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Department of Health and Human Services

CMS issues final rule on benefit and payment parameters for 2016

Posted on February 23, 2015

The Centers for Medicare and Medicaid Services (CMS) issued a final rule on the U.S. Department of Health and Human Services (HHS) Notice of Benefit and Payment Parameters for 2016. The final rule builds on previously issued standards to further strengthens transparency, accountability, and the availability of information for consumers about their health plans. The rule finalizes the annual open enrollment period for 2016 to begin on November 1, 2015 and run through January 31, 2016. CMS also released its final annual letter to issuers, which provides additional guidance on these and related standards for plans participating in the Federally-facilitated Marketplace.

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CMS issues FAQ on Medicaid plan marketing rules

Posted on January 20, 2015

The Centers for Medicare and Medicaid Services (CMS) posted a document which clarifies whether Medicaid managed care plans can market their private qualified health plans (QHP) to potential enrollees. CMS says federal rules do not prohibit Medicaid plans from providing information about QHPs to potential enrollees who might enroll in such a plan as an alternative to the Medicaid plan. However, CMS recommends that plans consult contracts and their state Medicaid agencies for more information on what is allowed.

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HHS issues proposed rule on summary of benefits and coverage

Posted on January 5, 2015

The U.S. Department of Health and Human Services (HHS) issued a proposed rule, simultaneously released by the Internal Revenue Service (IRS) and the Department of Labor (DOL), regarding the summary of benefits and coverage (SBC) and the uniform glossary for health insurance coverage in the group and individual markets under the Affordable Care Act (ACA). The proposed rule would change disclosure requirements to help plans and individuals better understand their health coverage and allow for informed comparisons of coverage options. The proposed regulation also makes amendments to the template for the SBC, instructions, sample language, guides for coverage example calculations, and the uniform glossary.

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CMS issues 2016 draft guidance on federal exchange participation

Posted on December 21, 2014

The Centers for Medicare and Medicaid Services published a draft letter to insurers who want to offer qualified health plans (QHP) in the federally run exchanges in 2016. The letter outlines key requirements that insurers must follow, including provider network and patient safety standards. It also explains how CMS plans to review plan rate increases and conduct oversight of marketing, agents, and brokers. The initial submission window for 2016 QHP applications would be from March 16 to April 15 2015. Certification notices and agreements with insurers would be sent between Aug. 17 and Sept. 15, according to the draft guidance.

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CMS releases monthly Medicaid and CHIP enrollment report

Posted on December 20, 2014

The Centers for Medicare and Medicaid Services released a report showing state Medicaid and Children’s Health Insurance Program (CHIP) enrollment and growth. The data shows that Medicaid and CHIP grew by 9.7 million enrollees between the beginning of the first Affordable Care Act (ACA) open enrollment period and October 2014- that’s a 17 percent growth in average monthly enrollment, compared to the July-September 2013 period. Additionally, the report finds that enrollment in states that expanded Medicaid increased by 24 percent since first open enrollment, compared to 7 percent in states that did not expand. In total, Medicaid and CHIP had 68.5 million enrollees in October, an increase of about 400,000 over the previous month.

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New report details health spending in 2013

Posted on December 5, 2014

The Centers for Medicare and Medicaid Services (CMS) Office of the Actuary published its annual health care spending report in the policy journal, Health Affairs. The report shows that total health care spending in the U.S. increased 3.6 percent in 2013. However, this increase was slower than that of 4.1 percent in 2012, and the share of GDP devoted to health care spending has remained at 17.4 percent since 2009. The deceleration in health care spending growth can be attributed to a slower growth in private health insurance and Medicare spending. Slower growth in spending for hospital care, investments in medical structures and equipment, and spending for physician and clinical care may also contribute to the low overall increase.

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CMS issues final rule on Medicaid DSH

Posted on December 3, 2014

The Centers for Medicare and Medicaid Services issued a final rule addressing the hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments. Under this limitation, DSH payments to a hospital cannot exceed the uncompensated costs of furnishing services to individuals who are Medicaid-eligible or uninsured. The final rule defines “uninsured” as those who have “no health insurance for the services furnished during the year.” The rule also provides that determinations of funding limits will be made on a service-specific basis rather than at the individual level. CMS says the regulation gives states and hospitals more flexibility in terms of which hospital costs can be considered uninsured costs than what had been in place under a final rule from 2008.

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CMS issues guidance on re-enrollment in the FFM

Posted on December 2, 2014

The Centers for Medicare and Medicaid Services (CMS) announced in guidance that it will create an “Enrollee Switched List” that allows issuers participating in federally facilitated exchanges to identify enrollees who actively re-enrolled in coverage with another issuer. However, enrollees who completed an active selection to change plans with the same issuer will not be included on the list because the issuer will be aware of the plan change via the active enrollment transaction. The guidance comes in response to issuer concerns that CMS’s decision to not send termination notices to issuers when members select other plans could result in duplicate billings and other problems.

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CMS issues proposed rule on Medicare ACOs

Posted on December 2, 2014

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule, which addresses changes to the Affordable Care Act’s (ACA) Medicare Shared Savings Program, including provisions relating to the payment of Accountable Care Organizations (ACO) participating in the Program.  The proposed rule includes several changes to eligibility requirements, definitions of an ACO participant, and how “pioneer” ACOs transition into the Medicare Shared Savings Program.  Notably, the rule would allow ACOs an extra three years without risk of penalties for poor performance, albeit with smaller shared savings for good performance. CMS also is considering making it easier for ACOs to meet spending targets by comparing them to providers in their region, instead of national comparisons, and by gradually making benchmarks less dependent on past ACO performance.

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HHS releases proposed rule on open enrollment

Posted on November 22, 2014

The U.S. Department of Health and Human Services (HHS) issued a proposed rule that would set future annual exchange open enrollment periods so that they begin October 1 and end December 15. Consumers selecting a plan during this time period would gain coverage starting January 1, 2016. HHS says this time period will be long enough for consumers to pick or change their plan, but not crossing calendar years will reduce consumer confusion. The proposed rule also touches on key aspects of the Affordable Care Act (ACA), including risk corridors, user fees for the federal exchange, essential health benefits, and network adequacy.

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