Posted on June 19, 2013
Two reports issued by the Government Accountability Office (GAO) indicate that substantial progress remains in the establishment of the individual and small group health insurance Exchanges, two key components of the Affordable Care Act (ACA). The GAO report focusing on Small Business Health Options Program (SHOP) Exchanges purports that many of the central aspects of the federally-facilitated SHOP Exchanges remain to be completed, including eligibility and enrollment, plan management, and consumer assistance. According to the report, 44% of the key activities the Centers for Medicare and Medicaid Services (CMS) intended to be completed by March 31st, 2013 were behind schedule. Furthermore, the continually evolving role that CMS plays in SHOP development presents a challenge for the agency to meet subsequent deadlines, several of which are very close to the roll out date.
Similar to the SHOP Exchange, CMS must still work to develop important aspects of the federally-facilitated individual health insurance Exchanges. One important task that has yet to be completed is the testing of the federal data hub with state and federal partners. According to this GAO report, CMS is still in the process of certifying qualified health plans (QHP) and publicizing this information on Exchange websites. CMS has also delayed Navigator funding by 2 months, which has impacted training activities. GAO reported that CMS has completed risk assessment for potential issues associated with the federal data hub. CMS has also been interacting with states to create contingency plans to facilitate successful Exchange implementation prior to the October 1st enrollment period.
Posted on June 11, 2013
The Congressional Research Service (CRS) published a new report demystifying how individuals may qualify for premium tax credits to help offset the costs of obtaining insurance through Exchanges. Health Insurance Exchanges Under the Patient Protection and Affordable Care Act (ACA) outlines the requirements for tax credit eligibility, such as having a household income between 100-400% of the federal poverty level. The report also details how the US Department of Treasury (DoT) will send monthly premiums to insurance companies on behalf of enrollees receiving the tax credit. Tax credits are advanceable and refundable, meaning receipt of the credit will coincide with the time at which monthly premiums are due. Furthermore, each Exchange is responsible for determining tax credit eligibility and the appropriate credit amount for qualifying individuals.
Posted on June 7, 2013
The Congressional Research Service (CRS) released a report claiming that under the Affordable Care Act (ACA), the federal government may oppose the dismissal of False Claims Act (FCA) cases that deal with publicly disclosed information. By amending the FCA’s public disclosure bar, Health Care Fraud and Abuse Laws Affecting Medicare and Medicaid: An Overview states that section 1313(a)(6) of the ACA provides greater discretion for the federal government in deciding which FCA cases they choose to pursue. Additionally, the CRS report said that relators and other whistleblowers may bring FCA cases to court that deal with publicly disclosed information published in state and local government reports.
Posted on June 7, 2013
The Congressional Budget Office (CBO) published a report describing the characteristics and costs associated with dual-eligible beneficiaries. A dual-eligible beneficiary, or dual, is someone that is eligible to receive benefits from both Medicare and Medicaid. Dual-Eligible Beneficiaries of Medicare and Medicaid: Characteristics, Health Care Spending, and Evolving Policies uses data from 2009 to examine the different payment systems used in both Medicare and Medicaid to pay for dual benefits, as well as methods by federal and state governments to integrate the payments systems and better coordinate care for this growing population.
Explaining Recent Changes in CBO Projections of Health Insurance Coverage and Costs under the Affordable Care Act
Posted on June 5, 2013
In May 2013, the Congressional Budget Office (CBO) issued its latest update of estimates of health insurance coverage and costs under the Affordable Care Act. This Implementation Brief summarizes the changes in CBO’s estimates over time, focusing on three key sets of estimates…
Posted on June 4, 2013
A recent report released by the Government Accountability Office (GAO) analyzed the progress of implementing the Affordable Care Act’s (ACA) state-based and partnership Exchanges in six states and DC. GAO found that the greatest challenges to achieving complete implementation by October 1, 2103 lie in IT-related work and financing. Several of the states in the study began working on the IT component of their Exchange prior to the release of federal guidelines, meaning significant changes to IT systems may be necessary in the future. Incomplete information on the federal data hub requirements has also hindered full development of several state IT systems. GAO reported that uncertainties associated with the 2014 enrollment numbers make finances very difficult to estimate. States have also employed several different methods to obtain operating funds for 2015. For instance, Oregon will charge an administrative fee of up to 5% of premiums, based upon the number of individuals that enroll in the Exchange. Nevada, however, will charge between $7.13 and $7.78 per member per month, which will be factored into enrollee’s premiums.
Posted on May 15, 2013
The Congressional Budget Office (CBO), in conjunction with the Joint Committee on Taxation (JCT), issued updated budget projections for fiscal years 2014-2023, which include updated impact estimates of the insurance provisions in the Affordable Care Act (ACA). Slower than anticipated growth in health care spending, particularly in programs such as Medicare and Medicaid, is one of several factors that influenced the revised estimates…
Posted on April 8, 2013
A Congressional Research Service (CRS) report released last week clarified confusion associated with how companies treat their part-time and seasonal workers, and how this treatment may make them eligible for employer penalties under the Affordable Care Act (ACA). The CRS report includes updated information on employer penalties, which was provided by IRS guidance released late last year. According to the ACA, employers with a minimum of 50 full-time equivalent employees must offer affordable and adequate health insurance to their employees, or run the risk of receiving significant penalties under the law. The confusion on the issue stems from the difference in calculating which businesses are subject to penalties, and the IRS guidance helps to clarify this issue by explaining the ACA’s classification of a full-time employee and provisions related to seasonal workers.
Posted on April 1, 2013
The Congressional Research Service (CRS) released a memorandum stating that the Centers for Medicare and Medicaid Services (CMS) may assume that Congress will amend the sustainable growth rate (SGR) in order to prevent doctors from taking massive cuts in their Medicare reimbursements. CMS claimed that they did not possess the legal authority to make that assumption, and therefore cited the SGR as a reason to propose a 2.3% cut to Medicare Advantage (MA). As a result, legislators are hoping that CMS will use this authority to reduce their proposed cuts to MA rates in light of the savings from the pending “doc fix” on SGR.
UPDATE: In response to the findings from CRS, CMS released a report stating they will assume a “doc fix” from Congress and therefore increase MA payments by 3.3% for next year.
Posted on March 28, 2013
A report issued by the Congressional Research Service (CRS) details how the House Budget Proposal impacts health care. Specifically, the report finds that provisions within the proposed budget would make it challenging for states to retain their current Medicaid programs. By combining Medicaid with the Children’s Health Insurance Program (CHIP), turning Medicaid into a block grant, and repealing the Medicaid expansion provided by the Affordable Care Act (ACA), the proposed budget elicits a $1.4 trillion reduction in Medicaid spending over the next 10 years. Such a drastic decrease would likely result in states being forced to cut provider reimbursements, cut benefits, and make changes in Medicaid eligibility requirements.