Centers for Medicare & Medicaid Services
Posted on March 7, 2014
The Centers for Medicare and Medicaid Services (CMS) released a final rule and payment notice for the Basic Health Program (BHP). Under the Affordable Care Act (ACA), many individuals will have an income too high to qualify for Medicaid, yet subsidies may not make their health insurance affordable. BHP, a program aiming to reduce churning between Medicaid and private coverage, helps to ensure continuity of care for individuals with fluctuating incomes. The rule allows for states to receive funding for BHP beginning in 2015.
CMS Bulletin on Retroactive Advance Payments of Premium Tax Credits and Cost Sharing Reductions in 2014 Due to Exceptional Circumstances
Posted on March 7, 2014
On February 27, 2014, CMS issued a Bulletin to Marketplaces on Availability of Retroactive Advance Payments of the PTC and CSRs in 2014 Due to Exceptional Circumstances. Using its authority to establish special enrollment periods under the ACA, CMS created a mechanism for recognizing certain “exceptional circumstances” that arise when as a result of “technical issues in establishing automated eligibility and enrollment functionality,” Exchanges have experienced difficulties in making timely eligibility determinations and enrolling people during the initial open enrollment period.
Posted on March 6, 2014
Posted on February 28, 2014
Guidance issued by the Center for Medicare and Medicaid Services (CMS) states that individuals who enrolled in health plans outside of the Affordable Care Act (ACA) insurance Marketplaces may retroactively receive premium subsidies. Under the ACA, advanced premium tax credits, or subsidies, are only available to individuals that purchased qualified health plans through the Marketplace. Many states have asked CMS to permit subsidies outside of the ACA Marketplace because IT issues prevented many eligible individuals from enrolling into QHPs before the deadline. Subsidies will retroactively be paid to insurers back to the effective date of plan enrollment.
Posted on February 27, 2014
The Centers for Medicare and Medicaid Services (CMS) issued the funding allocation for disproportionate share hospitals (DSH) for FY 2014. DSH payments are typically provided to hospitals that treat a disproportionate number of uninsured or under-insured patients. The Affordable Care Act (ACA) originally called for a cut in DSH payments, as more Americans would presumably be insured under Medicaid. The Supreme Court ruling that made Medicaid expansion optional, however, ultimately coerced CMS to delay DSH cuts for two years.
Posted on February 25, 2014
The Centers for Medicare and Medicaid Services (CMS) released a report to Congress late last week discussing the impact of the Affordable Care Act (ACA) on small business premiums. The report, mandated by the Budget Control Act, found that health insurance premiums for 11 million small business employees would likely rise under the ACA, while premiums for 6 million small business employees would decrease. Evidence as to how much premiums will rise for small business employees under the ACA is currently inconclusive.
Posted on February 11, 2014
Guidance recently released by the Centers for Medicare and Medicaid Services (CMS) states that individuals who have paid their first month’s premium and have already received coverage may change their insurance plan in order to obtain a more robust provider network. The guidance, which consists of five bulletins, provides information for both issuers and consumers in federally-facilitated and state-partnership marketplaces regarding the ability to alter application information or plan selections based upon certain life events or changes in enrollment periods.
Posted on February 4, 2014
The Centers for Medicare and Medicaid Services (CMS) released the draft version of the 2015 Letter to Issuers. This letter outlines key dates and guidance for health plan issuers interested in selling qualified health plans (QHP) on the federally-facilitated marketplace in 2015. The letter, which applies to issuers for both the individual and Small Business Health Options Program (SHOP) marketplaces, particularly focuses upon enhanced plan standards for network adequacy, essential community providers, and patient safety metrics.
Posted on January 28, 2014
The Centers for Medicare and Medicaid Services (CMS) issued a bulletin and question-and-answer explaining hospital presumptive eligibility. The documents are intended to aid hospitals in determining individual eligibility for Medicaid, or presumptive eligibility, under the Affordable Care Act (ACA). The documents provide relevant information on eligible populations, entities that can make coverage determinations, qualification standards, and federal matching assistance that may be relevant for hospitals that may treat patients without insurance. All states are expected to include an amendment to their Medicaid State Plans implementing the new presumptive eligibility standards.
Posted on January 24, 2014
The Centers for Medicare and Medicaid Services (CMS) issued a new report chronicling the numbed of individuals deemed eligible for Medicaid or the Children’s Health Insurance Program (CHIP) during the first three months of open enrollment. The report stated that 6.3 million Americans enrolled in Medicaid or CHIP in state-based Marketplaces or in-person at state Medicaid offices. The report does not, however, provide numbers for Medicaid enrollment in federally-facilitated Marketplaces, nor does it differentiate between individuals that are newly eligible for Medicaid as a result of expansion and those that were previously eligible under the original Medicaid criteria.