2011 and…

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Health Affairs article explores power of providers to win payment increases

Posted on May 10, 2012 | No Public Comments

An article published in Health Affairs entitled, “The Growing Power Of Some Providers To Win Steep Payment Increases From Insurers Suggests Policy Remedies May Be Needed,” explores the power that some health care providers, particularly dominant hospital systems, can wield to negotiate higher payment rates from insurers. The report discusses interviews conducted in twelve US communities which indicate that so-called must-have hospital systems and large physician groups can exert considerable market power to obtain steep payment rates from insurers. Other factors, such as offering an important, unique service or access in a particular geographic area, can contribute to provider leverage as well. Even in markets with dominant health plans, insurers generally have not been aggressive in constraining rate increases, perhaps because the insurers can simply pass along the costs to employers and their workers. The findings suggest a range of market and regulatory approaches should be examined in any attempt to address the consequences of growing provider market clout.

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Department of Labor releases FAQs on mental health parity compliance

Posted on May 10, 2012 | No Public Comments

The Department of Labor’s Employee Benefits Security Administration published a set of frequently asked questions (FAQs) regarding implementation of the Mental Health Parity and Addiction Equity Act of 2008.

Amongst other topics, the FAQs address…

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HHS announces funding for school-based health centers

Posted on May 10, 2012 | No Public Comments

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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New report explores federal plan management of the Exchanges

Posted on May 10, 2012 | No Public Comments

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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