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Health Information

Rating the Quality of Qualified Health Plans Sold in the Marketplace

Posted on January 7, 2014

On November 19, 2013, the Obama Administration published a Notice with comment that describes the overall Quality Rating System (QRS) framework for rating the quality of health plans (QHPs) sold in the health insurance Marketplace (another term for Exchanges). The purpose of the Notice is to solicit comments on the framework. Comments must be received by January 21, 2014. Comments are sought on both the proposed quality measures that QHP issuers would be expected to report, as well as on ways to preserve the integrity of QHP ratings and on areas for future measurement…

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Posted on January 2, 2014

A new brief released from, a partnership between The George Washington University Department of Health Policy and the Robert Wood Johnson Foundation, discusses the certification and accreditation standards for qualified health plans (QHP) to be offered on the Affordable Care Act’s (ACA) health insurance marketplaces. The article specifically discusses the impact of disclosing information on health insurance policies, practices, costs, and quality on public availability of data on health plan performance.

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New Resources Available to Help Understand and Digest Health Information Laws

Posted on September 13, 2013

Health Information & the Law, a project at the George Washington University School of Public Health and Health Services (SPHHS), released new resources on a website that offers easy-to-understand content on key issues related to the use and exchange of health information and how it affects the transformation of the U.S. health care system to a patient-centered, value-based system.

“The exchange of health information is critical to the transformation of our health care system,” says Jane Hyatt Thorpe, JD, project co-director and associate professor of health policy at the SPHHS. “These two new resources will help policymakers, consumers, health professionals, providers, and others better understand how health information laws can support rather than hinder the exchange of health information.”

The two new resources, Fast Facts and Myth Busters, add to the website’s library of material on federal and state laws governing the access, use, release and publication of health information.

Both offer insight into federal and state laws and regulations that govern health information, including implications for health care delivery, payment and beyond. Examples of the new resources now available at include:

  • Fast Facts: What types of data do public health agencies collect?
  • Myth Buster: MYTH: Public health data exception to HIPAA
  • Fast Facts: How is data collected & used in a health insurance marketplace?
  • Myth Buster: MYTH: Patients may sue providers for disclosing patient health information in violation of HIPAA

This library of resources will continue to grow over time and will include Fast Facts and Myth Busters on topics such as privacy and confidentiality, health information technology, HIPAA, public health data, health insurance marketplaces, and security. These new series augment existing resources available at including summaries of federal and state laws and regulations governing health information as well as in-depth analyses, comparative state maps and decision tools.

“Health information laws can be quite complex,” said Lara Cartwright-Smith, JD, MPH, project co-director and assistant research professor of health policy at the SPPHS. “These new resources, as well as the other content on the website, are intended to break down common misperceptions and barriers and highlight opportunities for broader health information exchange.”

Health Information & the Law is a project of the George Washington University’s Hirsh Health Law and Policy Program, developed with support from the Robert Wood Johnson Foundation.

The new resources and additional material can be accessed at


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Reporting to the National Instant Criminal Background Check System and the HIPAA Privacy Rule

Posted on August 21, 2013

On January 16, 2013, in the wake of the Newtown shootings, President Obama announced 23 executive orders aimed at reducing gun violence, including an instruction to the Department of Health and Human Services (HHS) to address any potential legal barriers to reporting to the National Instant Criminal Background Check System (NICS). On April 23, 2013, HHS issued an Advance Notice of Proposed Rulemaking (ANPRM) requesting public comments on whether the HIPAA Privacy Rule presents a barrier to reporting of individuals who should be prohibited from possessing firearms for specified mental health reasons (such as involuntary commitment to a mental institution).

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CMS enters into data hub agreement with state-based Marketplaces

Posted on August 20, 2013

The Centers for Medicare and Medicaid Services (CMS) released the latest in their series of federal data service hubs agreements. This particular agreement requires state-based Marketplaces (SBM) to alert the the Center for Consumer Information and Insurance Oversight (CCIIO) within one hour of detecting possible breaches of personally identifiable information on the data hub. CCIIO will then contact the appropriate agency responsible for the information that may have been leaked (i.e. the Internal Revenue Service (IRS) would be notified if the SBM determined that income tax information was hacked). In addition to alerting the SBM of important security practices, this agreement was issued to help assuage concerns about the security and privacy of the information channeled through the hub.

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OIG report details security risks of data hub

Posted on August 5, 2013

A new report from the US Department of Health and Human Services Office of Inspector General (OIG) chronicled observations from the implementation of the Centers for Medicare and Medicaid Services (CMS) data service hub. Under the Affordable Care Act (ACA), CMS created the data service hub to aggregate, but not store, data from several federal agencies required to make the Marketplaces operate. The report found that if CMS delays any more of the security preparedness components in implementing the Marketplaces, it is likely that CMS will possess “limiting information” on the potential privacy and security risks associated with the data services hub.

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Health Information Implications of the 2014 HHS Budget

Posted on May 29, 2013

On April 10, 2013, President Obama released his proposed FY 2014 budget, which includes $967.3 billion in outlays for the Department of Health and Human Services (HHS) and makes legislative proposals that would save an estimated $361.1 billion (net) over ten years. In conjunction with the release of the President’s budget, HHS published an overview of the budget provisions for HHS, which provides more detail on how the Department would allocate its budget in FY 2014 and describes its ongoing progress in meeting specific program goals and legislative requirements. Many of the proposals included in the President’s budget and HHS’ overview relate to the ongoing transformation of the health care delivery system to a value-based system that rewards quality and efficiency. Critical to the success of this transformation is the exchange of health information for activities such as quality measurement and reporting, value-based purchasing, consumer engagement, and comparative effectiveness research. Below are selected provisions of the HHS budget, the agency’s relevant legislative proposals for 2014, and progress reports for health care system reform efforts that require the use and exchange of health information. We also identify HHS’ stated priorities for 2014 that are related to health information…

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CCIIO releases FAQ on market reforms

Posted on April 29, 2013

The Center for Consumer Information and Insurance Oversight (CCIIO) released a set of eight questions on implementation of the Affordable Care Act (ACA). Specifically, this guidance clarifies the limitation provided in the Market Rule final rule stating that a plan issuer may have one geographic rating factor for each approved geographic rating area per single risk pool in a given state. The following topics are addressed in the FAQ to expand upon the meaning of this limitation:

  • Withdrawal of non-grandfathered business
  • Maintenance of alternative mechanisms
  • Geographic rating areas
  • Definition of association coverage
  • Premium adjustment when coverage becomes secondary to Medicare

Issuers submitting plans to the federally-facilitated Exchanges may make necessary changes to their plans in order to comply with this new guidance.

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Commonwealth finds millions of Americans still lacking affordable coverage

Posted on April 26, 2013

According to a new survey released by the Commonwealth Fund, 84 million Americans were either uninsured or under-insured in 2012. In addition, 75 million Americans in 2012 were either actively paying or having difficulty paying their medical bills, indicating that medical debt is still a prominent issue. Findings were not bleak for all demographics, however, as the 2012 Biennial Health Insurance Survey also found that the proportion of uninsured individuals ages 19-25 decreased from 48% to 41% in 2012. This phenomenon is most attributable to the Affordable Care Act’s (ACA) provision that allows children to remain on their parents’ health insurance until age 26.

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HHS enhances CLAS standards

Posted on April 24, 2013

The US Department of Health and Human Services (HHS) Office of Minority Health released enhanced standards on Culturally and Linguistically Appropriate Services (CLAS) in health care settings. There are many determinants that inhibit the achievement of health equity, and the implementation of CLAS is one mechanism by which disparities can begin to be whittled away. Building upon the original 2000 standards, National Standards for Culturally and Linguistically Appropriate Standards in Health and Health Care: A Blueprint for Advancing and Sustaining CLAS Policy and Practice is designed to provide an organization with the information and tools necessary to mitigate health care disparities and achieve health equity by using CLAS. The enhanced standards aim to improve health equality within health care settings by addressing the categories of (1) governance, leadership, and workforce, (2) communication and language assistance, and (3) engagement, continuous improvement, and accountability.

A synopsis of the enhanced CLAS standards is also available.

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