Tag: Health and Human Services
CMS releases DSH payment proposed rule
Posted by Nikki Hurt on May 14, 2013
The Centers for Medicare and Medicaid Services (CMS) released a proposed rule concerning reductions to Disproportionate Share Hospital (DSH) payments. Pursuant to the Affordable Care Act (ACA), the federal government had intended to cut DSH payments beginning in 2014, as the law’s Medicaid expansion would negate the need for such payments. Since the Supreme Court’s decision rendered Medicaid expansion optional, the federal government has elected to delay the DSH payment reduction until 2015 when they have a more accurate assessment of the nation’s uncompensated care level after initial implementation of the ACA.
A fact sheet summarizing the rule can be found here.
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CCIIO will amend Exchange regulations for Utah
Posted by Nikki Hurt on May 10, 2013
In a letter addressed to the governor of Utah, Center for Consumer Information and Insurance Oversight (CCIIO) Director Gary Cohen stated that CCIIO will release updated regulations that will permit Utah to operate their small business health option program (SHOP) while the federal government runs the individual Exchange. The letter addresses how Utah and the federal government will divvy up responsibilities concerning navigators and plan management, as well as data reporting requirements for their SHOP. In addition, the letter purports that other states may also pursue a similar Exchange model.
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CMS releases data on hospital charges
Posted by Nikki Hurt on May 8, 2013
In an effort to increase health care affordability and transparency, the Centers for Medicare and Medicaid Services (CMS) published data pertaining to hospital charges for the 100 most common services provided during Medicare inpatient stays. With more than 163,000 entries, the data released by CMS indicated wide variation in costs, both across the country and within similar regions. For instance, a joint replacement procedure can cost $5,300 in Ada, Oklahoma, while a similar procedure may cost upwards of $223,000 in Monterey Park, California. Similarly, heart failure treatments can cost anywhere between $9,000 and $51,000 in Jackson, Mississippi. To further promote the spirit of the Affordable Care Act (ACA), the US Department of Health and Human Services (HHS) will also be offering grants for entities to collect and analyze medical pricing and reimbursement data to aid consumers in their health care decision-making and promoting cost-effective care.
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Final Rule: Notice of Benefit and Payment Parameters for 2014
Posted by Nikki Hurt on
On March 11, 2013, the U.S. Department of Health and Human Services (HHS) released a final rule on the Notice of Benefit and Payment Parameters for 2014. This final rule addresses a variety of issues, including the specific payment parameters for the three premium stabilization programs – the permanent risk adjustment program, the transitional reinsurance program, and the temporary risk corridors program. In addition, the final rule also covers advance payments of the premium tax credit, cost-sharing reductions, and user fees for the federally-facilitated Exchanges, specific requirements related to the federally facilitated Small Business Health Option Program (SHOP), and the medical loss ratio program. This rule finalizes the provisions set forth in HHS’s proposed rule on these topics, December 7, 2012…
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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…
HHS releases shorter Exchange enrollment application forms
Posted by Nikki Hurt on April 30, 2013
In response to the comments received on the length and complexity of the 21-page health insurance application draft, the US Department of Health and Human Services (HHS) has shaved down the application and released their second iteration this morning. Under the Affordable Care Act’s (ACA) individual mandate, most Americans are required to have insurance by January 1st, 2014. The new application released by HHS is designed to make the enrollment process more streamlined and simple. Individuals wishing to enroll into the Exchange will submit a 5-page document entitled “Application for Health Coverage and Help Paying Costs (Short Form).” The family application, “Application for Health Coverage and Help Paying Costs” comes in at 12-pages in length. HHS has also provided a 5-page application titled “Application for Health Coverage” for anyone wishing to enter the Exchange, but is unsure of their eligibility.
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CMS extends QHP application deadline
Posted by Nikki Hurt on April 29, 2013
Today, the Centers for Medicare and Medicaid Service (CMS) announced a 3-day extension for insurers submitting a qualified health plan (QHP) on the Federally-Facilitated Exchanges (FFE). Insurers will have until May 3rd at 8:00 pm, after which CMS will provide the opportunity for a 3-day Limited Correction Window. The window will permit insurers to make minor application adjustments deemed appropriate by CMS.
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HHS enhances CLAS standards
Posted by Nikki Hurt on April 24, 2013
The US Department of Health and Human Services (HHS) Office of Minority Health released enhanced standards on Culturally and Linguistically Appropriate Services (CLAS) in health care settings. There are many determinants that inhibit the achievement of health equity, and the implementation of CLAS is one mechanism by which disparities can begin to be whittled away. Building upon the original 2000 standards, National Standards for Culturally and Linguistically Appropriate Standards in Health and Health Care: A Blueprint for Advancing and Sustaining CLAS Policy and Practice is designed to provide an organization with the information and tools necessary to mitigate health care disparities and achieve health equity by using CLAS. The enhanced standards aim to improve health equality within health care settings by addressing the categories of (1) governance, leadership, and workforce, (2) communication and language assistance, and (3) engagement, continuous improvement, and accountability.
A synopsis of the enhanced CLAS standards is also available.
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HHS releases BHP timeline
Posted by Nikki Hurt on April 19, 2013
The US Department of Health and Human Services (HHS) provided a timeline for the installation of the Basic Health Program (BHP) to Senator Maria Cantwell (D-WA), a champion of the model. Pursuant to Section 1331 of the Affordable Care Act (ACA), the BHP was intended to serve as a special state insurance option for low-income families and individuals, yet no deadline for HHS to create the BHP was stated in the statute. The timeline details key implementation events from now until January 1, 2015, the time at which the BHP is scheduled to become operational.
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HHS, Labor and Treasury extend temporary state external review process standards
Posted by Nikki Hurt on March 18, 2013
In a guidance issued Friday, the US Department of Health and Human Services (HHS), US Department of Labor, and US Department of the Treasury extended the interim standards for state external review processes. These standards are meant to make health care claim denials easier for patients to appeal, as set forth in the Affordable Care Act (ACA). Under the new guidance, health insurance issuers will be deemed compliant as long as their external review processes meet the National Association of Insurance Commissioner (NAIC) interim process standards established by Technical Release No. 2011-02. The transitional period expires January 1, 2016, and issuers will then have to meet the standards from the July 2010 regulations issued by the federal government.
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