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

CMS releases BHP final rule

Posted on March 7, 2014 | No Public Comments

The Centers for Medicare and Medicaid Services (CMS) released a final rule and payment notice for the Basic Health Program (BHP). Under the Affordable Care Act (ACA), many individuals will have an income too high to qualify for Medicaid, yet subsidies may not make their health insurance affordable. BHP, a program aiming to reduce churning between Medicaid and private coverage, helps to ensure continuity of care for individuals with fluctuating incomes. The rule allows for states to receive funding for BHP beginning in 2015.

Continue Reading »

Implementation Brief CMS Bulletin on Retroactive Advance Payments of Premium Tax Credits and Cost Sharing Reductions in 2014 Due to Exceptional Circumstances

Posted on March 7, 2014 | No Public Comments

On February 27, 2014, CMS issued a Bulletin to Marketplaces on Availability of Retroactive Advance Payments of the PTC and CSRs in 2014 Due to Exceptional Circumstances. Using its authority to establish special enrollment periods under the ACA, CMS created a mechanism for recognizing certain “exceptional circumstances” that arise when as a result of “technical issues in establishing automated eligibility and enrollment functionality,” Exchanges have experienced difficulties in making timely eligibility determinations and enrolling people during the initial open enrollment period.

Continue Reading »

IRS issues new ACA-related rules

Posted on March 6, 2014 | No Public Comments

A final rule released by the Internal Revenue Service (IRS) addresses the reporting requirements for large employers under the Affordable Care Act (ACA). Beginning in 2015, employers with more than 50 full-time employees are required to offer quality and affordable insurance to their employees. The new rule provides a methodology designed to simplify and reduce the costs associated with the employer reporting requirements mandated under the ACA. Another final rule issued by the IRS describes how issuers of minimum essential coverage are expected to report information to the IRS on the type and duration of coverage.

Continue Reading »

CMS rule extends transition policy to 2017

Posted on March 6, 2014 | No Public Comments

Yesterday, the Centers for Medicare and Medicaid Services issued the final rule on the Notice of Benefit and Payment Parameters for 2015. Several of the notable components of the rule include:

  • Extending the transitional policy from November 2013, which says that individuals may retain their insurance coverage even if it does not meet the Affordable Care Act (ACA) standards, through October 2016.
  • Finalizing that open enrollment for 2015 will being on November 15th, 2014 and conclude on January 15th, 2015.
  • Stabilizing the transitional reinsurance program by raising the attachment point and setting a reinsurance cap.
  • Refining the risk adjustment and risk corridor programs.
  • Implementing enrollee protections such as out-of-pocket limits and patient safety standards.
  • Finalizing provisions of the Small Business Health Options Program (SHOP) that address employee choice and premium aggregation.

In addition to the rule, Gary Cohen, the Director for the Center for Consumer Information and Insurance Oversight (CCIIO) released a letter explaining the extension of plans that do not meet the ACA meaningful coverage requirements. The letter further describes how states that did not implement this extension back in November may do so now.

Continue Reading »

Implementation Brief CMS 2015 Draft Letter to Issuers in the Federally Facilitated Marketplace: Network Adequacy and Inclusion of Essential Community Providers

Posted on March 5, 2014 | No Public Comments

In administering the FFM, CMS utilizes Issuer Letters to apprise issuers potentially interested in offering qualified health plans (QHPs) in the Marketplace regarding priorities and policies for the agency. In effect, CMS acts like a plan sponsor in managing the FFM, although unlike other sponsors (e.g., employers), the FFM has not, to date, been selective about which plans may be sold in the Marketplace. That is, plans that meet FFM (and where applicable, state) certification standards are eligible to be sold. At the same time, QHPs must meet a range of certification standards, and in its oversight capacity, CMS uses its Issuer Letters as a means of clarifying policy and delineating areas of emphasis for health plans.

Continue Reading »

CMS guidance permits retroactive subsidy access

Posted on February 28, 2014 | No Public Comments

Guidance issued by the Center for Medicare and Medicaid Services (CMS) states that individuals who enrolled in health plans outside of the Affordable Care Act (ACA) insurance Marketplaces may retroactively receive premium subsidies. Under the ACA, advanced premium tax credits, or subsidies, are only available to individuals that purchased qualified health plans through the Marketplace. Many states have asked CMS to permit subsidies outside of the ACA Marketplace because IT issues prevented many eligible individuals from enrolling into QHPs before the deadline. Subsidies will retroactively be paid to insurers back to the effective date of plan enrollment.

Continue Reading »

CMS issues DSH allotments

Posted on February 27, 2014 | No Public Comments

The Centers for Medicare and Medicaid Services (CMS) issued the funding allocation for disproportionate share hospitals (DSH) for FY 2014. DSH payments are typically provided to hospitals that treat a disproportionate number of uninsured or under-insured patients. The Affordable Care Act (ACA) originally called for a cut in DSH payments, as more Americans would presumably be insured under Medicaid. The Supreme Court ruling that made Medicaid expansion optional, however, ultimately coerced CMS to delay DSH cuts for two years.

Continue Reading »

CMS report addresses small business premiums

Posted on February 25, 2014 | No Public Comments

The Centers for Medicare and Medicaid Services (CMS) released a report to Congress late last week discussing the impact of the Affordable Care Act (ACA) on small business premiums. The report, mandated by the Budget Control Act, found that health insurance premiums for 11 million small business employees would likely rise under the ACA, while premiums for 6 million small business employees would decrease. Evidence as to how much premiums will rise for small business employees under the ACA is currently inconclusive.

Continue Reading »

Tri-agency rules address 90-day waiting period limit

Posted on February 20, 2014 | Comments Off

The US Department of Health and Human Services (HHS), the Internal Revenue Service (IRS) and the Employee Benefits Security Administration (EBSA) released several rules today concerning the 90-day waiting period limitation before insurance coverage can become effective. The final rule states that group health insurance plans cannot apply a waiting period that exceeds 90 days beginning January 2015. The proposed rule clarifies the 90-day limitation in terms of the length of employment-based orientation periods, stating that one month is the reasonable limit for employment-based orientation periods.

Continue Reading »

GAO report finds states spend one-third of Medicaid dollars on few beneficiaries

Posted on February 20, 2014 | Comments Off

The Government Accountability Office (GAO) released a new report citing how Medicaid spends a third of their funds on a small sect of high-expenditure Medicaid beneficiaries. The report, Medicaid: Demographics and Service Usage of Certain High-Expenditure Beneficiaries, found that states spent 31.6% of all Medicaid expenditures on 4.3% of the Medicaid population. Furthermore, the report stated that certain characteristics, such as residing in a long-term care facility, contributed to individuals being deemed high-expenditure Medicare beneficiaries.

Continue Reading »