Tag: Final Rule
CMS issues final rule on benefit and payment parameters for 2016
Posted by Sara Rothenberg on February 23, 2015
The Centers for Medicare and Medicaid Services (CMS) issued a final rule on the U.S. Department of Health and Human Services (HHS) Notice of Benefit and Payment Parameters for 2016. The final rule builds on previously issued standards to further strengthens transparency, accountability, and the availability of information for consumers about their health plans. The rule finalizes the annual open enrollment period for 2016 to begin on November 1, 2015 and run through January 31, 2016. CMS also released its final annual letter to issuers, which provides additional guidance on these and related standards for plans participating in the Federally-facilitated Marketplace.
CMS issues final rule on Medicaid DSH
Posted by Sara Rothenberg on December 3, 2014
The Centers for Medicare and Medicaid Services issued a final rule addressing the hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments. Under this limitation, DSH payments to a hospital cannot exceed the uncompensated costs of furnishing services to individuals who are Medicaid-eligible or uninsured. The final rule defines “uninsured” as those who have “no health insurance for the services furnished during the year.” The rule also provides that determinations of funding limits will be made on a service-specific basis rather than at the individual level. CMS says the regulation gives states and hospitals more flexibility in terms of which hospital costs can be considered uninsured costs than what had been in place under a final rule from 2008.
CMS publishes Medicare pay final rule
Posted by Sara Rothenberg on August 5, 2014
The Centers for Medicare and Medicaid Services (CMS) issued a final rule revising the Medicare hospital inpatient prospective payment systems (IPPS). In adherence to the Affordable Care Act (ACA), part of the rule would effectively reduce payments to disproportionate share hospitals (DSH), which serve the most vulnerable patients. DSH payment reductions are a result of the expansion of Medicaid, however in states that chose not to expand, hospitals still risk losing some payment for uncompensated care.
IRS releases final rules on tax credit and drug fee
Posted by Sara Rothenberg on July 24, 2014
The Internal Revenue Service (IRS) published a final rule clarifying its premium tax credit policy for those enrolling in health plans through Affordable Insurance Exchanges with complicated family and household situations. The rule clarifies that certain married individuals, including spouses in abusive relationships, and divorced or separated taxpayers, can be considered not married for the purposes of the Internal Revenue Code, under Section 7703(b).
The agency also released a final rule regarding the implementation of the Affordable Care Act’s (ACA) branded prescription drug fee. The rule provides guidance on the annual fee imposed on covered entities engaged in the business of manufacturing or importing branded prescription drugs.
Rule finalizes 90-day waiting limit
Posted by Nikki Hurt on June 20, 2014
Today, the US Department of Health and Human Services (HHS), the Internal Revenue Service (IRS) and the Employee Benefits Security Administration (EBSA) released a final rule concerning the 90-day waiting period limitation. The final rule states that group health insurance plans cannot apply a waiting period that exceeds 90 days after the employee has been approved for coverage. The rule further states that small group plan orientation periods, the time it takes from hire to when the plan deems the employee is eligible for coverage, cannot exceed one month.
HHS releases final Marketplace rule
Posted by Nikki Hurt on May 16, 2014
The US Department of Health and Human Services (HHS) issued a final rule entitled Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond. Some specific provisions in the rule include:
- Raising the administrative costs and profits ceiling under the risk corridor formula by 2%.
- Providing information on how to include ICD-10 costs under the medical loss ratio (MLR).
- Requiring qualified health plans (QHP) on the ACA Marketplace to have a more efficient and effective method for enrollees to acquire medications not covered on the plan. This specifically applies to enrollees on a course of treatment in which absence of the medication would substantially impact the individual’s life and health.
- Requiring insurers to annually report plan changes to beneficiaries.
- Beginning in 2016, Marketplaces will have to display quality data on all plans for public viewing. The data will be based on a five-star system and enrollee satisfaction surveys.
- Enumerating state requirements that may prohibit Navigators or other assistors from performing their roles. For example, Navigators may go door-to-door for enrollment assistance and outreach. They may not, however, provide gifts to entice enrollment.
- Delaying the “employee choice” option in the small business health options program (SHOP) to 2016.
The final rule is largely unchanged from the proposed version. An FAQ addressing market reforms and Marketplace standards can also be accessed here.
New CMS rule reduces burden and promotes efficiency
Posted by Nikki Hurt on May 8, 2014
A final rule released by the Centers for Medicare and Medicaid Services (CMS) is designed to loosen policies that could save hospitals up to $3.2 billion over the next five years. One policy addressed removes the requirement that a physician must be present at a rural health center every two weeks, which was implemented to help combat the shortage of rural health providers. The rule also relaxes supervision requirements for some providers, such as dieticians. Easing regulations under this rule follows suit with the administration’s “regulatory lookback” that began in 2012.
Update: Basic Health Program Final Regulations
Posted by Nikki Hurt on March 12, 2014
On March 7, 2014, the Centers for Medicare and Medicaid Services (CMS) published final regulations implementing the Affordable Care Act’s Basic Health Program (BHP) market option (PPACA §1331). On that date, CMS also published rules that set forth the BHP payment methodology and the data it will use to determine payments to states that establish certified BHP programs.
CMS releases BHP final rule
Posted by Nikki Hurt 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 rule extends transition policy to 2016
Posted by Nikki Hurt on March 6, 2014
- Extending the transitional policy from November 2013, which says that individuals may retain their insurance coverage even if it does not meet the Affordable Care Act (ACA) standards, through October 2016.
- Finalizing that open enrollment for 2015 will being on November 15th, 2014 and conclude on January 15th, 2015.
- Stabilizing the transitional reinsurance program by raising the attachment point and setting a reinsurance cap.
- Refining the risk adjustment and risk corridor programs.
- Implementing enrollee protections such as out-of-pocket limits and patient safety standards.
- Finalizing provisions of the Small Business Health Options Program (SHOP) that address employee choice and premium aggregation.
In addition to the rule, Gary Cohen, the Director for the Center for Consumer Information and Insurance Oversight (CCIIO) released a letter explaining the extension of plans that do not meet the ACA meaningful coverage requirements. The letter further describes how states that did not implement this extension back in November may do so now.