Department of Health and Human Services
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.
Posted on November 13, 2014
In a recent letter to Medicaid directors, the Centers for Medicare and Medicaid Services (CMS) revealed plans to issue new regulations that will codify the availability of the 90/10 federal matching funds under the Affordable Care Act (ACA) for Medicaid eligibility and enrollment systems on a permanent basis. The letter also announces CMS’s intention to provide a three-year extension of the A87 waiver authority, allowing states to use their federal funds to help integrate Medicaid eligibility and enrollment through other social services through December 2018.
Posted on October 22, 2014
The Centers for Medicare and Medicaid Services (CMS) issued a proposed notice on how the federal government will determine payment amounts for 2016 for states that decide to establish a Basic Health Program. The Basic Health Program is a voluntary option under the Affordable Care Act (ACA), which provides insurance to individuals between 133 and 200 percent of poverty through a separate program rather than having them go to the exchanges. The proposed notice says that states that establish the program will receive federal funding equal to 95 percent of the amount of premium tax credits and cost-sharing subsidies that would have otherwise been provided to those individuals for exchange plans. However, the funding does not cover states’ ongoing administrative or operational costs.
Posted on October 9, 2014
Guidance issued by the Centers for Medicare and Medicaid Services (CMS) advises states that that their capitated payment rates for Medicaid managed care plans should cover the costs of the Affordable Care Act’s (ACA) health insurance tax, as it is considered a “reasonable business cost.” The tax starts at $8 billion in 2014 and increases every year, up to $14.3 billion in 2018. Starting in 2019, the amount of the tax will increase annually based on premium trends. CMS contends that this fee is not unlike other taxes and fees that actuaries must take into account when developing capitation rates.
Posted on September 23, 2014
The Office of the Inspector General (OIG) conducted an audit of Healthcare.gov, the online Federal Marketplace, from February to June 2014, including vulnerability scans and simulated attacks. In doing so, they found that the site’s security had been improved since last October’s launch of the insurance marketplace. However, OIG still found some vulnerabilities and the report recommended ways to further improve the site’s security, which the Centers for Medicare and Medicaid Services (CMS) says have already been implemented.
Posted on September 17, 2014
The Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics released the results of its first quarter health insurance survey. The results show that the percentage of uninsured adults dropped to 18.4 percent from 20.4 percent in 2013. However, this modest reduction does not capture the influx of last minute sign-ups in March and is lower than other estimates that used data from later in the year.
A new Census report also examined uninsurance rates finding that forty-two million people in the U.S. lacked any health insurance for the whole of 2013- 13.4 percent of the population. The report breaks down the uninsured rate by race and estimates the proportion of the population insured through private, employer-sponsored, and public insurance. However, this report does not include data from the major expansion of coverage from the Affordable Care Act (ACA) starting in 2014.
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.
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..
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.
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.