Tag: Health and Human Services
IG reports examine ACA enrollment applications
Posted by Nikki Hurt on July 1, 2014
The US Department of Health and Human Services Office of the Inspector General (OIG) released two new reports concerning enrollment into qualified health plans (QHP) under the Affordable Care Act (ACA). The first report found that the vast majority of application inconsistencies were not resolved within the first three months of the open enrollment period. According to the report, many of the inconsistencies dealt with reported income and citizenship status, and states are at various points in rectifying these application data inconsistencies.
Another report investigated whether or not federally-facilitated Marketplaces (FFM) and two state-based Marketplaces (SBM) were able to verify enrollment eligibility. During the same three month window, OIG found that the FFM was not able to verify social security numbers. For the SBM states, California and Connecticut, the report found that both states also had some ineffective controls in regards to confirming various aspects of QHP enrollment.
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.
Tri-agency rules address 90-day waiting period limit
Posted by Nikki Hurt on February 20, 2014
The US Department of Health and Human Services (HHS), the Internal Revenue Service (IRS) and the Employee Benefits Security Administration (EBSA) released several rules today concerning the 90-day waiting period limitation before insurance coverage can become effective. The final rule states that group health insurance plans cannot apply a waiting period that exceeds 90 days beginning January 2015. The proposed rule clarifies the 90-day limitation in terms of the length of employment-based orientation periods, stating that one month is the reasonable limit for employment-based orientation periods.
HHS releases new FPL guidelines
Posted by Nikki Hurt on January 27, 2014
The US Department of Health and Human Services (HHS) updated the federal poverty level (FPL) guidelines for 2014. The guidelines, which are slightly higher than the 2013 levels, will not impact the eligibility thresholds used to determine subsidy eligibility for health insurance enrollment for 2014. For an individual, the the FPL is now set at $11,670, which represents a 1.6% increase from 2013.
HHS releases enrollment figures
Posted by Nikki Hurt on January 13, 2014
The US Department of Health and Human Services (HHS) recently released enrollment figures from October 1st, 2013 to December 28th, 2013 for the Affordable Care Act’s (ACA) health insurance marketplace. Below are several of the key findings:
- Nearly 2.2 million Americans have enrolled in health insurance;
- About 24% of these individuals are between the ages of 18 and 34;
- 60% of enrollees selected a silver plan; and
- 79% of individuals selected a plan with financial assistance.
The most recent Assistant Secretary for Planning and Evaluation (ASPE) Issue Brief provides a detailed breakdown and explanation of the enrollment figures.
HHS allows individuals with canceled plans to claim hardship exemptions
Posted by Nikki Hurt on December 30, 2013
The US Department of Health and Human Services (HHS) has permitted individuals whose insurance plans were canceled under the Affordable Care Act (ACA) to qualify for a hardship exemption and not be subject to the individual mandate for 2014. Hardship exemptions were created for individuals that experienced “financial or domestic circumstances, including an unexpected natural or human-caused event, such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan,” and the new decision by HHS places individuals with canceled health plans under this classification. The policy change, announced both in a letter to several senators and through official guidance from the Centers for Medicare and Medicaid Services (CMS), requires individuals with canceled plans to submit a hardship exemption form and proof of plan cancellation. Individuals choosing to claim a hardship exemption may forgo insurance for 2014 without a penalty or choose to enroll into catastrophic plans, which are bare-bones plans typically reserved for individuals under the age of 30.
HHS releases progress and performance report for HealthCare.gov
Posted by Nikki Hurt on December 2, 2013
Yesterday, the US Department of Health and Human Services (HHS) released a progress report on the administration’s recent efforts to fix and improve the Affordable Care Act’s (ACA) website, healthcare.gov. The website has been plagued with issues and errors since its debut on October 1st. The document, HealthCare.gov: Performance and Progress Report, outlines all of the improvements and changes made to the website over the past two months. Some of these improvements include fixing over 400 bugs and software issues and updating the server so that the site may be able to host 800,000 visitors a day. The report cites management and collaborations issues, as well as inadequate systems and a multitude of technical software bugs, as key causes of the early site malfunction.
106,185 enroll in health plans through ACA during October
Posted by Nikki Hurt on November 13, 2013
Today, the US Department of Health and Human Services (HHS) issued the first set of enrollment statistics for health insurance plans offered through the Affordable Care Act’s (ACA) Marketplaces. The report stated that 106,185 individuals signed up for coverage during the first month of open enrollment. About 75% of these individuals enrolled through State-Based Marketplaces. The remainder, about 26,000 people, reside in a state in which the Marketplace is operated by the federal government. While these individuals have completed the enrollment process, they have not necessarily purchased a plan.
Administration issues mental health final rule
Posted by Nikki Hurt on November 8, 2013
The Department of Health and Human Services (HHS), Department of Labor (DoL), and the Department of the Treasury (DoT) released the joint final rule implementing the Mental Health Parity and Addiction Equity Act of 2008. Under this law, insurers that offer coverage for mental health services are expected to treat mental health equitably, meaning cost-sharing and limits for mental health services should be comparable to that of physical health services. Several other specific provisions addressed in this rule include:
- Parity for intermediate care offered in residential or outpatient settings and all plan standards (i.e. network adequacy and geographic limits);
- Clarifying transparency expectations for insurers to remain compliant with the law; and
- Eliminating provisions that enabled insurers to make exceptions for parity requirements for certain benefits offered.
The law was passed in 2008, and an interim final rule was issued in January 2010. The Centers for Medicare and Medicaid Services (CMS) also published an FAQ on today’s rule.