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

Administration releases more ACA guidance

Posted on May 5, 2014 | Comments Off

Last Friday, the Centers for Medicare and Medicaid Services (CMS) posted a new bulletin on special enrollment periods and hardship exemptions under the Affordable Care Act (ACA). The bulletin provides information on how federally-facilitated Marketplaces (FFM) should address coverage for individuals that fall into the following four categories: hardship exemptions for individuals that obtained coverage effective May 1st, special enrollment periods for individuals eligible for or enrolled in COBRA, special enrollment periods for individuals whose plans are renewing outside of open enrollment, and special enrollment periods for AmeriCorps/VISTA/National Civilian Community Corps Members. The bulletin suggests that state-based Marketplaces (SBM) use these guidelines to help individuals that fall into these categories.

The administration also released a new FAQ set regarding ACA implementation. This FAQ, prepared jointly by the US Department of Treasury, the US Department of Health and Human Services, and the US Department of Labor, addresses questions concerning a myriad of health reform topics. Several of the issues addressed include updated Department of Labor Model Notices for COBRA, out-of-network and out-of-pocket charges, and Summaries of Benefits and Coverage (SBC).

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CMS releases payment rules

Posted on May 1, 2014 | Comments Off

A final rule released on Tuesday indicates that federally qualified health centers (FQHCs) may receive a 32% payment boost under Medicare’s new payment system. Effective October 1st of this year, Medicare will pay FQHCs a per member per day fee of $158.85, which will be adjusted for geographic differences in healthcare costs. The Centers for Medicare and Medicaid Services (CMS) currently does not adjust payments for FQHC patients.

Another rule released by CMS discusses inpatient payment regulations for 2015. Per the Hospital Readmission Reduction Program, Medicare payments to physicians with poor readmission rates could be reduced by as much as 3%. Hospitals with poor performance regarding hospital acquired conditions may face an additional penalty.

Other payment rules released by CMS include skilled nursing facilities, rehabilitation facilities, and psychiatric facilities, which all call for payment increases of 2%, 2.2%, and 2.1% respectively.

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Study finds large employers could save money under ACA by dropping benefits

Posted on May 1, 2014 | Comments Off

A report issued by S&P Capital IQ found that if publicly traded companies drop employer-sponsored insurance (ESI) benefits by 2020, they could save more than $700 billion by 2025. The report, released earlier today, said that these companies would save substantially by paying the Affordable Care Act’s (ACA’s) penalty rather than paying premium contributions and other costs associated with offering ESI. The authors postulate that once several notable companies elect to no longer offer ESI, many others will follow suit, leading to potentially 90% of major corporation employees receiving ACA Marketplace coverage by 2020.

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Health Affairs study indicates plan cancellations not abnormal

Posted on April 24, 2014 | Comments Off

A new study published in Health Affairs this week says that some insurance plans cancelled under the Affordable Care Act (ACA) may have been cancelled regardless by policyholders. The study, Insurance Cancellations In Context: Stability Of Coverage In The Nongroup Market Prior To Health Reform, uses Census data to assess the individual insurance market prior to ACA implementation and reported three key findings:

  • There was high turnover in the market;
  • 80% of those in the market acquired another form of coverage within in the year, mainly from an employer; and
  • turnover varied among groups (age, employment status, etc.)

As a result, the study purports this market experienced disruption well before the implementation of the ACA’s insurance reforms.

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CRS memo indicates number of missed ACA deadlines

Posted on April 23, 2014 | Comments Off

An updated memo released from the Congressional Research Service (CRS) outlines the number of deadlines the federal government has missed during implementation of the Affordable Care Act (ACA). The memo consists of three tables, each representing a year after ACA enactment, with a list of the statutory tasks intended to have been achieved that year and the actions taken by the administration on that task as of April 15, 2014. According to Politico, the administration still has about 22 outstanding deadlines on ACA implementation.

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NBER study discusses positive impact of including dental benefits in Medicaid

Posted on April 22, 2014 | Comments Off

A new study released by the National Bureau of Economic Research (NBER) indicates that including adult dental benefits in Medicaid plans can have a multitude of positive results. The study, How Do Providers Respond to Public Health Insurance Expansions? Evidence from Adult Medicaid Dental Benefits, found that covering dental benefits resulted in more dentists participating in Medicaid without decreasing the number of privately insured patients these dentists see. Additionally, the study reported that dentists participating in Medicaid were able to make greater use of dental hygienists while only mildly increasing patient wait times.

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CBO lowers ACA cost estimate

Posted on April 14, 2014 | Comments Off

The Congressional Budget Office (CBO) recently updated their cost estimate for the Affordable Care Act (ACA). The new estimate states that the ACA will cost $1.383 trillion over the next ten years, which is $104 billion less than the February estimate. The CBO states that the readjustment can be attributed to administrative changes, changes in the law, judicial decisions, new data (such as projected healthcare expenditures for both the private and public sectors), and changes in modeling.

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CMS FAQ discusses risk corridor

Posted on April 12, 2014 | Comments Off

A new set of Frequently Asked Questions (FAQs) issued by the Centers for Medicare and Medicaid Services (CMS) answers several questions concerning the risk corridor provision of the Affordable Care Act (ACA). Pursuant to the Notice of Benefit and Payment Parameters for 2015 final rule, CMS stated that the risk corridor provisions would be implemented in a budget neutral manner. The new FAQ stated how the administration will address various issues that may arise in providing risk corridor payments, including sufficiency and medical loss ratio (MLR) determinations.

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Update: State Medicaid, Marketplace and Navigator Law Status

Posted on April 11, 2014 | Comments Off

Click here to see an updated version of our HealthReformGPS map that provides a comprehensive depiction of each state’s status on Medicaid expansion, Marketplace operations, and Navigator laws. Note that partnership marketplaces are considered federally-facilitated marketplaces for the purposes of this map.

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CRS memo explains premium subsidies for plans offered outside of Marketplaces

Posted on April 10, 2014 | Comments Off

A memorandum from the Congressional Research Service (CRS) released by the House Energy and Commerce Committee states that a “literal application” of the law would prohibit premium subsidies to be offered for plans sold outside of the Affordable Care Act’s Marketplaces. The memo also provided means by which the administration could argue they possessed the authority to offer subsidies outside of the Marketplaces.

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