Department of Health and Human Services
Posted on December 2, 2013
Yesterday, the US Department of Health and Human Services (HHS) released a progress report on the administration’s recent efforts to fix and improve the Affordable Care Act’s (ACA) website, healthcare.gov. The website has been plagued with issues and errors since its debut on October 1st. The document, HealthCare.gov: Performance and Progress Report, outlines all of the improvements and changes made to the website over the past two months. Some of these improvements include fixing over 400 bugs and software issues and updating the server so that the site may be able to host 800,000 visitors a day. The report cites management and collaborations issues, as well as inadequate systems and a multitude of technical software bugs, as key causes of the early site malfunction.
Posted on November 29, 2013
In a letter sent to State Medicaid Directors, the Centers for Medicare and Medicaid Services (CMS) stated the agemcy would allow states to use “flat files,” or files with very little information about new Medicaid enrollees, to intermittently count as full applications in terms of enrolling individuals into state Medicaid programs under the Affordable Care Act (ACA). The ACA permits states, if they so choose, to expand their Medicaid population, and provides the opportunity for individuals to enroll in Medicaid through the health insurance Exchanges. Currently, the federal government cannot transfer complete Medicaid applications to states, which prevents states from enrolling their constituents into Medicaid in a timely fashion. CMS is addressing this issue by allowing the “flat files” to count as enrollment applications so that states may ensure these new enrollees have Medicaid coverage by January 2014. This fix is a transitional policy, and states must apply for a waiver in order to use the flat files for enrollment.
Posted on November 26, 2013
In response to changes made by the administration’s new transitional policy, which continues plans slated for cancellation under the Affordable Care Act (ACA), the US Department of Health and Human Services (HHS) issued a proposed rule to modify the health insurance risk pool. The proposed rule, 255 pages in length, outlines changes in payment parameters and oversight for the “triple r”- risk adjustment, risk corridors, and reinsurance.
In addition to changes to the “triple r,” this rule formally announces the administration’s decision to delay annual open enrollment for 2015, which will now be held November 15, 2014 through January 15, 2015. HHS also delayed the Exchange blueprint submission deadline for states choosing to operate their own health insurance marketplace in future years. States applying to create their own Exchange must submit their materials to HHS by June 1st of the year prior to opening the Exchange, and HHS will certify the Exchange by June 15.
Posted on November 22, 2013
The Centers for Medicare and Medicaid Services (CMS) released several sample letters that may be used to notify plan members of their options in regards to the transitional policy announced last week. The transitional policy effectively states that individuals or small businesses currently enrolled in plans that would be cancelled by the Affordable Care Act (ACA) may remain in or re-enroll in these plans. CMS provided three documents concerning this issue: a sample letter to be sent to individuals that have already received a cancellation notice for their coverage, a sample letter to individuals that have yet to receive a cancellation notice, and a document containing standard language that will satisfy the notification requirement under the transitional policy.
Posted on November 14, 2013
A letter written to state insurance commissioners from Gary Cohen, Direct of the Center for Consumer Information and Insurance Oversight (CCIIO), encouraged states to adopt a transitional policy concerning cancellation of health plans as a result of the Affordable Care Act (ACA). The letter states that active plans in the individual and small group markets may be renewed for the 2014 plan year if (1) the plan was in effect as of October 1st, 2013 and (2) the insurance issuer sends a letter to plan members that have or will have their plans terminated. The letter should describe:
- changes in available insurance options;
- how the plan member’s current plan deviates from the market reforms instituted by the ACA (i.e. no coverage of individuals with pre-existing conditions, no guaranteed issuance, etc.);
- the right and ability of a plan member to enroll in a plan through the ACA’s health insurance marketplaces;
- how a plan member may enroll in a new plan through the ACA marketplaces; and
- the ability of the plan member to enroll in another plan outside of the marketplaces that adheres to ACA market reforms.
Posted on November 13, 2013
Today, the US Department of Health and Human Services (HHS) issued the first set of enrollment statistics for health insurance plans offered through the Affordable Care Act’s (ACA) Marketplaces. The report stated that 106,185 individuals signed up for coverage during the first month of open enrollment. About 75% of these individuals enrolled through State-Based Marketplaces. The remainder, about 26,000 people, reside in a state in which the Marketplace is operated by the federal government. While these individuals have completed the enrollment process, they have not necessarily purchased a plan.
Posted on November 8, 2013
The Department of Health and Human Services (HHS), Department of Labor (DoL), and the Department of the Treasury (DoT) released the joint final rule implementing the Mental Health Parity and Addiction Equity Act of 2008. Under this law, insurers that offer coverage for mental health services are expected to treat mental health equitably, meaning cost-sharing and limits for mental health services should be comparable to that of physical health services. Several other specific provisions addressed in this rule include:
- Parity for intermediate care offered in residential or outpatient settings and all plan standards (i.e. network adequacy and geographic limits);
- Clarifying transparency expectations for insurers to remain compliant with the law; and
- Eliminating provisions that enabled insurers to make exceptions for parity requirements for certain benefits offered.
The law was passed in 2008, and an interim final rule was issued in January 2010. The Centers for Medicare and Medicaid Services (CMS) also published an FAQ on today’s rule.
Posted on October 29, 2013
The Center for Consumer Information and Insurance Oversight (CCIIO), within the Centers for Medicare and Medicaid Services (CMS), published an FAQ concerning the open enrollment period for individuals purchasing qualified health plans (QHPs) under the Affordable Care Act (ACA). The guidance states that individuals will be able to enroll in QHPs throughout the entire enrollment period, which lasts through March 31st, and not be subject to the individual shared responsibility payment. According to the ACA, individuals would have to enroll in a plan by the 15th of each month in order for their QHP coverage to be effective at the start of the following month. Individuals that enrolled in plans after the 15th would not be covered for another two months. The issue pertains to individuals that would enroll in QHPs between February 16th and February 28th of 2014. These individuals would not be covered until April 1st, and would therefore be subject to the minimum essential coverage penalty under the ACA (the minimum essential coverage provision states that an individual must pay a penalty if he or she does not have coverage for more than three consecutive months in a year). This guidance removes that snafu in the law and states that CCIIO will provide additional guidance on the issue in 2014.
Posted on October 24, 2013
Today, the Centers for Medicare and Medicaid Services (CMS) published a final rule concerning financial integrity and oversight for Marketplaces and qualified health plans (QHP). Some of the key components addressed in this rule include: clarifications and amendments to market reform rules, standards for special enrollment periods, and standards for survey vendors that may conduct enrollee satisfaction surveys for QHP issuers. One specific amendment in the rule enables QHP issuers to use a “simplified methodology” in determining cost-sharing reductions for qualifying plan enrollees, which CMS states will protect federal funds and minimize administrative burden.
Posted on October 22, 2013
Yesterday, the Centers for Medicare and Medicaid Services (CMS) issued a Request for Comment (RFC) concerning new exemptions to the individual mandate under the Affordable Care Act (ACA). This particular RFC asks for additional information on the burden experienced by health care sharing ministries, and if such burden would qualify for an exemption from the individual mandate.