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

Archive: August 2011

Urban Institute paper offers steps to improve Medicare coverage process

Posted on August 31, 2011

The Urban Institute, funded by The Robert Wood Johnson Foundation, recently released the paper, “Improving the Quality and Efficiency of the Medicare Program Through Coverage Policy: Timely Analysis of Immediate Health Policy Issues,” which offers several steps to reform Medicare coverage. Medicare coverage determinations can influence the appropriate use of medical technology and the creation of better evidence to support clinical and health policy decision. The paper explores the five following areas in hopes of improving the Medicare coverage process: 1) strengthening evidence-based policies; 2) improving the evidentiary base of coverage policies through improved comparative effectiveness research; 3) using coverage with evidence development more consistently; 4) enabling consideration of costs in making coverage and payment policies; and 5) adopting least costly alternative pricing strategies in particular circumstances.

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Republican Governors Public Policy Committee releases proposal to develop a more efficient Medicaid system

Posted on August 31, 2011

The Republican Governors Public Policy Committee, a branch of the Republican Governors Association (RGA), released the proposal, “A New Medicaid: A Flexible, Innovative and Accountable Future,” which refers the super committee to 31 ideas for saving and reforming Medicaid. Specifically, the governors support block grants and capped allotments outside of a waiver and the reform of multiple federal programs including workforce training programs. The RGA report opposes cost shifting and tax increases. Key areas of agreement between the GOP report and the Democratic governors include the support of “dual-eligible” health care reform and an opposition to cost shifting proposals such as “blended rates.”

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Update: Medicaid Program Eligibility Changes under the Affordable Care Act

Posted on August 31, 2011

This update to the Medicaid Implementation and health insurance Exchange Briefs reviews a Notice of Proposed Rulemaking (NPRM) implementing the Medicaid and CHIP eligibility, enrollment simplification, and coordination provisions of the Affordable Care Act. Issued by the United States Department of Health and Human Services on August 17, 2011, the rule is comprehensive in scope; its public comment period ends October 31, 2011.

The Medicaid NPRM is part of a group of three regulations, all of which are summarized at HealthReformGPS.org. Together the rules are designed to implement both the Medicaid eligibility expansions, the process of determining eligibility for premium tax credits and cost sharing assistance in the Exchange individual market, and standards for employers purchasing coverage in Exchanges. Collectively, the rules are designed to allow individuals and families to acquire and keep coverage and move more seamlessly among publicly-supported sources of health insurance as family income and circumstances change.

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Commonwealth article recommends reinstatement of COBRA until 2014

Posted on August 28, 2011

Chronically high unemployment rates have left many Americans without job-based health insurance. Affordable insurance programs such as Medicaid and the Children’s Health Insurance Program (CHIP) are, at present, only available to pregnant women, children, and parents with very low incomes. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), which was in place from 2008-2010, individuals who were employed by a firm with 20 or more workers and had health insurance sponsored by that firm could retain their coverage for up to 18 months in the event that they lost their job. The Affordable Care Act (ACA), upon full implementation in 2014, will dramatically increase coverage options for people who lose their jobs. In the report, “Realizing Health Reform’s Potential: When Unemployed Means Uninsured: The Toll of Job Loss on Health Coverage, and How the Affordable Care Act Will Help,” the Commonwealth Fund encourages policymakers to bridge the gap for Americans until 2014. The Commonwealth Fund recommends that first, policymakers should consider an additional extension of unemployment benefits, as the current extension is set to expire in December 2011. Second, the paper suggests that government consider reestablishing the COBRA premium subsidies to help the millions of Americans who have lost their job-based health insurance until the ACA coverage takes effect in 2014.

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CMS releases details, RFA on bundled payment initiative

Posted on August 24, 2011

The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) has formerly announced the Bundled Payments for Care Improvement initiative. This initiative, authorized by the Affordable Care Act (ACA), proposes that various provider reimbursements for multiple services a person may receive during the normal course of an illness or injury be bundled together into one payment. The initiative allows broad flexibility for providers to determine which services may be bundled, as well as what share of the single payment may be allocated to each provider. CMS intends for this initiative to improve care coordination and reduce costs in Medicare, and has issued a Request for Applications (RFA) from interested parties on the four (4) different proposed bundling models.

For more information on bundled payments, click here.

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CRS issues report on individual mandate under ACA

Posted on August 24, 2011

The Congressional Research Service (CRS) has released a report on the individual requirement to purchase health insurance (individual mandate) under the Affordable Care Act (ACA). The report, “Individual Mandate and Related Information Requirements under PPACA,” lays out the various exemptions granted from the individual mandate provisions under the law, as well as explains how enforcement of the mandate by the IRS will work once the mandate takes effect in 2014.

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IRS Notice and Request for Comments Regarding the Community Health Needs Assessment Requirements for Tax-Exempt Hospitals

Posted on August 23, 2011

On July 7, 2011, the Treasury Department and the Internal Revenue Service (IRS) published a Notice and Request for Comments on a proposed policy regarding the Affordable Care Act’s new requirements related to tax exempt hospitals’ community health needs assessment (CHNA) obligations. Section 9007 of the Act added new Section 501(r) to the Internal Revenue Code, which delineates a series of statutory requirements, outlined in a previous implementation brief, applicable to nonprofit hospitals that seek tax-exempt status under Section 501(c)(3). The purpose of the Treasury/IRS Notice is to both describe the agencies’ approach to implementing hospital organizations’ CHNA obligations and to invite comments regarding their proposals. The CHNA requirements are effective for taxable years beginning after March 23, 2012. However, the Notice specifies that hospitals currently engaged in conducting CHNA-related activities — including development and wide publication of a needs assessment and adoption of an implementation strategy — can rely on the policies contained in the Notice as they move forward.

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Treasury, DOL, HHS issue new rules on providing insurance information to consumers

Posted on August 17, 2011

The Internal Revenue Service (IRS) of the U.S. Department of Treasury (Treasury), The Employee Benefits Security Administration (EBSA) of the U.S. Department of Labor (DOL), and the U.S. Department of Health and Human Services (HHS) have jointly-released two Notices of Proposed Rulemaking (NPRMs) covering the disclosure of the Summary of Benefits and Coverage and the Uniform Glossary to insurance consumers, aimed at providing clear, consistent, and comparable information about their health plan. The rules apply to group health plans and health insurance coverage in the group and individual markets under the Affordable Care Act (ACA), and include not only what must be disclosed to consumers, but also examples of the templates on which the information will be disclosed.

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TIGTA releases final report regarding TE/GE Division’s planning activities for the ACA

Posted on August 17, 2011

The Treasury Inspector General for Tax Administration (TIGTA) recently performed an audit on the Affordable Care Act (ACA) and the the Health Care and Education Reconciliation Act of 2010. TIGTA performed the audit to review the Tax Exempt and Government Entities (TE/GE) Division’s initial planning activities for ACA implementation. The TIGTA review did not identify any concerns relating to the methodology the TE/GE Division is using to monitor and coordinate planning efforts.

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Update: Consumer Operated and Oriented Plan (CO-OP) Program

Posted on August 17, 2011

On July 20, 2011, the Centers for Medicare and Medicaid Services (CMS) issued a notice of proposed rulemaking (NPRM) with comments due September 16, 2011, regarding the Consumer Operated and Oriented Plan (CO-OP) program. Established by §1322 of the Affordable Care Act (ACA), the CO-OP program develops and creates new private, non-profit health insurance issuers to offer qualified health plans (QHPs) through state Exchanges as an alternative for consumers to traditional, for-profit plans. CO-OP plans are consumer-run, and accountable to their individual membership in a way that most traditional for-profit health plans typically are not. The ACA requires HHS to award funds for start-up loans and solvency grants to eligible CO-OP applicants in order to enable each state to have at least one CO-OP. In making these awards, HHS must take into account recommendations from the Advisory Board created by §1322(b)(2) of the ACA.

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