Archive: December 2011

Update: Essential Health Benefits

Posted on December 20, 2011

On December 16, 2011, the HHS Center for Consumer Information and Insurance Oversight (CCIIO) released an Essential Health Benefits Bulletin, whose purpose is to “provide information and solicit comments on the regulatory approach that the Department of Health and Human Services (HHS) plans to propose to define essential health benefits under section 1302 of the Affordable Care Act.” Comments on the Bulletin can be sent directly to EssentialHealthBenefits@cms.hhs.gov and will be accepted until January 31, 2011

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NIHCR report suggests ACA will not amply address primary care physician shortages

Posted on December 20, 2011

A report released by the National Institute for Health Care Reform (NIHCR) finds that provisions under the Affordable Care Act (ACA) to increase the number of primary care physicians may not be sufficient to meet the rising demands of medical services. Such provisions under the ACA include higher payment rates and educational loan forgiveness for primary care doctors. NIHCR urges policymakers to focus on ways to expand primary care that will yield more timely results. Such improvements could include opening the field of primary care to more non-physician providers, and improving the efficiency of existing practitioners.

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RWJF report explores Exchange options for States

Posted on December 20, 2011

The Robert Wood Johnson Foundation (RWJF) released a report today that explores three ways that states can comply with the Affordable Care Act’s (ACA’s) health insurance exchange provision. First, states can establish an exchange of their own; second, states can default to a federal exchange; or third, states can create a hybrid exchange. On behalf of the National Academy of Social Insurance (NASI), the authors evaluated the considerations associated with each option to help states determine which model may work best for the unique needs of their residents. Although the underlying goals are the same in all three Exchange models, there are differences in the amount of flexibility and autonomy granted to the States with each. State Exchanges, for example, offer the greatest independence in functions like coordinating plan enrollment, eligibility, and financial management. States cede much of this autonomy with the Federal Exchange model. As its name implies, the Hybrid Exchange allows states to retain responsibility for certain core functions, while importantly, also providing an interim pathway for an eventual State Exchange. The authors conclude that regardless of the model, success can only be achieved through intensive collaboration between individual states and the U.S. Department of Health & Human Services.

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ACA Demonstration to provide home care for Medicare patients

Posted on December 20, 2011

The Centers for Medicare & Medicaid Services (CMS) announced today a new Demonstration under the Affordable Care Act (ACA) that will enable up to 10,000 Medicare beneficiaries with chronic conditions to receive most of their necessary care at home. The new Independence at Home Demonstration, a provision of the ACA, significantly expands the scope of in-home care that Medicare patients are eligible to receive. If they choose to opt into the Demonstration, beneficiaries with have access to a wide range of primary care services. Participation is optional. The Demonstration will reward providers with an incentive payment if they offer high-quality care care and reduce Medicare expenditures. CMS will implement quality measures to ensure beneficiaries experience high quality care under the new Demonstration.

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BCBS releases Health Reform Toolkit on Exchanges

Posted on December 20, 2011

This spring, as the Affordable Care Act (ACA ) celebrated its first birthday, Massachusetts commemorated five years since the implementation of its revolutionary health reform law, passed in 2006. Marking these milestones, the Blue Cross Blue Shield of Massachusetts Foundation, the Robert Wood Johnson Foundation, and the Commonwealth Health Insurance Connector Authority developed the Health Reform Toolkit Series to offer insight on key health reform topics to state leaders in the process of ACA implementation. The Blue Cross Blue Shield (BCBS) of Massachusetts Foundation recently published the fourth report of the series, “Mitigating Risk in a State Health Insurance Exchange.” This toolkit focuses on the ACA’s three key strategies intended to mitigate adverse selection and stabilize health insurance premiums when insurance market reforms are implemented in 2014. These strategies are also designed to decrease health insurance plans’ economic incentives to employ tactics designed to enroll healthier persons. These three risk mitigation strategies include: 1) Risk corridors; 2) Reinsurance; and 3) Risk adjustment. By mitigating risk to health insurers, these three strategies – along with standardized product designs – work together to allow issuers to compete on quality, efficiency, and value, rather than on the basis of designing products intended to attract and enroll only the healthiest individuals.

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Prominent Republican Discusses Importance of Medicaid on Senate Floor

Posted on December 19, 2011

Senator Charles Grassley (R-IA), Ranking Member of the Senate Judiciary Committee, gave a speech on the Senate floor warning members of the dire consequences to Congressional powers if the Supreme Court finds in favor of States on the ‘Medicaid Commandeering’ argument. The Court has agreed to hear oral arguments on multiple challenges to the Affordable Care Act (ACA) over a three day stretch in late March of 2012. These challenges include an objection by States of the Medicaid expansion provisions of the ACA, which require States to expand Medicaid eligibility to 133% of the federal poverty level (FPL) in order to receive additional federal dollars.

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HHS announces 32 health care organizations to participate in Pioneer ACO Model

Posted on December 19, 2011

Today, the U.S. Department of Health and Human Service (HHS) named 32 health care organizations that will participate in the Pioneer Accountable Care Organization Model. The goal of the new ACO Model is to encourage providers, hospitals, specialists, and caregivers to provide more coordinated care, which could save $1.1 billion over a five year period, HHS projects. The Centers for Medicare & Medicaid Services (CMS) Innovation Center is spearheading this initiative and will reward groups that have formed ACOs based on improvements in health of their Medicare patients and their ability to lower health care costs. Under the Pioneer ACO Model, the 32 selected health care organizations will test the effectiveness of several innovative payment models. The goal of the Pioneer ACO model is to provide better care for beneficiaries, improved coordination with private payers, a reduction Medicare cost growth, and rewards for health care providers that deliver high-quality care. The 32 selected Pioneer ACOs represent urban and rural organizations from various geographic regions of the country, covering 18 states and 860,000 Medicare beneficiaries.

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Sen. Wyden (D-OR) joins Rep. Ryan (R-WI) on Medicare Plan

Posted on December 18, 2011

Democratic Sen. Ron Wyden of Oregon teamed up with Republican Rep. Paul Ryan of Wisconsin on a Medicare overhaul plan that would provide beneficiaries with a fixed amount to buy private coverage or pay for a traditional fee-for-service plan. Different from the Ryan plan introduced earlier this year, the Ryan-Wyden proposal would not do away with Medicare, but instead would leave it is an option for beneficiaries to purchase with their vouchers. However, this plan would not ensure that the voucher would make Medicare affordable, nor would it preclude private insurance policies from designing benefit plans to exclusively attract healthy beneficiaries.

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House passes bill with 2-year SGR fix

Posted on December 16, 2011

Introduced by Republican leadership only days earlier, the U.S. House of Representatives has passed a legislative package, some of which is paid for by reducing funding of certain components of the Affordable Care Act (ACA). The legislation provides funding for the controversial Keystone XL pipeline, preempts certain rules issued by the Environmental Protection Agency, extends unemployment insurance, and prevents a reduction in physician payments under Medicare (the “SGR fix”), among other provisions. The legislation is paid for, at least in part, by increasing the amount of ineligible premium sharing tax-credit money that can be recoped by the IRS under the ACA, and by cutting the Public Health and Prevention trust fund by $8 billion.

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HHS releases bulletin on essential benefits, allows for state flexibility

Posted on December 16, 2011

The U.S. Department of Health and Human Services (HHS) has issued a pre-rule informational Bulletin which lays out its proposed approach for determining the Essential Benefits package required of all qualified health plans (QHPs) under the Affordable Care Act (ACA). HHS deferred to States’ judgment by allowing a State to create a benchmark essential benefits package from a currently-available plan within the State, as long as the package includes benefits from the ten benefit categories laid out in the ACA. HHS proposes that States choose the benchmark plan from a list of plan types:

  • One of the three largest small group plans in the State by enrollment
  • One of the three largest State employee health plans by enrollment
  • One of the three largest federal employee health plan options by enrollment
  • The largest HMO plan offered in the State’s commercial market by enrollment

If a State does not select a benchmark plan, HHS intends to propose that the default benchmark be the benefits package from the largest small group plan within the State.

For more information on Essential Benefits, click here.

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