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Department of Health and Human Services

HHS releases final rule on ACA eligibility and re-enrollment

Posted on September 3, 2014

The US Department of Health and Human Services (HHS) released a final rule on eligibility and re-enrollment for the second open enrollment season of the Affordable Care Act (ACA).  The rule specifies additional options for annual eligibility redeterminations and renewal and re-enrollment notice requirements for qualified health plans offered through the Exchange, for benefit year 2015.  This final rule provides additional flexibility for Exchanges, including the ability to propose unique approaches that meet the specific needs of the state.

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CMS approves PA Medicaid waiver

Posted on August 29, 2014

The Centers for Medicare and Medicaid Services (CMS) approved Pennsylvania’s waiver application to receive matching funds under the Affordable Care Act (ACA) for extending Medicaid eligibility to residents who earn up to 133 percent of the federal poverty level.  Although substantially revised from the original proposal, the approved waiver creates a five-year Medicaid demonstration, entitled “Healthy Pennsylvania.”  Starting in January, as many as 600,000 Pennsylvanians could be eligible for new coverage on the private market, according to Pennsylvania Governor Tom Corbett’s office..

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OIG releases report on federal exchange contracts

Posted on August 26, 2014

The US Department of Health and Human Services (HHS) Office of the Inspector General (OIG) released a report which provides an overview of the contracts that contributed to the development of the Federal Marketplace. The Centers for Medicare and Medicaid Services (CMS) relied, and continues to rely, extensively on contractors to operate the Federal Marketplace under the Affordable Care Act (ACA). The report analyzes the planning, acquisition, management, and performance oversight of these contracts, but does not make recommendations.

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HHS publishes rules on contraception coverage

Posted on August 25, 2014

The U.S. Department of Health and Human Services (HHS) published an interim final rule which provides an alternative process for an eligible organization to provide notice of its religious objections to providing contraceptive coverage.  It will allow qualifying organizations to notify HHS of their religious objections to providing coverage and the government will in turn contact their insurers, which are to provide contraceptive benefits to the employees without any cost sharing.  HHS additionally released a proposed rule which changes  the definition of an eligible organization that can avail itself of an accommodation with respect to coverage of certain preventive services. These rules come in response to recent decisions against the Affordable Care Act’s (ACA) birth control mandate from multiple federal courts. HHS also released a coinciding fact sheet on the rules.

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CMS announces updated training program for ACA navigators

Posted on August 15, 2014

The Centers for Medicare and Medicaid Services (CMS) released a bulletin updating the Navigator, non-Navigator assistance personnel, and certified application counselor training curriculum for the Federally-facilitated and State Partnership Marketplaces in preparation for the next Open Enrollment Period beginning November 15, 2014.  The expanded curriculum will include more information on immigration, household income calculations and help for specific populations, including victims of domestic abuse and college students.  All assisters, whether they are seeking recertification or initial certification, will be required to complete the new training program.

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CMS publishes Medicare pay final rule

Posted on August 5, 2014

The Centers for Medicare and Medicaid Services (CMS) issued a final rule revising the Medicare hospital inpatient prospective payment systems (IPPS). In adherence to the Affordable Care Act (ACA), part of the rule would effectively reduce payments to disproportionate share hospitals (DSH), which serve the most vulnerable patients. DSH payment reductions are a result of the expansion of Medicaid, however in states that chose not to expand, hospitals still risk losing some payment for uncompensated care.

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CMS issues regulations on premium payment

Posted on July 24, 2014

The Center for Consumer Information and Insurance Oversight (CCIIO) and the Centers for Medicare & Medicaid Services (CMS) issued Federal guidance which gives individuals a three-month grace period to pay a premium without losing coverage. However, the same guidance states that if individuals choose enroll in a new policy for 2015, insurance companies cannot apply new premiums to outstanding 2014 debt. Some have suggested that this inconsistency could allow consumers to avoid paying their December premiums. However, nothing bars an insurer from making a bona fide effort to collect any unpaid premiums, as the consumer would still owe this amount to the insurer.

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HRSA removes orphan drug exemption under 340B

Posted on July 22, 2014

A rule released yesterday by the Health Resources and Services Administration (HRSA) clarifies a portion of the 340B program, which requires drug manufacturers to offer their pharmaceuticals at a discounted rate to covered entities.  Under 340B, a covered entity typically refers to healthcare providers treating medically vulnerable populations, such as Ryan White Clinics or Disproportionate Share Hospitals.  The new rule specifically removes the discount exemption for orphan drugs sold for off-label usage.  A recent lawsuit led to the promulgation of this interpretative rule,  as many orphan drugs are used to treat conditions other than the rare conditions for which the drugs were created.

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Study finds an increase in premiums in 2013

Posted on July 17, 2014

The Agency for Healthcare Research and Quality’s (AHRQ) Medical Expenditure Panel Survey reports that premiums for employer-sponsored insurance increased by about 3.5 percent in 2013. Out-of-pocket costs also climbed by at least 4 percent in 2013. However, the majority of Affordable Care Act (ACA) insurance market reforms did not take effect until 2014, meaning data on 2014 premiums will provide more meaningful insight into the law’s impact on premiums and cost sharing.

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CMS releases 2015 Medicare payment rules

Posted on July 4, 2014

The Centers for Medicare and Medicaid Services (CMS) issued several rules concerning Medicare payments for 2015.  First, CMS released the 2015 physician fee schedule.  Pursuant to the “doc fix” legislation recently passed, this proposal holds physician payments for the first quarter of next year.  The rule also bolsters the Physician Payment Sunshine Act by requiring providers to report payments received from speaking at continuous education events.  Additionally, the proposal revises the quality scoring methodology so that accountable care organizations (ACOs) are better able to exemplify the improvements they make in quality measures.  The number of metrics will increase from 33 to 37.

Yesterday, CMS also updated the payment scheme for outpatient services by 2.1% for 2015.  Biologics and non-pass-through drugs are still expected to be paid at average sales price plus 6%.  Payments are anticipated to increase by $5.2 billion compared to 2014.

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