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

Archive: May 2012

IRS releases notice extending medical loss ratio compliance date

Posted on May 31, 2012

The Internal Revenue Service (IRS) recently published a notice giving health organizations another year to comply with the medical loss ratio (MLR) provision enacted by the Affordable Care Act (ACA). Under the MLR provision, Blue Cross Blue Shield organizations and others that meet certain tax code requirements could lose special tax treatment under Section 833 if the organization’s MLR during the taxable year is not less than 85 percent. For purposes of Section 833, an organization’s MLR is equal to the “percentage of total premium revenue expended on reimbursement for clinical services provided to enrollees under its policies during such taxable year.” IRS plans to issue rules specific to MLR, but the industry needs more time to digest related final rules from the Department of Health and Human Services (HHS). Those rules were issued in December 2011. Comments on the notice are requested by September 10 of this year.

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KFF publishes report on Medicaid ACOs

Posted on May 30, 2012

The Kaiser Family Foundation reviews a number of state initiatives related to Medicaid Accountable Care Organizations (ACOs) in a recently published report. Findings indicate that most Medicaid ACOs are currently at an early stage of development. The structure of the Medicaid ACO initiatives is influenced by individual states’ history and experience with managed care, other existing care delivery arrangements within Medicaid, and the challenges inherent in serving low-income and chronically ill populations. Medicaid ACOs directly engage providers and provider communities in improving care and contain costs.

ACOs are provider-run organizations in which the participating providers are collectively responsible for the care of an enrolled population. Under an ACO, the managing providers may share in any savings associated with improvements in the quality and efficiency of the care they provide. Several states are rolling out ACO initiatives with the goal of improving Medicaid care.

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Commonwealth paper makes recommendations about wellness incentives under the ACA

Posted on May 30, 2012

In the United States, the Affordable Care Act (ACA) raised the maximum allowed wellness incentives, which are thought to improve health and reduce costs. Public insurers in Germany operate many such programs. Participation in these programs nearly doubled between 2004 and 2008, reaching one-quarter of the publicly insured population. An evaluation of one large wellness program there found that it reduced costs. However, population-level survey data also suggest that individuals with low incomes or poor health are less likely to enroll. Under the ACA in the United States, the increase in allowed wellness incentives could lead to wide differences in insurance premiums between users and nonusers of programs, and may risk reintroducing a form of medical underwriting. The German case study confirms the cost-saving potential of programs, but also suggests that they should be evaluated rigorously to ensure they do not disadvantage those with health problems or low incomes. A report published by The Commonwealth Fund reviews and provides insight on this issue.

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Increased Medicaid Payment for Primary Care Services Under the Affordable Care Act: Overview and CMS Implementation

Posted on May 30, 2012

Low physician participation rates in Medicaid — virtually since the program’s 1965 enactment[1] — have long posed a key limitation to its effectiveness. Many factors are thought to account for limited physician participation but, historically, low payment rates have stood out as a primary underlying problem.[2] As of 2008, Medicaid physician fees stood at approximately 72 percent of Medicare fees[3]

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NACCHO study explores impact of economic recession on local health departments

Posted on May 29, 2012

The National Association of County and City Health Officials (NACCHO) surveyed local health departments (LHDs) nationwide to measure the impact of the economic recession on LHDs’ budgets, staff, and programs. Results of the study, the seventh in a series, show that many LHDs continue to struggle to serve their communities in the face of ongoing fiscal constraints.

In 2011, 57 percent of LHDs reduced or eliminated services…

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Report finds that ACA will increase coverage for veterans

Posted on May 29, 2012

Ten percent of the nation’s 12.5 million nonelderly veterans report either not having health insurance coverage or using Veterans Affairs (VA) health care, according to the 2010 American Community Survey (ACS). A report prepared by the Urban Institute and released by the Robert Wood Johnson Foundation provides estimates of uninsurance rates among veterans and their families both nationally and at the state level, and assesses the potential for the Affordable Care Act (ACA) to reduce these uninsurance rates.

Veterans are less likely than…

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Families USA report explores Summary of Benefits and Coverage

Posted on May 29, 2012

Research has found that consumers have significant difficulty understanding health insurance plans. This can prevent consumers from receiving clear information regarding their health insurance plan benefits. Without a clear understanding of what their insurance covers, consumers are more likely to delay or forgo care, to make uninformed choices about treatment, and to end up with large and unexpected bills.

The Affordable Care Act (ACA) will give consumers the…

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Update: Draft Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges, General Guidance on Federally-facilitated Exchanges

Posted on May 25, 2012

On May 16, 2012, the United States Department of Health and Human Services issued a Draft Blueprint for Approval of Affordable State-based Exchanges (SBEs) and State Partnership Exchanges (SPEs). HHS also issued General Guidance on Federally Facilitated Exchanges (FFEs). Together, these two documents provide additional implementation information related to the final Exchange regulations issued by HHS on March 27, 2012, (click here for the regulations) which broadly describe the structural and operational requirements for state Exchanges, specify the Exchange approval process, and provide for FFEs in states that do not elect to operate a state Exchange. The newest guidance amplifies on the approval process for both state-based Exchanges (SBEs) and state Partnership Exchanges (SPEs) as a sub-class of FFEs but with…

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GW Legal Barriers Project Launches New Health Information Website

Posted on May 24, 2012

Today researchers at The George Washington University’s Hirsh Health Law and Policy Program launched Health Information and the Law (HealthInfoLaw.org), a website designed to serve as a practical online resource regarding federal and state laws governing access, use, release, and publication of health information. The site addresses the current legal and regulatory framework for health information, as well as changes in the legal and policy landscape that have an impact on health information law and its implementation particularly as health information moves into an electronic phase.

Health Information and the Law will enable cross-state comparisons and analysis of state and federal law on key health information issues, including how the revolution in the creation, collection, and exchange of health information affects…

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GAO report examines factors contributing to low use and complexity of Small Employer Health Insurance Tax Credit

Posted on May 21, 2012

At present, many small employers do not offer health insurance to employees. The Affordable Care Act (ACA) established the Small Employer Health Insurance Tax Credit to help eligible small employers provide health insurance to employees. The base of the credit is premiums paid or the average premium for an employer’s state if premiums paid were higher. The Government Accountability Office (GAO) was asked to examine (1) the extent to which the credit is claimed and any factors that limit claims; (2) how fully the Internal Revenue Service (IRS) is ensuring that the credit is correctly claimed; and (3) how the effects of the credits can be evaluated.

The GAO report found that…

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