HHS releases proposed rule on changes to the “triple r”
Posted by Nikki Hurt 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.
CMS provides sample letters for insurance issuers to notify beneficiaries of transitional policy
Posted by Nikki Hurt 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.
Administration issues transitional policy to address plan cancellations
Posted by Nikki Hurt 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.
CCIIO issues enrollment period FAQs
Posted by Nikki Hurt 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.
CMS issues loaded Marketplace final rule
Posted by Nikki Hurt 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.
CMS issues RFC for exemptions to individual mandate
Posted by Nikki Hurt 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.
Update: Ohio expands Medicaid
Posted by Nikki Hurt on
After the measure to expand Medicaid failed in the Legislature this summer, the Ohio Controlling Board voted 5-2 to approve Medicaid expansion under the Affordable Care Act (ACA). This decision, which will likely be met by a multitude of legal challenges in the coming months, makes Ohio the 25th state to accept enhanced federal funding to help insure the state’s most impoverished residents. Our map has been updated to reflect these changes.
CMS releases draft application for ACA exemptions
Posted by Nikki Hurt on October 16, 2013
The Centers for Medicare and Medicaid Services (CMS) issued a draft application and a corresponding data collection comment request concerning exemptions from the individual mandate. Under the Affordable Care Act (ACA), certain groups of individuals, such as those experiencing financial hardships or those that belong to a religious organization that opposes the use of insurance, are deemed exempt from the individual mandate and are therefore not required to pay the $95 penalty in 2014. This specific draft application, which is for individuals requesting a hardship exemption, is 6 pages in length and requires applicants to provide the type of hardship they are experiencing and their tax information. CMS anticipates that more than 12 million individuals will apply for the individual mandate exemption. The data collection comment request outlines options for states to rely on the Department of Health and Human Services (HHS) to determine eligibility exemptions, and asks the Office of Management and Budget (OMB) to approve the annual information collection requirements associated with the application.
CMS releases enrollment guidance
Posted by Nikki Hurt on October 14, 2013
The Centers for Medicare and Medicaid Services (CMS) recently published their “Enrollment Operational Policy and Guidance” concerning Federally-Facilitated Marketplaces (FFM). The guidance, released on October 3rd, stated that enrollments made after October 1st must comply with the provisions in the document. The guidance applies to entities associated with the enrollment process, such as FFM, qualified health plan issuers, and agents and brokers, and describes how these groups are expected to operate in terms of aiding individuals in obtaining health insurance and subsidies. The guidance purports that CMS intends the document to be “living,” and the agency will provide consistent updates and clarification on the provisions therein.
Update: Medicaid DSH Final Rule
Posted by Nikki Hurt on October 8, 2013
On September 13th, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a final rule concerning the reduction of Medicaid Disproportionate Share Hospital (DSH) payments to hospitals. The reduction methodology discussed in this rule will be effective for FY 2014 and FY 2015…