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

CRS report discusses medical child support

Posted on December 30, 2013 | Comments Off

A new report released by the Congressional Research Service (CRS) explains the background a current policy regarding medical child support, a legal provision concerning the payment of healthcare services for children not residing with their parents. Specifically, the report mentions the impact of the Affordable Care Act (ACA) on both uninsured children and Child Support Enforcement (CSE), the agencies responsible for enforcing medical child support.

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EBSA and HHS rule expands excepted benefits

Posted on December 30, 2013 | Comments Off

A proposed rule released jointly by the Employee Benefits and Security Administration (EBSA) and the US Department of Health and Human Services (HHS) expanded the “excepted benefits” category under the 1996 Health Insurance Portability and Accountability Act (HIPAA) to include employee assistance programs. Excepted benefits include benefits related to health, but do not constitute comprehensive healthcare coverage, such as workers compensation, disability coverage, and auto insurance. Employee assistance programs, the newest excepted benefit, generally cover services such as substance abuse or mental health counseling, financial counseling, or legal services, and are usually provided to employees at no cost. Market reforms under the Affordable Care Act (ACA) do not apply to excepted benefits, and excepted benefits do not count as being covered under the individual mandate.

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Commonwealth Fund releases several ACA publications

Posted on December 30, 2013 | Comments Off

As a wrap-up to 2013, The Commonwealth Fund has published a slew of studies and reports concerning the implementation of the Affordable Care Act (ACA). Several of these publications are highlighted below.

The first publication, Realizing Health Reform’s Potential: How Are State Insurance Marketplaces Shaping Health Plan Design?, analyzes how state-based marketplaces (SBM) and state-partnership marketplaces (SPM) utilized their plan certification capabilities to enhance or alter the requirements for plans to participate in the marketplaces. The report examines the following certification areas: inclusion of essential community providers, benefit substitution, and provider networks. The second publication, What’s Behind Health Insurance Rate Increases? An Examination of What Insurers Reported to the Federal Government in 2012–2013, found that increases in healthcare rates from mid-2012 to mid-2013 can predominantly be attributed to medical trends, and a slight increase resulted from rate increases associated with the ACA. The third publication, Realizing Health Reform’s Potential: What States Are Doing to Simplify Health Plan Choice in the Insurance Marketplaces, discusses several policies employed by SBM to help simplify plan choices for consumers. Several of these policies include: incorporating meaningful difference standards (where a plan cannot be offered if it is too similar to one already in existence on the marketplace), limiting the number of plans or benefit designs an insurer may offer in the marketplace, and requiring standardized benefit designs.

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IRS rule prohibits grant-funded work to count as community benefit

Posted on December 30, 2013 | Comments Off

A draft rule released by the Internal Revenue Service (IRS) states that not-for-profit hospitals are no longer permitted to count local community benefit services funded by grant revenue when reporting these activities for tax exemptions. In order for non-federal hospitals to receive tax exemptions, these hospitals are required to perform and document their community benefit efforts, such as health-education or free healthcare services, on their Schedule H form. Proponents of the rule state that this change will increase transparency in how community benefit activities are funded, as well as level the playing field for teaching and non-teaching hospitals, who sometimes receive disparate amounts of grant funding.

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HHS allows individuals with canceled plans to claim hardship exemptions

Posted on December 30, 2013 | Comments Off

The US Department of Health and Human Services (HHS) has permitted individuals whose insurance plans were canceled under the Affordable Care Act (ACA) to qualify for a hardship exemption and not be subject to the individual mandate for 2014. Hardship exemptions were created for individuals that experienced “financial or domestic circumstances, including an unexpected natural or human-caused event, such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan,” and the new decision by HHS places individuals with canceled health plans under this classification. The policy change, announced both in a letter to several senators and through official guidance from the Centers for Medicare and Medicaid Services (CMS), requires individuals with canceled plans to submit a hardship exemption form and proof of plan cancellation. Individuals choosing to claim a hardship exemption may forgo insurance for 2014 without a penalty or choose to enroll into catastrophic plans, which are bare-bones plans typically reserved for individuals under the age of 30.

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IRS provides ACA tax relief for some small employers

Posted on December 19, 2013 | Comments Off

In guidance released by the Internal Revenue Service (IRS), the agency is providing some small businesses a one-year reprieve in meeting the criteria to qualify for small business tax credits in qualified health plans (QHPs) sold on the Small Business Health Options Program (SHOP). In many counties in Wisconsin and Washington state, however, QHPs will not be available on SHOP Marketplaces, meaning many small businesses would be ineligible to receive the tax credit that would help employers pay for premiums for their employees. According to IRS, this guidance permits small businesses in these areas to qualify for the 2014 tax credits based upon the 2013 rules.

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CMS issues rule on BHP

Posted on December 19, 2013 | Comments Off

The Centers for Medicare and Medicaid Services (CMS) released a new rule outlining funding methodology for the Basic Health Program (BHP). BHP was created to provide an affordable insurance option for individuals earning between 133-200% of the federal poverty level. The new rule released by CMS was accompanied by a letter to State-Based Marketplaces (SBM) requesting information on the second-lowest-cost silver plan offered on the Marketplace, which will be used to help set the premium for BHP. This provision of the Affordable Care Act (ACA) was delayed until January 2015 earlier this year.

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McKinsey report shows variation in Marketplace networks and premiums

Posted on December 16, 2013 | Comments Off

A report issued by McKinsey & Company this month discusses changes in insurance network configurations resulting from the Affordable Care Act (ACA). The report, Hospital networks: Configurations on the exchanges and their impact on premiums, analyzed over 20 cities in both federally-facilitated and state-based marketplaces. McKinsey found that nearly 60% of insurance plans sold on ACA Marketplaces cover fewer hospitals than current insurance plans. Moreover, ACA insurance plans with larger hospital networks charge higher premiums, with the more comprehensive plans costing 26% more than plans offering limited network coverage.

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New brief outlines issues with premium administration

Posted on December 13, 2013 | Comments Off

A new report from the Georgetown University Health Policy Institute Center for Children and Families discusses some of the issues with premium administration for public and subsidized insurance programs from the perspective of low-income individuals and families. The report, Handle with Care: How Premiums Are Administered in Medicaid, CHIP and the Marketplace Matters, describes how the absence of policy alignment between Medicaid, the Children’s Health Insurance Program (CHIP), and insurance subsidies from the Affordable Care Act (ACA) can be very detrimental to low-income individuals enrolling in and maintaining coverage. Some of the specific policies addressed by the brief include payment and collection options, grace periods, and cancellation rules.

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Iowa expands Medicaid

Posted on December 13, 2013 | Comments Off

Yesterday, Governor Terry Branstad announced that Iowa and the Centers for Medicare and Medicaid Services (CMS) reached a deal to expand Medicaid to over 100,000 Iowans under the Affordable Care Act (ACA). Iowa submitted a waiver (part one and part two) to CMS requesting to adopt an expansion model similar to Arkansas in which the state would use federal funds to purchase private insurance for the new Medicaid population. The difference with the Iowa model was that the state would require individuals earning between 50-133% of the federal poverty level to pay a premium for their coverage of no more than 2% of their income. CMS renegotiated with the state, and both parties now agree that individuals earning between 100-133% of the federal poverty level will pay premium on their coverage. Iowa is now the 10th state with a Republican governor to expand Medicaid.

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