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.
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.
Will People Who Enroll in Health Insurance Marketplace QHPs be Able to Qualify for Premium Assistance if they Enroll Directly through an Insurer’s Website?
Posted by Mark Dorley on November 20, 2013
The Administration recently announced that its improvements to Healthcare.gov, the federal Health Insurance Marketplace, will include a new direct purchase feature that enables individuals to buy an Exchange-certified qualified health plan (QHP) directly at the website of the insurer who sells the plan. A question has arisen as to whether such an arrangement is lawful from a subsidy perspective: that is, whether direct enrollment at the QHP issuer website counts as…
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.
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.
HHS posts premium rates for FFM states
Posted by Nikki Hurt on October 2, 2013
In an effort to help consumers circumvent the backlog to access plan information on federally-facilitated Marketplaces (FFM), the US Department of Health and Human Services (HHS) posted a list of 17,000 plans and premium rates that consumers may browse to see what options are available in their states. Plans are broken down by metal tier (platinum, gold, silver, and bronze), plan type (HMO, PPO, etc.), and the state and county in which the plan is offered. HHS has provided plan information for health insurance and stand-alone dental plans in the individual and small group markets.
HHS releases premium rates in federal exchanges
Posted by Nikki Hurt on September 25, 2013
Early this morning, the US Department of Health and Human Services (HHS) Office for the Assistant Secretary for Planning and Evaluation (ASPE) released the rates for qualified health plans (QHP) to be offered on the 36 federally-facilitated Marketplaces (FFM). The rates released overall are 16% lower than anticipated, and seem to be commensurate to rates released by several other state-based Marketplaces. FFM states will host an average of 53 QHP, with 95% of consumers having more than two options. HHS stated that FFM with more competition and more transparency boasted lower premium rates. The ASPE Issue Brief, where the rates were initially published by HHS, cites that 95% of uninsured individuals reside in states where the FFM premium is at or lower than the expected rate. Moreover, HHS defended several of the common criticisms surrounding premiums, such as the smaller provider networks and the lack of comparison to current rates.
OIG issues fraud warning for Marketplaces
Posted by Nikki Hurt on September 18, 2013
The US Department of Health and Human Services Office of Inspector General (OIG) issued a consumer alert concerning potential signs of fraud in the health insurance Marketplaces. The OIG alert addresses specific actions that may indicate fraudulent activity around the Marketplaces. Some of the actions consumers should be wary of include:
- individuals asking consumers for money to enroll in Marketplaces or Obamacare;
- sham or look-a-like websites;
- persistent, high-pressure solicitation to purchase insurance; and
- individuals asking consumers for personally identifiable information without previous contact.
Additionally, OIG used this alert to remind Medicare beneficiaries that they do not need to enroll in the Marketplace.
The Centers for Medicare and Medicaid Services (CMS) also released a tip sheet alerting consumers on ways in which they can protect themselves against fraud in the Marketplaces.
HHS sends letter to Energy and Commerce Majority in response to Navigator inquiry
Posted by Nikki Hurt on September 9, 2013
On August 29th, the House Energy and Commerce Committee sent a letter to 51 Navigator groups requesting answers to various questions on their roles and requirements under the Affordable Care Act (ACA). Today, the US Department of Health and Human Services (HHS) sent a letter to Chairman Fred Upton (R-MI) answering the questions posed by the committee. HHS stated that the timing of the committee’s letter may interfere with the ability of Navigator groups to perform their roles of outreach and education of health insurance options available to consumers through the ACA. Moreover, as the agency that granted and authorized Navigator groups, HHS has the information to answer the questions posed by Chairman Upton’s committee.
CRS releases new report on MLR
Posted by Nikki Hurt on August 19, 2013
In a report, the Congressional Research Service (CRS) provides an explanation of the medical loss ratio (MLR). Under the Affordable Care Act (ACA), the MLR requires that insurers in the individual and small group market spend at least 80%, or 85% in the large group market, of premium dollars received on medical expenses for plan beneficiaries. If the insurer does not spend 80%, they must return the difference to beneficiaries in the form of a rebate. The MLR was instituted as a way to promote accountability and transparency for insurance company allocation of premium dollars. The CRS document clarifies that beneficiaries will only receive the rebate if the company as a whole does not meet the MLR threshold, not if the individual did not meet the threshold in his or her policy. Additionally, the MLR provisions only apply to fully-funded insurance plans. The CRS report also clarifies that some states do not have to adhere to MLR provisions if the US Department of Health and Human Services (HHS) determined that doing so would be detrimental to the state’s health insurance market.