Archive: November 2011

HHS awards Affordable Insurance Exchange grants to 13 states and releases new FAQs

Posted on November 30, 2011

The Department of Health and Human Services (HHS) awarded nearly $220 million in Affordable Insurance Exchange grants to 13 states (Alabama, Arizona, Delaware, Hawaii, Idaho, Iowa, Maine, Michigan, Nebraska, New Mexico, Rhode Island, Tennessee, and Vermont) to booster Exchange creation. The grants will provide the states with more flexibility and resources to implement the Exchange provisions under the Affordable Care Act (ACA). To date, forty-nine states and the District of Columbia have received planning grants, and 45 states have consulted with consumer advocates and insurance companies. Thirteen states have passed legislation to create an Exchange.

The Department also released several new Frequently Asked Questions, which provide information states may need as they begin creating the Exchange marketplaces. Critical among this new information is that states that run Exchanges have more options than originally proposed regarding eligibility determination for tax credits and Medicaid. States also have more time to apply for “Level One” Exchange grants.

To read more about the Exchanges, click here.

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CMS announces new deadlines for Advance Payment Model

Posted on November 30, 2011

The Advance Payment Accountable Care Organization (ACO) Model is an initiative developed by the Centers for Medicare and Medicaid (CMS) Innovation Center designed for organizations participating as ACOs in the Medicare Shared Savings Program (Shared Savings Program). Through the Advance Payment Model, selected participants in the Shared Savings Program will receive advance payments that will be recouped from the shared savings they earn. CMS released a notice today announcing the new application deadline for participation in the Advance Payment Model for certain ACOs. Applications for the performance period beginning on April 1, 2012 will be accepted from January 3, 2012 through February 1, 2012. The period during which applications will be accepted for the performance period beginning on July 1, 2012 will remain identical to the period for the Medicare Shared Savings Program.

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U.S. trumps other countries in health care spending again

Posted on November 23, 2011

The Organization for Economic Co-operation and Development recently released the 6th annual Health at a Glance report. The OECD paper shows that the United States is number one in health spending even though Americans have a lower rate of doctor visits and hospitalizations than most of the other 34 member countries. The United States spent approximately $7,960 per person on health care in 2009. This rate was about 2.5 times the average per capita health care cost in the other countries studied.

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Departments release FAQs on ACA, Mental Health Parity

Posted on November 22, 2011

According to a set of frequently asked questions (FAQs) recently released by the Departments of Health and Human Services (HHS), Treasury (DOT), and Labor (DOL), the final rule under an Affordable Care Act (ACA) provision, which requires health care insurers and group health plans to make available to consumers a standardized summary of the benefits and coverage for each plan they offer, will be released “as soon as possible.” The FAQs pertain to implementation of ACA market reform provisions and mental health parity requirements. Until this final rule is released, plans are not required to comply with the proposed rule’s provisions. The ACA requires plans to provide consumers with a standardized form containing definitions of benefits and information on coverage. Along with the benefits and coverage summary, the departments also included several FAQs addressing the implementation of the Mental Health Parity and Addiction Equity Act of 2008, which mandates equal treatment for medical and surgical care and mental health and substance use disorder care in areas such as out-of-pocket costs and benefit limits and practices.

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Employer Responsibilities under the Affordable Care Act

Posted on November 21, 2011

Under federal law, employers are not required to offer health insurance coverage to their employees; however, most do voluntarily. In fact, employer-sponsored health insurance is the primary source of health care coverage for most Americans, with roughly 60 percent of the non-elderly receiving health coverage through the workplace. Initially offered as a way to attract workers during wartime wage freezes and price controls, health insurance coverage is still used as a way to recruit and retain workers, and as a means of improving employees’ health and productivity. However, not all workers have health insurance. Indeed, three-fourths of the approximately 50 million uninsured Americans are working people and their dependents.

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HHS announces release of tool for small businesses to compare health insurance plans

Posted on November 18, 2011

The U.S. Department of Health and Human Services announced the release of a greatly expanded website to give small business owners a venue to review health insurance plan choices. The tool enables small business owners to compare the benefits and costs of health plans and choose those that are best for their employees. Small businesses will be able to research locally available products in an unbiased manner. The aim of the tool is to foster a more transparent and competitive marketplace. At present, the market is often difficult to analyze and small businesses do not fare as well as their large employer counterparts when negotiating health care prices. Ideally, the new tool will help ensure insurance companies will compete for business on the basis of price and quality.

The tool was created under requirements contained in the Affordable Care Act (ACA). The Centers for Medicare & Medicaid Services collected information from insurers across the country to develop the site.

Information on the website includes:

  • Insurance product choices for a given ZIP code, sorted by out-of-pocket limits, average cost per enrollee, or other factors.
  • A summary of cost and coverage for small group products that shows the available deductibles, range of co-pay options, included and excluded benefits, and benefits available for purchase at additional cost.
  • The ability to filter product selection based on whether the plans are Health Savings Account eligible, have prescription drug, mental health, or maternity coverage, or allow for domestic partner or same sex coverage.

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RWJF releases summary documenting that public health interventions lead to health care cost savings

Posted on November 16, 2011

The Affordable Care Act (ACA) created the Prevention and Public Health Fund, a 10-year, $15 billion commitment to support programs, medical screenings, and research related to public health and prevention. This national commitment to investment in preventing disease before it occurs is in line with evidence from a variety of recent reports and studies indicating that strategic investments in proven, community-based prevention programs could result in significant U.S. health care cost savings and overall economic cost savings. The Robert Wood Johnson Brief, “Return Investments in Public Health: A Summary of Groundbreaking Research Studies,” summarizes the findings and recommendations from four major studies released between 2008 and 2011.

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CRS issues report regarding presidential power over the ACA

Posted on November 15, 2011

On November 14, 2011, the Congressional Research Service issued a memorandum regarding the extent to which a President, through use of an executive order or other administrative actions, could impact provisions under the Affordable Care Act (ACA). The report confirms that while the President would be able to alter certain regulations, a “President would not appear to be able to issue an executive order halting an agency from promulgating a rule that is statutorily required by PPACA, as such an action would conflict with an explicit congressional mandate…” CRS examined the issue for Republican Senator Tom Coburn of Oklahoma, finding that federal courts would frown upon any attempt to undo White House legislation.

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Supreme Court agrees to hear health reform challenges

Posted on November 14, 2011

The U.S. Supreme Court has granted writ of certiorari (cert) to three appellate court cases involving multiple issues related to the constitutionality of the Affordable Care Act (ACA). The Court set aside 5-1/2 hours for oral arguments, which will likely take place in March. The justices will hear arguments on four issues: (1) the constitutionality of the individual mandate; (2) whether other provisions of the ACA should be severed (and remain in effect) if the individual mandate is found to be unconstitutional; (3) the applicability of the Anti-Injunction Act on whether the Court has jurisdiction to hear the cases, and; (4) the legality of the ACA’s Medicaid eligibility expansion.

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GAO recommends automatic increases in FMAP

Posted on November 10, 2011

A recent Government Accountability Office (GAO) report introduces a prototype formula to provide states with temporary Medicaid assistance during national economic downturn. Once a threshold number of states–26 in the GAO formula–demonstrate a sustained decrease in their employment-to-population ratio, temporary increases to the Federal Medical Assistance Percentage (FMAP) will be automatically triggered under the GAO plan. This assistance will end when fewer than the threshold number of states show a decline in the ratio. Targeted state assistance would be calculated based on 1) increases in unemployment, as a proxy for changes in Medicaid enrollment; and 2) reductions in total wages and salaries, as a proxy for changes in states’ revenues. Such assistance would facilitate state budget planning, provide states with greater fiscal stability, and better align federal assistance with the magnitude of the economic downturn’s effect on individual states.

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