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

RAND survey shows uptick in employer sponsored insurance

Posted on April 9, 2014 | Comments Off

A survey recently released by the RAND Corporation found that a net of 9.3 million individuals gained health insurance during the Affordable Care Act’s (ACA) open enrollment period. The majority of these individuals gained coverage through employer sponsored insurance (ESI), with Medicaid coming in as the second most frequent payer. RAND posits the uptick in ESI resulted from either the individual mandate forcing people to take coverage they had previously denied, or the improvements in the economy that have enabled more individuals to be employed and therefore receive benefits.

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Implementation Brief Update: Final 2015 Letter to Issuers in the Federally-Facilitated Marketplace: Access and Non-Discrimination Considerations

Posted on April 9, 2014 | Comments Off

On March 14, 2014 the Centers for Medicare and Medicaid Services (CMS) published its 2015 letter to issuers selling qualified health plans in the federally facilitated Exchange Marketplace (FFM). The issuers letter is designed to provide federal guidance on the qualified health plan certification process to health insurance issuers and states that use the FFM while also maintaining plan management partnerships with the federal government (AL, AK, AZ, AR, DE, FL, GA, IL, IN, IA, KS, LA, ME, MI, MS, MO, MT, NE, NJ, NY, NC, ND, OH, OK, PA, SC, SD, TN, TX, UT, VA, WV, WI, WY). This Update reviews highlights of the final 2015 letter (we reviewed the draft letter in a prior Update.

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BPC releases report on LTC

Posted on April 8, 2014 | Comments Off

A new report issued by the Bipartisan Policy Center (BPC) warns of the pending demand for long term care (LTC) services. According to BPC, the number of Americans needing LTC is expected to double by 2050. The report, compiled by BPC’s Long-Term Care Initiative, provides different delivery and financing reforms that may be instituted to help address the growing need for LTC.

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Implementation Brief Insurance Affordability: Payment of premium and cost sharing payments made on behalf of enrollees by federal and state programs

Posted on April 2, 2014 | Comments Off

Individuals purchasing qualified health plans and stand-alone dental plans (for the child component) through the Health Insurance Marketplace can qualify for premium subsidies and cost sharing reduction assistance if their modified adjusted gross incomes fall between 100% and 400% of the federal poverty level. Although as a matter of law the subsidies provided are deemed sufficient to make coverage affordable, for many individuals, the level of subsidy furnished is insufficient as a practical matter. Governmental programs such as the Ryan White Care Act and other federal and state programs may be available to help these individuals meet the cost of coverage by paying their share of premiums or assisting them with their portion of deductibles and other cost sharing. In recent weeks, however, news reports surfaced regarding the refusal by some insurers to accept payment made on behalf of enrollees.

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IRS guidance aids victims of domestic violence

Posted on March 26, 2014 | Comments Off

Guidance issued by the Internal Revenue Service (IRS) permits married individuals separated from their spouses due to domestic violence to receive income-based premium tax credits. Typically, spouses are expected to file taxes jointly in order to be eligible for premium subsidies under the Affordable Care Act (ACA). Today’s guidance allows for an exception to this rule and also extends the enrollment deadline for this population by two months, through May 31st.

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Administration extends ACA enrollment

Posted on March 26, 2014 | Comments Off

Today, the US Department of Health and Human Services (HHS) released guidance permitting extended enrollment for those seeking coverage under the Affordable Care Act’s (ACA) Health Insurance Marketplaces. The enrollment period, which was scheduled to end on March 31st, was extended in response to various circumstances that may have prevented eager enrollees to gain coverage within the specified time frame. One guidance document released by HHS specifies specific case scenarios in which an individual may be deemed eligible for extended enrollment, such as a natural disaster or Marketplace errors. A second document provides information for how individuals deemed “in-line” at the end of the enrollment period may still procure coverage after the deadline.

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Implementation Brief Update: Expanded Federal Regulation of Navigators and Other Consumer Assistance Personnel

Posted on March 26, 2014 | Comments Off

Federal regulations establish standards governing Navigator and non-Navigator consumer assistance programs. Navigators and non-Navigator assistance personnel must meet federal standards as well as state licensing and certification standards. Our prior update reviewed proposed federal rules that would clarify the criteria the federal government will apply in determining whether a state licensure or certification standard is preempted by federal law. The proposed rules also set additional federal standards governing Navigators and other consumer assistance personnel. Comments are due 30 days from publication of the proposed rule, which was published in the federal register on March 21, 2014.

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Implementation Brief Proposed Standards for Navigators and Consumer Assistance Counselors: Preemption of Certain State Navigator Regulatory Laws

Posted on March 19, 2014 | Public Comment (1)

On March 17, 2014, HHS released a proposed rule in public view form that addresses a variety of issues including Exchanges, Navigators and Non-Navigator consumer assistance personnel, and other matters. The rule will appear in the Federal Register on…

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Administration releases a deluge of ACA rules

Posted on March 17, 2014 | Comments Off

The administration recently issued several rules and guidance concerning the implementation of the Affordable Care Act (ACA). Below are key points from some of these new releases:

  • A new Frequently Asked Question (FAQ) document from the Centers for Medicare and Medicaid Services (CMS) states that most insurance plans will be required provide the same benefits to married gay couples as they do to heterosexual married couples. Insurance companies will extend these nondiscrimination policies to same sex couples for plans offered on the ACA marketplaces.
  • An interim final rule released by CMS requires plans offered through the ACA marketplaces to accept premium and cost-sharing payments from certain federal government programs. Such programs include the Ryan White HIV/AIDS program and various Indian organizations.
  • CMS also released the proposed rule concerning market standards for 2015. The rule covers a multitude of topics, ranging from new standards for self-funded non-federal plans opting out of certain Public Health Service Act (PHSA) requirements to amending guaranteed renewability stipulations.
    • One particular provision of this rule was designed to preempt state laws created to increase the certification requirements and restrict the roles of navigators and other assistors under the ACA. Additionally, the rule prohibits assistors from performing certain activities that received substantial criticism, such as cold calling potential consumers or offering cash incentives to promote enrollment. The rule also provides some leeway for insurers under the medical loss ratio (MLR) requirements as a result of the stymied roll out of the federal health insurance marketplace.
    • Another interesting provision in the rule will require insurers to provider a more robust network of doctors and hospitals for consumers. Many plans offer “narrow networks” as a mechanism to cut costs for consumers, yet many consumers are losing coverage for their family practitioners. CMS will determine whether or not the plans provide “reasonable access” to certain services, such as mental health, oncology, and primary care.
    • In addition to the rule, CMS also provided guidance regarding discontinuing or renewing policies in the group or individual markets.

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CMS releases 2015 final letter to issuer

Posted on March 14, 2014 | Comments Off

Today, the Centers for Medicare and Medicaid Services (CMS) released the finalized version of the 2015 Letter to Issuers in the Federally-facilitated Marketplaces. The letter provides technical and operational guidance to help qualified health plans (QHP) and stand-alone dental plans successfully participate in the Affordable Care Act (ACA) Marketplaces operated by the federal government.

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