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

Archive: January 2013

CMS and IRS release rules on exemptions to individual mandate, penalties

Posted on January 31, 2013

The Internal Revenue Service (IRS) and the Centers for Medicare and Medicaid Services (CMS) have released 2 new proposed rules related to the individual requirement to purchase health insurance (mandate). The IRS rule clarifies the requirement that nonexempt individuals maintain minimum essential coverage or make a shared responsibility payment (penalty). The CMS rule lays out specific exemptions to minimum coverage requirement, most notably that any person otherwise eligible for Medicaid under the new ACA eligibility expansion, but who resides in a state that has chosen not to expand, will not be subject to the shared responsibility payment.

Stay tuned to HealthReformGPS for a detailed analysis of these rules in the future.

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KFF publishes report on sustaining Medicare

Posted on January 31, 2013

A report recently released by the Kaiser Family Foundation (KFF) serves as a review of Medicare policy options that may be discussed in upcoming budget debates. The report presents a wide array of options in several areas and lays out the possible implications of these options for Medicare beneficiaries, health care providers, and others, as well as estimates of potential savings, when available.

The report includes options in the following areas:

  • Medicare eligibility, beneficiary costs, and program financing;
  • Medicare payments to providers and plans;
  • Delivery system reform and care for high-need beneficiaries;
  • Medicare program structure; and
  • Medicare program administration, including program integrity.

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SBA launches new website to educate small business about ACA

Posted on January 31, 2013

The U.S. Small Business Administration launched a website and corresponding blog featuring information about the Affordable Care Act (ACA) for employers, in attempt to correct misconceptions about the law’s impact and prepare business owners for implementation. The website reviews ACA provisions, breaking them down based on how they will impact different parties: those who are self-employed, businesses with fewer than 25 employees, those with fewer than 50 employees and those with more than 50. The site also includes a glossary of key ACA-related terms and links to an HHS timeline outlining when important provisions of the law will go into place.

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Patient Centered Outcomes Research Institute: Final Rule on Calculation of Fees on Policies and Plans

Posted on January 30, 2013

The Patient-Centered Outcomes Research Institute (PCORI) was established under the Affordable Care Act (ACA) as a non-profit corporation to serve as a resource to patients, providers, purchasers and policymakers in making informed decisions about health outcomes, clinical effectiveness and appropriateness of medical treatments, items and services. The corporation is charged with advancing quality and evidence as to how health conditions can be prevented, diagnosed, treated, monitored and managed through research and evidence synthesis. The primary duties outlined in the ACA include identifying research priorities and setting an agenda for research provided through federal funding. PCORI is authorized to carry out a research project agenda through systematic reviews and…

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HHS releases single streamlined insurance marketplace application, solicits comment

Posted on January 29, 2013

The Centers for Medicare and Medicaid Services (CMS) has released a draft of the single, streamlined applications for both individual health insurance coverage and the SHOP applications, in preparation for the launch of the new Health Insurance Marketplace (formerly known as the Exchange) next fall. Model applications and documentation for individuals and for the small business health options program (SHOP) are now available for public comment via the paperwork reduction act (PRA).

The individual application is a single point of entry to purchase private insurance through the Marketplace and assess eligibility for assistance, including Medicaid, CHIP, and the Advanced Premium Tax Credits (PTCs). CMS has asked that people review the paper and online applications and provide feedback in the way of comments, which can be done by accessing the documents at the PRA website here.

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GAO releases report on health coverage tax credits

Posted on January 29, 2013

A new report recently published by the Government Accountability Office (GAO) found that people eligible for health coverage tax credits due to unemployment related to foreign trade competition will likely to receive similar health benefits, but smaller subsidies in the new marketplaces under the Affordable Care Act (ACA). The tax credits expire at the end of this year, but only 44,000 people participate in the program. 469,000 other Americans are eligible, but do not participate.

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HHS releases sample business associate agreement provisions

Posted on January 26, 2013

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights yesterday released sample business associate agreement provisions for use in revising contracts to comply with the new Health Insurance Portability and Accountability Act (HIPAA) rule. According to the new rule, covered entities and business associates have until September 23, 2013 to comply with most of the provisions. For existing business associate agreements, covered entities have until September 2014 to make modifications.

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New report examines hospital community benefit obligations

Posted on January 25, 2013

The Affordable Care Act (ACA) revises the federal tax exemption standards for nonprofit hospitals by clarifying and augmenting their community benefit obligations. The ACA’s amendments followed the 2009 launch of Schedule H (the form on which hospital community benefit, financial, and institutional activities are reported and which must be appended to each facility’s annual Form 990 nonprofit institution information return). Schedule H creates a reporting system covering the nation’s more than 2,900 nonprofit hospitals, delineates financial assistance and bad debt, and requires identification of community health improvement and community building. A report recently released by Sara Rosenbaum, et al., analyzes state statutes and reporting systems for a sample of 24 states. The report concludes that, in general, state laws lack the clarity of the IRS approach in terms of how community benefit is defined, categorized and reported. In contrast to Schedule H, state laws tend to be broadly drawn, with considerable variability in terms, less delineation among bad debt and financial assistance, and variability in treatment of community health improvement and community building.

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KCMU releases annual Medicaid report

Posted on January 25, 2013

The Kaiser Commission on Medicaid and the Uninsured (KCMU) recently published its twelfth annual Medicaid report, which provides a snapshot of current Medicaid eligibility and enrollment policies and procedures and highlights changes states will need to make in the coming year to implement the Medicaid provisions of the Affordable Care Act (ACA). The report provides results from a 50-state survey of eligibility, enrollment, renewal, and cost-sharing policies in Medicaid and CHIP, documenting changes made during 2012 and policies in place as of January 1, 2013.

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Update: CMS NPRM on Medicaid, Children’s Health Insurance Program, and Exchanges

Posted on January 25, 2013

On January 14, 2013, HHS issued a Notice of Proposed Rulemaking (NPRM) whose aim is to address a number of issues that arise at the intersection of the three principal federal “insurance affordability programs” established or modified under the Affordable Care Act (ACA): Medicaid; the Children’s Health Insurance Program (CHIP); and the advance premium tax credits and cost sharing reduction assistance available to individuals who apply for coverage in Exchanges.

The proposed rules seeks to more closely align these pathways in several basic respects: the process…

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