A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

CMS issues loaded Marketplace final rule

Posted on October 24, 2013 | Comments Off

Today, the Centers for Medicare and Medicaid Services (CMS) published a final rule concerning financial integrity and oversight for Marketplaces and qualified health plans (QHP). Some of the key components addressed in this rule include: clarifications and amendments to market reform rules, standards for special enrollment periods, and standards for survey vendors that may conduct enrollee satisfaction surveys for QHP issuers. One specific amendment in the rule enables QHP issuers to use a “simplified methodology” in determining cost-sharing reductions for qualifying plan enrollees, which CMS states will protect federal funds and minimize administrative burden.

Continue Reading »

Editor’s Comment: What Policy Options Exist if the Healthcare.gov Website Remains Non-Functional?

Posted on October 23, 2013 | Comments Off

The federal healthcare.gov website is limping along. The Administration has now taken a number of steps to begin to quickly and decisively address the problem, including adding a “surge” of technology experts to their contract teams and appointing a high-level overseer with extensive business management expertise. But fixing the website could take a long time…

Continue Reading »

CMS issues RFC for exemptions to individual mandate

Posted on October 22, 2013 | Comments Off

Yesterday, the Centers for Medicare and Medicaid Services (CMS) issued a Request for Comment (RFC) concerning new exemptions to the individual mandate under the Affordable Care Act (ACA). This particular RFC asks for additional information on the burden experienced by health care sharing ministries, and if such burden would qualify for an exemption from the individual mandate.

Continue Reading »

Update: Ohio expands Medicaid

Posted on October 22, 2013 | Comments Off

After the measure to expand Medicaid failed in the Legislature this summer, the Ohio Controlling Board voted 5-2 to approve Medicaid expansion under the Affordable Care Act (ACA). This decision, which will likely be met by a multitude of legal challenges in the coming months, makes Ohio the 25th state to accept enhanced federal funding to help insure the state’s most impoverished residents. Our map has been updated to reflect these changes.

Continue Reading »

Verifying Income Eligibility for Premium Subsidies and Cost-Sharing Assistance under the ACA: Impact of the Continuing Appropriations Act of 2013

Posted on October 17, 2013 | Comments Off

Although similar at first blush, the two provisions are quite different in their actual wording and their potential impact. The provision that ultimately became law requires that the Secretary take steps to assure that Exchanges comply with the ACA’s income verification requirements…

Continue Reading »

CMS releases draft application for ACA exemptions

Posted on October 16, 2013 | Comments Off

The Centers for Medicare and Medicaid Services (CMS) issued a draft application and a corresponding data collection comment request concerning exemptions from the individual mandate. Under the Affordable Care Act (ACA), certain groups of individuals, such as those experiencing financial hardships or those that belong to a religious organization that opposes the use of insurance, are deemed exempt from the individual mandate and are therefore not required to pay the $95 penalty in 2014. This specific draft application, which is for individuals requesting a hardship exemption, is 6 pages in length and requires applicants to provide the type of hardship they are experiencing and their tax information. CMS anticipates that more than 12 million individuals will apply for the individual mandate exemption. The data collection comment request outlines options for states to rely on the Department of Health and Human Services (HHS) to determine eligibility exemptions, and asks the Office of Management and Budget (OMB) to approve the annual information collection requirements associated with the application.

Continue Reading »

Implementation Brief Notice of Proposed Rulemaking: Small Employer Tax Credit

Posted on October 16, 2013 | Comments Off

This Implementation Brief examines a Notice of Proposed Rulemaking (NPRM) issued by the Internal Revenue Service (IRS) on August 26, 2013 concerning the tax credit available to small employers that offer health insurance coverage to their employees…

Continue Reading »

CMS releases enrollment guidance

Posted on October 14, 2013 | Comments Off

The Centers for Medicare and Medicaid Services (CMS) recently published their “Enrollment Operational Policy and Guidance” concerning Federally-Facilitated Marketplaces (FFM). The guidance, released on October 3rd, stated that enrollments made after October 1st must comply with the provisions in the document. The guidance applies to entities associated with the enrollment process, such as FFM, qualified health plan issuers, and agents and brokers, and describes how these groups are expected to operate in terms of aiding individuals in obtaining health insurance and subsidies. The guidance purports that CMS intends the document to be “living,” and the agency will provide consistent updates and clarification on the provisions therein.

Continue Reading »

Medicaid Map Update: Expansion likely in Ohio

Posted on October 14, 2013 | Comments Off

The HealthReformGPS map documenting the current status of Medicaid expansion and Marketplace structure has been updated to reflect the likelihood that Ohio will be the newest state to expand Medicaid under the Affordable Care Act (ACA).

Continue Reading »

Implementation Brief Program Integrity: Exchange, SHOP, and Eligibility Appeals

Posted on October 10, 2013 | Comments Off

By Taylor Burke Introduction On August 30, 2013, HHS published a final rule entitled “Patient Protection and Affordable Care Act; Program Integrity: Exchange, SHOP, and Eligibility Appeals.”[1] This rule finalizes certain policies proposed in the Program Integrity NPRM published June 19, 2013, as well as certain policies proposed in the NPRM entitled “Essential Health Benefits [...]

Continue Reading »