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

Archive: September 2012

HHS announces grants for community health centers

Posted on September 28, 2012

Health and Human Services (HHS) Secretary Kathleen Sebelius announced new Affordable Care Act (ACA) funded grants that will improve the quality of care at community health centers and ensure more women are screened for cervical cancer. The grants will help 810 community health centers become patient-centered medical homes (PCMHs) and increase their rates of cervical cancer screening. The patient-centered medical home is a care delivery model designed to improve quality of care through better coordination, treating the many needs of the patient at once, increasing access, and empowering the patient to be a partner in their own care.

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Romney and Obama present health reform visions in NEJM articles

Posted on September 27, 2012

President Barack Obama and former Massachusetts Governor Mitt Romney released essays in the New England Journal Medicine (NEJM) presenting their visions for the future of health care reform. Obama calls for additional steps to fix the nation’s health care delivery system, including a “permanent fix to Medicare’s flawed payment formula that threatens physicians’ reimbursement.” President Obama also pledges his commitment to life sciences research, distancing himself from vice presidential candidate Paul Ryan’s proposal to slash medical research investments. Obama also touts various popular Affordable Care Act (ACA) provisions including the end of lifetime benefit caps, expanded preventive care services coverage, permitting young adults to remain on their parents insurance until age 26, rebates from insurance companies from the medical loss ratio (MLR) provision, and the efforts to reduce Medicare and Medicaid fraud. Romney touches on his premium support plan for Medicare, Medicaid block grants, and plan to prevent discrimination against patients with pre-existing conditions “who maintains continuous coverage.”

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OPM multi-state plan draft application implies plans may participate in part of a state

Posted on September 27, 2012

A draft of a multi-state plan application indicates that the Office of Personnel Management intends to allow the Affordable Care Act’s (ACA’s) multi-state plans to initially participate in part of a state, as opposed to the entire state. This comes as a surprise, as the ACA states that multi-state plans must be offered “in all geographic regions…” According to the ACA provision, these multi-state plans must be operating in 60 percent of states in the first year of an insurance plan’s participation. By the fourth year, they must scale up and offer coverage nationwide. These plans will be certified to be offered in all exchanges, so they will not need to apply for separate state certifications.

Comments on the draft application are due to OPM by October 22, 2012.

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EBRI report finds fewer Americans obtain coverage through employer

Posted on September 27, 2012

According to a new Employee Benefit Research Institute (EBRI) report, the uninsured rate shrank for working-age Americans last year. The percentage of non-elderly Americans with coverage increased to 82 percent in 2011, up from 81.5 percent in 2010. Employment-based health insurance coverage rates dropped, however. Although employer-sponsored coverage remains the dominant source of health coverage in the United States, providing coverage for 155.5 million people under age 65 in 2011, the percentage of non-elderly individuals with employer-sponsored coverage has declined every year since 2000.

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CRS details medical loss ratio requirements

Posted on September 27, 2012

The Congressional Research Service (CRS) published a report which outlines three issues on which legislation and hearings regarding the Affordable Care Act’s (ACA’s) medical loss ratio (MLR) requirement have focused. The issues include broker commissions, high-deductible health plans (HDHPs), and special rules for nonprofit insurers.

Under the MLR provision, individual and small group plans must spend at least 80 percent of premiums on medical benefits or activities to improve consumer health care quality. Large group plans must spend at least 85 percent. If plans do not meet this MLR requirement, they must refund the different to beneficiaries. In August 2012, insurance companies refunded $1.1 billion to approximately 12.8 million consumers for 2011, due to the ACA provision.

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CMS announces program to improve nursing care facility quality

Posted on September 27, 2012

The Centers for Medicare & Medicaid Services (CMS) announced seven awards partnering with 145 nursing facilities to implement the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents. The CMS initiative will test models to improve health care delivery quality and reduce the number of preventable rehospitalizations among nursing facility residents. The initiative will fund organizations to provide additional support to members of nursing facility communities.

Many nursing facility residents are enrolled in both Medicaid and Medicare, and are thus known as dual eligibles. Dual eligibles are the most chronically ill patients served by the two programs. Research found that approximately 45 percent of hospitalizations among duals receiving either Medicare skilled nursing facility services or Medicaid nursing facility services could have been avoided. Total costs for these potentially avoidable hospitalizations for Medicare-Medicaid enrollees for 2011 were estimated to be between $7 and 8 billion.

CMS will partner with seven organizations to improve care for long-stay nursing facility residents. These organizations will collaborate with nursing facilities and State Medicaid programs to provide better quality of care in nursing facilities.

For more information on the initiative, click here.

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5 states and Washington, DC receive exchange grants

Posted on September 27, 2012

Today, the U.S. Department of Health and Human Services (HHS) announced six new health insurance exchange grant awards. The grants will go to Arkansas, Colorado, Kentucky, Massachusetts, Minnesota, and Washington, D.C. The federal support will aid the states and D.C. in creating the new exchange marketplace. D.C. received $73 million, Massachusetts $41.7 million, Arkansas $18.6 million, Minnesota $42.5 million, Colorado $43.5 million, and Kentucky $4.4 million.

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OIG releases study on Medicare payments and fraud

Posted on September 26, 2012

According to a study recently released by Office of the Inspector General (OIG), between 2001 and 2010, Medicare payments for Part B goods and services increased by 43 percent, from $77 billion to $110 billion. During this same time, Medicare payments for evaluation and management (E/M) services increased by 48 percent, from $22.7 billion to $33.5 billion. E/M services have been vulnerable to fraud and abuse. In 2009, two health care entities paid over $10 million to settle allegations that they fraudulently billed Medicare for E/M services. The Centers for Medicare & Medicaid Services (CMS) also found that certain types of E/M services had the most improper payments of all Medicare Part B service types in 2008. The OIG report is the first in a series of evaluations of E/M services.

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Health Affairs / RWJF brief explores improving care transitions

Posted on September 26, 2012

Health Affairs and the Robert Wood Johnson Foundation published a new policy brief regarding efforts to improve care transitions. Care transitions are movements that patients make among health care providers and settings as their needs change during the course of illness. Without well-planned coordination, these transitions may result in patient harm and needless expense. According to the brief, researchers estimated that in 2011, poor transitions caused between $25 and $45 billion in wasteful medical spending through avoidable complications and unnecessary hospital readmissions.

Topics covered in the brief include the causes of poor care transitions, improving care transitions, and policy options to address transition coordination.

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Update: Legal Challenges to the Affordable Care Act’s Medicaid Maintenance of Effort Provisions

Posted on September 26, 2012

The Affordable Care Act (ACA), in addition to expanding coverage to individuals with incomes below 133 percent of the federal poverty level (FPL), includes provisions designed to preserve existing Medicaid coverage — known as the maintenance of effort provision, or MOE — until the ACA is fully implemented. The ACA’s MOE provision requires states to maintain their current Medicaid eligibility standards, methodologies, and procedures until the Secretary of the Department of Health and Human Services (HHS) determines that a state Exchange is fully operational. For children, the ACA’s MOE extends through September 30, 2019. States may reduce eligibly for certain non-pregnant, non-adult…

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