Archive: February 2011
State Health Insurance Exchange Navigators
Posted on February 28, 2011
One of the great challenges of our health care system for individuals and small employers is figuring out health insurance. Multiple products are available in the market, and they can differ enormously with respect to benefits and cost-sharing, coverage standards, who – and what – is in or out of provider networks, and how to make the best use of insurance coverage. Insurance agents and brokers – sometimes referred to as “producers” – provide an important service by helping people and small businesses make purchasing choices. But brokers and agents perform a specific task: their primary job is to sell insurance products. Thus, while their role is key to a functioning insurance market, brokers and agents may not be sources of impartial advice on how to select among competing plans, and they may not provide post-enrollment assistance in understanding and using coverage once purchased.
CMS issues additional guidance on “maintentance of effort” requirements under health reform
Posted on February 26, 2011
The Centers for Medicare and Medicaid Services (CMS) has issued a State Medicaid Directors Letter (SMDL), further clarifying the “maintenance of effort” (MOE) provisions of the Affordable Care Act (ACA). The letter offers guidance that includes a list of helpuful questions & answers, and is especially important for States facing serious budget deficits because it details the specific instances when the MOE provisions apply.
Chronic Disease Management
Posted on February 23, 2011
More than 40% of the U.S. population has one or more chronic condition. Although the likelihood of having a chronic disease increases with age, approximately half of working-age Americans has at least one chronic condition. The prevalence of chronic diseases is increasing in both the elderly and non-elderly populations, with a significant increase in the number of people with multiple chronic diseases. Increased spending on chronic diseases in Medicare is a significant driver of the overall increase in Medicare spending over the last twenty years. Nevertheless, given the high cost of treating chronic diseases, the Affordable Care Act (ACA) includes many provisions to encourage chronic disease management as part of the overall emphasis on improving the efficiency of health care.
HHS issues final rule on provider conscience protections
Posted on February 21, 2011
The U.S. Department of Health and Human Services has issued Final Rule on the enforcement of Federal Health Care Provider Concience Protection Laws.
Obama administration asks judge to clarify Florida health reform ruling
Posted on February 19, 2011
The U.S. Department of Justice has submitted a motion to Florida Judge Roger Vinson, which asks him to clarify whether or not his judgement relieves states of their responsibilites under the Affordable Care Act (ACA). The “Motion to Clarify” seeks to resolve the confusion between the Obama Administration and States on whether Judge Vinson’s judgement allows implementation of the ACA to continue moving forward while the case is currently under appeal.
Health Reform and Community Living Assistance Services and Supports (CLASS)
Posted on February 18, 2011
Approximately 10 million American seniors and individuals with disabilities need long-term services and supports (LTSS), and the number is expected to increase to nearly 21 million by 2040. Private long-term care insurance represents only a fraction of long-term care financing, due to a host of issues ranging from the high cost of insurance premiums to concerns about the high rate of coverage denials. Medicare only covers short-term skilled nursing care services and home health services, and Medicaid, the primary payer of LTSS (almost 50%), covers a range of services, but is only available to low-income individuals with disabilities. In the Patient Protection and Affordable Care Act (ACA), Congress addressed the long-term care needs of the elderly and disabled by making a number of changes in Medicaid coverage of home and community based services, and by establishing the Community Living Assistance Services and Support (CLASS) program, a voluntary, federally administered health insurance program designed to assist eligible individuals in purchasing long-term community living services and supports.
Sebelius to Arizona: allowing waivers to expire does not violate MOE requirements of health reform
Posted on February 17, 2011
In a letter from U.S. Department of Health and Human Services Secretary Kathleen Sebelius to Arizona Governor Jan Brewer, the Secretary explains that any eligiblity reductions resulting from the expiration of Arizona’s section 1115 demonstration waiver do not violate the Maintenance of Effort (MOE) provisions of the Affordable Care Act (ACA). The letter is in response to Governor Brewer’s request of Secretary Sebelius to use her 1115 demonstration authority to waive the MOE requirements of the ACA.
For more information on Medicaid eligibility, click here.
CMS issues proposed rule on Medicaid payments for hospital-acquired conditions
Posted on February 17, 2011
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that prohibits States from receiving Medicaid funding for any medical care related to a health care-acquired conditions (HCAC). The proposed rule, which implements Section 2702 of the Affordable Care Act (ACA), also authorizes States to identify additional “provider-preventable” conditions and will take effect on July 1, 2011.
HHS announces Early Innovator grants
Posted on February 17, 2011
The U.S. Department of Health and Human Services has awarded “Early Innovator” grants to seven states for their efforts in designing cutting-edge I.T. systems. The awards total $241 million and are intended to help the Early Innovator states develop transferrable technology that can be used in other states as they progress toward fully implementing Exchanges.
CRS issues new report on Medicare and health reform
Posted on February 11, 2011
The Congressional Research Service has released a new report summarizing the Medicare provisions of the Affordable Care Act (ACA). The report, “Medicare Provisions in the Patient Protection and Affordable Care Act: Summary and Timeline,” highlights important changes to Medicare as a result of health reform and also marks key dates and deadlines required by the ACA.