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

Archive: February 2012

Update: Prevention and Public Health Fund

Posted on February 27, 2012

The Patient Protection and Affordable Care Act (ACA) of 2010 created the Prevention and Public Health Fund (Prevention Fund) to improve American health through disease prevention efforts. The ACA allotted almost $20 billion over 10 years to the Prevention Fund with the goal of improving wellness and restraining cost growth incurred by the increasing prevalence of chronic disease. This fund is structured as a trust fund, and is not subject to the annual appropriations process.

Continue Reading "Update: Prevention and Public Health Fund" »

HHS bulletin reviews actuarial value definition, cost sharing

Posted on February 27, 2012

On February 24, The Department of Health and Human Services (HHS) outlined the proposal it plans to use to define actuarial value for individual and small group health plans. The bulletin also outlines the plans for cost-sharing requirements for benefits that insurers must cover for moderate-income people purchasing policies through insurance exchanges.

Actuarial value (AV), a measure of the percentage of expected health care costs a health plan will cover…

Continue Reading "HHS bulletin reviews actuarial value definition, cost sharing" »

Update: Release of Medicare Data for Performance Measurement

Posted on February 24, 2012

Health policy experts and lawmakers believe that measuring and publicly reporting information about the performance of physicians, hospitals, and other health care providers is critical to improving health care quality and controlling costs. Advancing health information access and transparency is a goal of the Patient Protection and Affordable Care Act (ACA) [1], which includes a number of provisions to incentivize quality measurement and reporting and to enable more informed consumer decision-making. Across the country, community organizations, such as the Alliances participating in the Robert Wood Johnson Foundation’s Aligning Forces for Quality initiative, have been demonstrating the power of using private payer and Medicaid medical claims data to measure and publicly report on provider performance. Their work could be further strengthened by access to Medicare claims data because it is the single largest pool of information about how health care is delivered in America. Combining Medicare data with data from other public and private payers such as Medicaid and employer sponsored plans, holds the potential to generate more complete and accurate provider performance measurement information, thereby further empowering consumer engagement and quality improvement.

Continue Reading "Update: Release of Medicare Data for Performance Measurement" »

CMS releases proposed rule on stage 2 of meaningful use requirements for HIT

Posted on February 23, 2012

On February 23, The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for Stage 2 requirements for the Medicare and Medicaid electronic health record (EHR) incentive programs. The proposed rule outlines the second stage of “meaningful use” criteria for eligible providers and hospitals. If implemented, the rule would increase requirements for the EHRs, as well as increase the requirements for information exchange. Additionally, the proposal introduces changes to the program timeline, details payment adjustments for providers and hospitals, and adds objectives for specialists in the EHR incentive programs.

The final rule for Stage 1 of the EHR incentive program was published in the July 28, 2010.

Continue Reading "CMS releases proposed rule on stage 2 of meaningful use requirements for HIT" »

ACA covers nearly 50,000 Americans with pre-existing conditions

Posted on February 23, 2012

The Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today announced that the Affordable Care Act’s (ACA’s) Pre-Existing Condition Insurance Plan (PCIP) program is providing insurance to nearly 50,000 people with high-risk pre-existing conditions nationwide. HHS released a new report demonstrating how PCIP is helping to fill a void in the insurance market for consumers with pre-existing conditions who are denied insurance coverage and are ineligible for Medicare or Medicaid coverage.

Continue Reading "ACA covers nearly 50,000 Americans with pre-existing conditions" »

10 states receive Exchange grants and Final Rule for “Innovation Waivers” released

Posted on February 23, 2012

The Department of Health and Human Services announced yesterday that ten states will receive $229 million in federal grants to establish health insurance exchanges in accordance with the Affordable Care Act (ACA). HHS also issued a final rule, allowing states to request “innovation waivers” from the ACA beginning in 2017. Eligible states must demonstrate they can cover as many residents with coverage as comprehensive and as affordable as would be provided under the ACA, under a plan that would not increase the federal deficit.

Under ACA, the online insurance exchanges are to be in operation in all states by 2014 to allow individuals and small businesses to buy coverage and receive federal subsidies if they are eligible. In states that do not create their own exchanges, the federal government will create exchanges, and states can partner with the federal government to perform some exchange functions.

The establishment grants are intended to help states build new health insurance marketplaces. The recipients of the 10 establishment grants are…

Continue Reading "10 states receive Exchange grants and Final Rule for “Innovation Waivers” released" »

Study shows only 1 in 4 low-wage workers received employer health insurance in 2010

Posted on February 23, 2012

A paper recently released by the Center for Economic and Policy Research and Georgetown University uses data from the Current Population Surveys for 1980 through 2011 to review trends in health-insurance coverage rates for low-wage workers (defined as workers in the bottom fifth of the wage distribution in each survey year). In 2010, over 38 percent of low-wage workers lacked health insurance from any source, up from 16 percent in 1979. The biggest reason for the decline in coverage is the erosion of employer-provided health insurance, either through a worker’s own employer or as a dependent on another family member’s employer-provided policy. Over the last three decades, the role of public insurance in providing coverage for low-wage workers has increased, though not nearly enough to offset the declines in private insurance. In 2010, about 10 percent of low-wage workers had coverage through Medicaid, double the share in 1979. While a great deal of uncertainty still surrounds the Affordable Care Act (ACA) and its likely impact on employers and workers, reasonable estimates based on consensus projections suggest that the ACA will have a substantial positive effect on health-insurance coverage rates for low-wage workers. Even so, the ACA will likely leave an important share of low-wage workers, especially low-wage Latino, African American, and Asian workers, as well as many immigrant workers, without coverage. At the same time, if the ACA is blocked – in the courts or in Congress – there is every indication that coverage rates for low-wage workers will continue their long, steady decline.

Continue Reading "Study shows only 1 in 4 low-wage workers received employer health insurance in 2010" »

CMS awards $639 million in loans to nonprofit health insurers

Posted on February 22, 2012

The Centers for Medicare & Medicaid Services (CMS) announced a total of $638.7 million in federal loans to seven nonprofit health insurance co-operatives. The groups are the first to receive loan funds under the Affordable Care Act (ACA). The purpose of these funds will be to improve quality, benefits, and premium affordability for subscribers. The creation of Consumer Operated and Oriented Plans (known as CO-OPs) is a provision under the ACA . CO-OPs are intended to be directed by their customers to offer individuals and small businesses more affordable, consumer-friendly health insurance.

CMS issued a final rule establishing the CO-OP program in December 2011 (237 HCDR, 12/9/11).

The groups receiving the awards Feb. 21 were…

Continue Reading "CMS awards $639 million in loans to nonprofit health insurers" »

OIG report finds that contractors are unable to identify overpayments due to flawed CMS database

Posted on February 21, 2012

A study released by the Department of Health and Human Services Office of the Inspector General (OIG) presents an early assessment of the efforts of Review Medicaid Integrity Contractors (Review MIC) to conduct data analysis to identify potential overpayments and provide or recommend audit leads to the Centers for Medicare & Medicaid Services (CMS). The objectives were: (1) to determine the extent to which Review MICs completed assignments, recommended audit leads, and identified potential fraud; and (2) to describe barriers that Review MICs encountered in their program integrity activities.

The OIG recommend that CMS…

Continue Reading "OIG report finds that contractors are unable to identify overpayments due to flawed CMS database" »

Supreme Court grants request for more time

Posted on February 21, 2012

The Supreme Court justices announced that they would lengthen the time allotted to hear the Anti-Injunction Act issue from 60 to 90 minutes. This issue surrounds whether the justices have the authority to decide whether the Affordable Care Act’s (ACA’s) minimum coverage provision is constitutional. This will bring the case to a total of six hours, making it the longest Supreme Court case in modern history. For the Anti-Injunction Act, the court will hear from a third-party attorney for 40 minutes, the Justice Department for 30 minutes, and the NFIB and the states will get 20 minutes. Next, the justices will hear two hours regarding whether the insurance mandate is constitutional. This issue of the severability of the individual mandate from the rest of the ACA will receive two and a half hours. The court will finally spend an hour on the states’ challenges to Medicaid expansion.

Continue Reading "Supreme Court grants request for more time" »