Key Developments

HHS publishes Exchange guidance and draft blueprint

Posted on May 16, 2012

The US Department of Health and Human Services (HHS) published guidance today on the implementation of the federally-run fallback exchange that the government will run in states that are not ready to operate a state-run exchange. In addition to the higher level operational approach, the paper also discusses how states can partner with HHS to implement selected functions in a Federally-facilitated Exchange (FFE), key policies organized by Exchange function, and how HHS will consult with a variety of stakeholders to implement an FFE. HHS also released a draft blueprint for approval of state-based or state-federal partnership exchanges. State exchanges must be certified by HHS by the beginning of 2013.

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Health Insurance, Key Developments, Office of Consumer Information and Insurance Oversight

HHS releases web-based search tool to track health care system performance

Posted on May 16, 2012

Health and Human Services (HHS) announced the launch of a new web-based tool to track how the nation’s health care system is performing. The tool, known as the Health System Measurement Project, will enable policymakers, providers, and the public to develop consistent data-driven views regarding changes in critical U.S. health system indicators. The tool brings together data sets from across the federal government that span topical areas, such as access to care, cost and affordability, prevention and health information technology. It presents these indicators by population characteristics, such as age, sex, income level, insurance coverage, and geography. The measures included in the tool were developed by the HHS Office of the Assistant Secretary for Planning and Evaluation. They are aligned with the HHS Strategic Plan, the National Quality Strategy, and other departmental strategic planning efforts.

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Categories: Department of Health and Human Services, Health Care Quality and Delivery System Reform, Key Developments

CMS releases final rule on MLR requirements

Posted on May 12, 2012

The Centers for Medicare & Medicaid Services (CMS), a department within the U.S. Department of Health and Human Services (HHS), released final rules on Friday May 11th requiring insurers to notify subscribers when the medical loss ratio (MLR) provision of the Affordable Care Act (ACA) is met or exceeded for spending on medical claims or quality improvements. The December 2011 interim final rule and final rule on MLR only required that notices be sent to policyholders when insurers did not meet the MLR requirements.

The ACA requires both individual and small group plans to meet the MLR requirements by spending at least 80 percent of premiums on medical claims or quality improvements. Large plans are required to spend at least 85 percent. Beginning in August of 2012, insurers must refund the difference to consumers.

The goal of the notice is to educate consumers regarding the MLR measures and to help consumers know that the majority of premium payments go towards health care, as opposed to advertising, executive bonuses, or administrative overhead costs.

HHS said the rule is not expected to have an economic impact of more than $100 million a year.

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Categories: Centers for Medicare & Medicaid Services, Key Developments

Department of Labor releases FAQs on mental health parity compliance

Posted on May 10, 2012

The Department of Labor’s Employee Benefits Security Administration published a set of frequently asked questions (FAQs) regarding implementation of the Mental Health Parity and Addiction Equity Act of 2008.

Amongst other topics, the FAQs address…

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Categories: Department of Health and Human Services, Department of Labor, Employee Benefit Security Administration, Key Developments

HHS announces funding for school-based health centers

Posted on May 10, 2012

Health and Human Services (HHS) Secretary Kathleen Sebelius recently announced the availability of funding for the construction and renovation of school-based health centers. These new investments, totaling up to $75 million, are part of the School-Based Health Center Capital (SBHCC) Program, created by provisions under the Affordable Care Act (ACA).

School-based health centers are an important component of…

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Categories: Department of Health and Human Services, Key Developments

HHS releases two rules to streamline regulations for hospitals and providers

Posted on May 10, 2012

Today, the Centers for Medicare & Medicaid Services (CMS) released two final rules. The first rule revises the Medicare Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs). CMS estimates that annual savings to hospitals and CAHs will be approximately $940 million per year. The second, the Medicare Regulatory Reform rule, will produce savings of $200 million in the first year by promoting efficiency. This rule eliminates duplicative, overlapping, and outdated regulatory requirements for health care providers.

Among other changes, the final rules will…

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Key Developments, Medicaid and CHIP, Medicare

CMS releases proposed rule to increase Medicaid payments

Posted on May 9, 2012

Today the Centers for Medicare & Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services (HHS), released a proposed rule on Medicaid payments. The proposed rule would implement Medicaid payment for primary care services furnished by certain physicians in years 2013 and 2014 at rates not less than Medicare rates in effect in that time period. The rule would apply to physicians who practice family medicine, general internal medicine, or pediatric medicine, and to services paid through Medicaid managed plans. The proposal also permits providers to charge higher rates for vaccinations under the federally backed Vaccines for Children program. CMS estimated the provision will cost the government $5.5 billion the first year, and $5.6 billion in the second.

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Key Developments, Medicaid and CHIP

HHS announces first 26 Health Care Innovation Awards

Posted on May 8, 2012

Health and Human Services (HHS) Secretary Kathleen Sebelius today announced the first batch of organizations for Health Care Innovation awards. The awards, a provision under the Affordable Care Act (ACA), will support 26 new innovation projects. The goals of the projects are to lower health care costs, improve quality of care, and enhance the provider workforce. The preliminary awardees announced today expect to reduce health spending by $254 million over the next 3 years.

Projects include…

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Categories: Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Key Developments

CMS issues final and proposed rules on Medicaid and community-based services

Posted on May 7, 2012

The Centers for Medicare & Medicaid Services (CMS) issued final and proposed rules on April 26 giving states more flexibility regarding community-based services and support for Medicaid enrollees. The regulations were published in today’s Federal Register.

The final rule implements section 2401 of the Affordable Care Act (ACA), which establishes a new State option to provide home and community-based attendant services and supports. These services and supports are known as Community First Choice (CFC). The regulation provides an incentive for states to expand Medicaid coverage for home and community-based services by boosting the federal match rate. To qualify for this improved federal match rate, a state must agree to develop its Community First Choice benefit, maintain a quality assurance system, and collect and report information to CMS. Additionally, during the first 12 months of Community First Choice benefit implementation, the state must maintain or exceed the level of expenditures for home and community-based services provided under the state plan, waivers or demonstration for the preceding 12 months. While this final rule sets forth the requirements for implementation of CFC, it does not finalize the section concerning the CFC setting. CMS estimated that the final rule would have an impact of $1.3 billion in FY 2012.

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Key Developments

CMS takes steps to improve transparency of demonstration waiver process

Posted on April 30, 2012

The Centers for Medicare & Medicaid Services (CMS) issued guidance on Friday, April 27 regarding the process the agency will use to review and approve state demonstration projects under Medicaid and the Children’s Health Insurance Program (CHIP). The guidance outlines how CMS plans to implement requirements for improving public input and transparency with regard to the demonstration projects. These “1115 Waivers” authorize states to test new coverage and delivery models after obtaining appropriate waivers from CMS.

The guidance, accompanied by a letter to state Medicaid directors, also introduces the user guide that CMS is providing for stakeholder organizations.

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Key Developments