A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Tag: HHS

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.

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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.

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ASPE report indicates premium variation among states

Posted by Nikki Hurt on June 18, 2014

A new report by the US Department of Health and Human Services (HHS) describes how premiums vary among the 36 states operating federally-facilitated Marketplaces under the Affordable Care Act (ACA). The report, released by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within HHS, found the average premium payment by an individual receiving subsidies to be $82, with the subsidized average for the silver plan metal tier being $69. Average subsidized premiums ranged from $23/month in Mississippi to $148/month in New Jersey. The report does not capture the corresponding data for the state-based Marketplaces.

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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.

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Proposed Standards for Navigators and Consumer Assistance Counselors: Preemption of Certain State Navigator Regulatory Laws

Posted by Mark Dorley on March 19, 2014

On March 17, 2014, HHS released a proposed rule in public view form that addresses a variety of issues including Exchanges, Navigators and Non-Navigator consumer assistance personnel, and other matters. The rule will appear in the Federal Register on…

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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.

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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.

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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.

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HHS submits marketplace verification report to Congress

Posted by Nikki Hurt on January 2, 2014

On the last day of the year, US Department of Health and Human Services (HHS) Secretary Kathleen Sebelius submitted a report to Congress certifying that Marketplaces are verifying applicants receiving premium support and cost-sharing reductions for their insurance under the Affordable Care Act (ACA) are in fact eligible for that assistance. The report, Verification of Household Income and Other Qualifications for the Provision of Affordable Care Act Premium Tax Credits and Cost-Sharing Reductions, contains information on “statutory, regulatory, and policy requirements that both State-based Marketplaces and Federally-facilitated Marketplaces must follow” in regards to verification requirements and the associated procedures.

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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.

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