Administration released final rule on employee-sponsored wellness programs
Posted by Nikki Hurt on May 29, 2013
A joint rule released by the US Department of Labor (DoL), the US Department of the Treasury (DoT), and the US Department of Health and Human Services (HHS) addresses new provisions regarding participatory wellness programs in the workplace. Workplace wellness programs are designed to reduce the prevalence of chronic disease, stifle growing health care costs, and improve overall health by rewarding employees for participating in certain activities, such as educational classes or obtaining memberships to fitness centers. The final rule sets the maximum reword for completion of a nondiscriminatory health-contingent wellness program to 30% of coverage costs, up from the original 20%. Employees that successfully complete tobacco-related wellness programs are eligible for up to 50% of cost of coverage.
Health Information Implications of the 2014 HHS Budget
Posted by Nikki Hurt on
On April 10, 2013, President Obama released his proposed FY 2014 budget, which includes $967.3 billion in outlays for the Department of Health and Human Services (HHS) and makes legislative proposals that would save an estimated $361.1 billion (net) over ten years. In conjunction with the release of the President’s budget, HHS published an overview of the budget provisions for HHS, which provides more detail on how the Department would allocate its budget in FY 2014 and describes its ongoing progress in meeting specific program goals and legislative requirements. Many of the proposals included in the President’s budget and HHS’ overview relate to the ongoing transformation of the health care delivery system to a value-based system that rewards quality and efficiency. Critical to the success of this transformation is the exchange of health information for activities such as quality measurement and reporting, value-based purchasing, consumer engagement, and comparative effectiveness research. Below are selected provisions of the HHS budget, the agency’s relevant legislative proposals for 2014, and progress reports for health care system reform efforts that require the use and exchange of health information. We also identify HHS’ stated priorities for 2014 that are related to health information…
Jackson Hewitt explores issue of “unbanked” Americans gaining ACA insurance coverage
Posted by Nikki Hurt on May 24, 2013
A new study released by Jackson Hewitt Tax Service Inc. describes an issue that may arise when uninsured individuals without bank accounts enroll into the Affordable Care Act’s (ACA) health insurance Exchanges. Uninsured + Unbanked = Unenrolled= How Health Insurance Companies May Exclude 1 in 4 Eligible Americans from ACA Coverage- and What the Federal Government Can Do to Stop It finds that one quarter of Americans eligible for federal premium subsidies under the ACA, meaning their annual income falls between 100-400% of the federal poverty level, do not have a checking account. This presents an issue in regards to the types of premium payments insurers are willing to accept, as many insurers will not take debit or credit card as a payment form. The US Department of Health and Human Services (HHS) claimed they ameliorated this concern in their guidance letter issued last month by stating that insurance companies must “accept payment in ways that are non-discriminatory.”
CCIIO releases Marketplace FAQ
Posted by Nikki Hurt on May 17, 2013
The Center for Consumer Information and Insurance Oversight (CCIIO), a division of the Centers for Medicare and Medicaid Services (CMS), recently posted new guidance concerning federally-facilitated and state-based Exchanges (Marketplaces) established under the Affordable Care Act (ACA). The guidance purports that if states do not adhere to and enforce the requisite standards for health insurance issuers in federally-facilitated Exchanges, then CMS intends to coerce enforcement through civil penalties and plan decertification. CMS does not believe that decertification will be a common occurrence. In addition, the guidance stated that qualified health plans (QHP) paired with health savings accounts (HSA) must meet the cost-sharing reduction standards that apply to low income-individuals.
CCIIO published additional guidance that expands upon which activities, in both federally-facilitated and state-based Marketplaces, that qualify for grant funding under ACA Section 1311. For instance, state-based Marketplaces are not permitted to use this funding for navigator outreach and education, yet they are allowed to use Section 1311 funds for “in-person assistance programs.”
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.
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.
Obama administration announces $150 million in funding to CHCs for in-person enrollment assistance
Posted by Mark Dorley on May 9, 2013
Today the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) announced the awarding of $150 million in funding to the nation’s 1200 community health centers for the purposes of providing in-person enrollment assistance under the Affordable Care Act (ACA). With these new funds, health centers will be able to hire new staff, train existing staff, and conduct community outreach events and other educational activities in order to help provide in-person enrollment assistance to uninsured individuals across the country, according to the agency press release here. The full funding announcement, which contains detailed breakouts of the dollar amounts awarded to specific health centers, can be found here.
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.
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…
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…