Tag: Exchanges
CA releases proposed premium rates for 2014
Posted by Nikki Hurt on May 23, 2013
This morning, California published proposed premium rates from 13 issuers to be offered on the state’s health insurance Exchange, Covered California. California chose to negotiate rates with insurers through active purchasing, meaning that Covered California worked directly with the insurance companies on determining the plans that would be offered on the Exchange. Initially, 33 issuers had applied to offer plans through Covered California, but that number significantly dwindled in response to proposed premiums that were set too high and issuers that were not able to be the “active partners” Covered California required.
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CO releases 2014 Exchange rates
Posted by Nikki Hurt on May 22, 2013
Colorado became the sixth state to post their proposed premium rates for plans entering the state’s 2014 state-based insurance Exchange. In total, 831 health insurance plans, including both individual and small-group options, have been proposed by 17 issuers. Reviews of the proposed plans are currently being conducted by the Colorado Division of Insurance and are scheduled to be completed by July 31st.
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CMS State Resources FAQ: Medicaid Eligibility Determinations, Medicaid/Exchange Interactions, and §1115 Demonstrations that Use Enrollment Caps
Posted by Nikki Hurt on
The interaction between Medicaid and Exchanges around eligibility determination issues represents one of the most important and complex aspects of the ACA. An estimated 28 million adults, along with 19 million children, can be expected to transition at least once annually between insurance affordability programs, as Medicaid and premium subsidies are termed under implementing CMS regulations. Collaboration between Medicaid agencies and Exchanges is essential in order to avert unnecessary delays in eligibility determinations and breaks in coverage that in turn can affect not only the affordability of care but access itself, given the link between coverage and health care access through plans’ provider networks…
WA releases Exchange premiums
Posted by Nikki Hurt on May 20, 2013
The Washington State Office of the Insurance Commissioner (OIC) recently released proposed premium rates for their state-based health insurance Exchange, Washington Health Plan Finder. Fears of rate increases were assuaged, as the plans presented ultimately indicated more coverage at a reduced cost, attributable to Washington’s already competitive insurance market. The proposed rates must be evaluated by OIC prior to being issued on the Exchange.
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CCIIO releases Marketplace FAQ
Posted by Nikki Hurt on May 17, 2013
The Center for Consumer Information and Insurance Oversight (CCIIO), a division of the Centers for Medicare and Medicaid Services (CMS), recently posted new guidance concerning federally-facilitated and state-based Exchanges (Marketplaces) established under the Affordable Care Act (ACA). The guidance purports that if states do not adhere to and enforce the requisite standards for health insurance issuers in federally-facilitated Exchanges, then CMS intends to coerce enforcement through civil penalties and plan decertification. CMS does not believe that decertification will be a common occurrence. In addition, the guidance stated that qualified health plans (QHP) paired with health savings accounts (HSA) must meet the cost-sharing reduction standards that apply to low income-individuals.
CCIIO published additional guidance that expands upon which activities, in both federally-facilitated and state-based Marketplaces, that qualify for grant funding under ACA Section 1311. For instance, state-based Marketplaces are not permitted to use this funding for navigator outreach and education, yet they are allowed to use Section 1311 funds for “in-person assistance programs.”
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CBO releases new report describing budgetary impact of the ACA
Posted by Nikki Hurt 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…
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EBSA preliminary guidance requires employers to notify employees about insurance options
Posted by Nikki Hurt on May 10, 2013
The Employee Benefits Security Administration (EBSA), a division of the Department of Labor, published guidance concerning employer notification of insurance options in the health insurance marketplaces established by the Affordable Care Act (ACA), including model language for employers to notify their employees on marketplaces and employer-sponsored coverage. Technical Release Number 2013-02 states that employers must begin to inform their employees about available insurance options beginning October 1st, and the guidance contains a model notice for employers to utilize. EBSA released this guidance in advance of the proposed rule so that employers are equipped with the appropriate knowledge so they may begin to notify employees as soon as they desire.
Obama administration announces $150 million in funding to CHCs for in-person enrollment assistance
Posted by Mark Dorley on May 9, 2013
Today the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) announced the awarding of $150 million in funding to the nation’s 1200 community health centers for the purposes of providing in-person enrollment assistance under the Affordable Care Act (ACA). With these new funds, health centers will be able to hire new staff, train existing staff, and conduct community outreach events and other educational activities in order to help provide in-person enrollment assistance to uninsured individuals across the country, according to the agency press release here. The full funding announcement, which contains detailed breakouts of the dollar amounts awarded to specific health centers, can be found here.
CCIIO provides Model Language for issuers
Posted by Nikki Hurt on May 8, 2013
The Center for Consumer Information and Insurance Oversight (CCIIO) provided permissible Model Language for issuers to use when notifying existing customers of the new plan options that will be available to them through the Affordable Care Act’s (ACA) health insurance marketplaces. CCIIO provided several examples as to how issuers may phrase their notices, and gives issuers the flexibility to either provide the notice by itself or as part of the customer’s policy renewal notice. Furthermore, issuers of qualified health plans (QHP) and non-grandfathered health plans are barred from using practices that would discourage enrollment of those with poor health statuses.
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Interim Final Rule: Alternative Approaches to Cost-Sharing Reduction Payment and Risk Corridor Calculations
Posted by Nikki Hurt on
The temporary risk corridors program allows the federal government to share a QHP’s profits or losses among other QHP issuers due to inaccurate rate setting inside the Exchanges from 2014-2016. To determine whether a QHP issuer has inaccurately set premium rates that lead to an unjustified profit or loss, a QHP’s “allowable costs” must be calculated per the requirements in the Premium Stabilization Rule. The IFR modifies the definition of “allowable costs” such that a QHP’s allowable costs are to be determined based on its pro-rata share of the QHP issuer’s incurred claims for all non-grandfathered health plans within a state, and allocated to the QHP based on premiums earned by the issuer in the market…
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Most Popular Content
- State Health Insurance Exchange Navigators posted on February 28, 2011
- The QHP Certification Process in Federally-Facilitated Exchanges: Network Adequacy and Essential Community Providers posted on March 27, 2013
- Reform Overview posted on April 12, 2010
- Summary of the U.S. Supreme Court decision in the case of National Federation of Independent Businesses et al. v. Sebelius, Secretary of Health and Human Services, et al. posted on June 28, 2012
- Navigators and Application Counseling and Assistance posted on April 24, 2013
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Recent Posts
- NEJM article correlates decline in health spending to recession
- EBRI study explores trends in part-time health coverage
- CO releases 2014 Exchange rates
- CMS State Resources FAQ: Medicaid Eligibility Determinations, Medicaid/Exchange Interactions, and §1115 Demonstrations that Use Enrollment Caps
- CMS letter addresses enrollment strategies for Medicaid and CHIP
- WA releases Exchange premiums
- CMS rule requires MA and Medicare Part D to comply with MLR
- CMS sets PCIP payment at Medicare rates
- CCIIO provides additional guidance on Navigators and Marketplace assistance
- CCIIO releases Marketplace FAQ
