Posted on July 11, 2013
A blog post created by Marilyn Tavenner, the Administrator of the Centers for Medicare and Medicaid Services (CMS), clarifies concerns surrounding Exchange operability after last week’s release of new Affordable Care Act (ACA) regulations. In the post, Tavenner proclaimed that the Exchanges will be fully operational by the October 1st enrollment deadline. Of chief import, Tavenner responded to concerns about whether or not the Exchanges will verify an applicant’s submitted income information and if there are safeguards in place to prevent applicants from fraudulently receiving subsidies. Tavenner responded in the affirmative to both, stating that an applicant’s income will be compared against tax filings, social security data, and income reports. Tavenner found that individuals who falsely apply for subsidies will run the risk of receiving a penalty for perjury, and that the Internal Revenue Services (IRS) already has mechanisms in place to recollect subsidies that were overpaid or provide subsidies to those that did not initially receive the correct amount.
Posted on June 4, 2013
The White House recently released a memo detailing health plan competition and choices anticipated to be available under the Affordable Care Act’s (ACA) health insurance Exchanges. According to the memo, 75% of states with federally-facilitated insurance markets will have at least one new insurance carrier enter their market. The White House memo also reported that 90% of target enrollees will be able to select plans offered by a minimum of five insurance companies. These findings were compared to the current individual insurance market, where two or fewer insurance companies control the market in most states. The memo confirms that state-specific rates will not be released for federally-facilitated Exchanges until September.
Posted on September 14, 2012
According to the Office of Management and Budget (OMB) report released today, many Affordable Care Act (ACA) provisions would be slashed under the $120 billion sequester. Medicare, for example, would be cut by more than $11.6 billion over 10 years. The Medicare cuts would apply to Parts A and B and the prescription drug program.
The report, almost 400 pages long, details the effects that the sequestration would have if Congress and the White House cannot reach an agreement to avert it. The sequester cuts would slash $2.5 billion in National Institutes of Health (NIH) funds, cut ACA exchange establish grants, and trim the Prevention and Public Health Fund. The Budget Control Act sequester would cut 8.2 percent from discretionary HHS programs and 7.6 percent from mandatory ones.
Importantly, the Consumer Operated and Oriented Plans, the Pre-Existing Condition Insurance Plans, and premium subsidies to assist low-income individuals obtain health insurance through the exchanges were left untouched.
Posted on April 2, 2012
Today the U.S. Office of Personnel Management (OPM) issued a final regulation amending the Federal Employees Health Benefits (FEHB) regulations and also the Federal Employees Health Benefits Acquisition Regulation (FEHBAR). This final regulation makes minor changes to an interim final regulation published June 29, 2011. The rule replaces the procedure by which premiums for community rated FEHB carriers are compared with the rates charged to a carrier’s similarly sized subscriber groups (SSSGs). The new procedure utilizes a medical loss ratio (MLR) threshold, analogous to that defined in both the Affordable Care Act (ACA), and in Department of Health and Human Services (HHS) regulations and replaces the outdated SSSG methodology with a more modern and transparent calculation while still ensuring that the FEHB Program is receiving a fair rate. This will result in a more streamlined process for plans and increased competition and plan choice for enrollees. The new process will apply to all community rated plans, except those required by their state to use traditional community rating (TCR). This new process will be phased in over two years, with optional participation for non-TCR plans in the first year.
Posted on October 17, 2011
The United States Government Accountability Office (GAO) released a report, “Long-Term Care Hospitals: CMS Oversight is Limited and Should Be Strengthened,” which recommends that the Centers for Medicare & Medicaid Services (CMS) strengthen its oversight of long-term care hospital (LTCH) survey activities and improve data collection on quality of care. LTCHs specialize in the provision of care to individuals with multiple or chronic conditions. CMS does currently collect data on the quality of care at LTCHs, but the GAO argues that the data are limited for several reasons. First, CMS does not have detailed data on survey results conducted by The Joint Commission (TJC) prior to 2009. Second, CMS does not currently collect data on LTCH quality measures regarding health care delivery because LTCHs are not required to report them. However, under the ACA, LTCHs will be required to make such reports beginning in 2014.
Posted on September 20, 2011
President Obama sent “Living Within Our Means and Investing in the Future: The President’s Plan for Economic Growth and Deficit Reduction,” his plan to jumpstart economic growth and job creation, to the Joint Committee yesterday. The plan proposes additional savings on top of those signed into law under the Budget Control Act. Specific to health savings, the President recommended cuts to erroneous and wasteful spending under Medicare and Medicaid. He stressed that he would “veto any bill that takes one dime from the Medicare benefits seniors rely on without asking the wealthiest Americans and biggest corporations to pay their fair share.”
Posted on January 18, 2011
President Barack Obama issued an Executive Order today aimed at “enhancing effectiveness and efficiency in Government.” The Executive Order was issued jointly with a memo from the President to all heads of executive departments and agencies, giving them 120 days to make their regulatory compliance activites publicly available online.
Posted on December 1, 2010
The National Commission on Fiscal Responsibility and Reform, otherwise known as the Debt Commission, recently released its report on the nation’s fiscal crisis. The report, titled “The Moment of Truth,” offers options and recommendations on how to reduce the U.S. national debt. The report includes numerous recommendations for health care savings and spending reductions, namely reforming the Medicare Sustainable Growth Rate and establishing a health care spending budget, among other recommendations.
Posted on November 10, 2010
The Co-Chairs of the National Commission on Fiscal Responsibility and Reform have released their draft report.
Posted on June 4, 2010
The Office of Management and Budget has posted on its website a draft application and instructions for a program to reimburse companies for some of the costs for providing benefits to early retirees.