Department of Health and Human Services

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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CMS issues letter to Medicaid directors

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.

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CMS issues Basic Health Program information for 2016

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.

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CMS issues guidance on ACA health insurance tax

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.

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OIG releases report on security of online Marketplaces

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.

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Reports speculate on uninsurance rates

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.

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