ASPE report finds reduction in premium rate increases
Posted by Michal McDowell on February 22, 2013
According to a report published today by the Office of the Assistant Secretary for Planning and Evaluation (ASPE), a division of the U.S. Department of Health and Human Services (HHS), evidence suggests that the ACA has contributed to a reduction in the rate of increase in premiums in the individual market since 2010. These numbers are based on data collected from the 15 states that publicly post all requests for rate increases in the individual market. The proportion of rate filings in which the requested increase was 10 percent or more declined from 75 percent in 2010 to 34 percent in 2012. Available data for 2013 suggest that this pattern of slower premium growth has been maintained so far in 2013, with only 14 percent of requested rates at 10 percent or more. In addition, the average premium increase in 2012 was 30 percent below that in 2010.
CCIIO releases FAQ on state plan management
Posted by Michal McDowell on February 21, 2013
According to a Frequently Asked Questions (FAQ) guidance posted by the Center for Consumer Information and Insurance Oversight (CCIIO), states can determine whether health insurance plans qualify for the online health insurance exchange markets and conduct other plan management activities without submitting a “blueprint” application to the Department of Health and Human Services (HHS). The blueprints are applications that must be submitted to HHS in order for states to operate state-based exchanges or to participate in a state partnership exchange under the Affordable Care Act (ACA).
OIG finds most states on track to comply with ACA technical demands
Posted by Michal McDowell on
According to a report published by the U.S. Department of Health and Human Services’ (HHS) Office of Inspector General (OIG), 35 States reported that they anticipate implementing streamlined eligibility and enrollment systems, streamlined application forms, and data sharing and matching by January 1, 2014, as mandated under section 1413 of the Affordable Care Act (ACA). However, the report also describes challenges reported by States, such as implementing the requirements by the target date and upgrading outdated eligibility and enrollment systems. The report details various funding issues related to implementing needed changes. According to the paper, States also reported needing information and guidance, particularly on the Secretary’s application form, the planned Federal data services hub, and the calculation of Modified Adjusted Gross Income (MAGI). The OIG report concluded that the Centers for Medicare & Medicaid Services (CMS) should continue to provide guidance to States as they prepare to implement the streamlined eligibility and enrollment systems.
Departments of Labor, Treasury, and HHS release ACA FAQs Part XII
Posted by Michal McDowell on February 20, 2013
The Departments of Labor, Health and Human Services (HHS) and Treasury have jointly prepared a new set of Frequently Asked Questions (FAQs) regarding implementation of various provisions of the Affordable Care Act (ACA). The twelfth installment of the set, these FAQs answer questions from stakeholders to help people understand the new law and benefit from it, as intended. This round of FAQs covers cost-sharing limitations and coverage of preventive services. The FAQs state that employers cannot limit contraceptive coverage to oral contraceptives only. The Obama administration also specifies that over-the-counter contraceptives that are FDA-approved and prescribed by a doctor are included as required coverage.
CMS publishes essential benefits final rule
Posted by Michal McDowell on
The Centers for Medicare & Medicaid Services (CMS) has released the long-awaited final rule on the Affordable Care Act’s (ACA’s) essential health benefits (EHB), actuarial value, and accreditation requirements. In the rule, the Obama administration finalizes the state benchmark approach to defining mandated benefits through 2014 and 2015. As previously proposed, insurers may substitute benefits within the 10 services mandated to be covered under the ACA’s EHB package. The final rule also finalized a 2 percentage point leeway regarding the ACA’s cost-sharing metal tiers. With regards to drug coverage, the final rule requires plans in the Exchanges to cover one drug in each class, or as many medications as are covered in the state’s benchmark plan. In establishing Exchange drug coverage rules, States must choose the option that provides consumers with greater drug coverage.
For a fact sheet on the rule, click here.
CMS suspends PCIP enrollment
Posted by Michal McDowell on February 16, 2013
Yesterday, the Centers for Medicare & Medicaid Services (CMS) suspended enrollment in pre-existing condition insurance plans (PCIPs), effective March 2 of this year. The letter, sent from Richard Popper, the director of Insurance Plan Groups, to PCIP contractors, also included language regarding benefit adjustment analysis.
CMS issues RFI on brokers and agents for FFEs
Posted by Michal McDowell on February 11, 2013
The Centers for Medicare & Medicaid Services (CMS) issued a proposal to collect data on licenses and other information to register and monitor health insurance brokers and agents for the federal health insurance exchange. Health insurance brokers and agents would enter basic identifying information on the exchange portal during initial registration and when registration is complete, brokers and agents would be routed to CMS’s Learning Management System to complete required training and exams. CMS would use broker and agent usernames and ZIP codes to record training history and to communicate the results with the federally facilitated exchange (FFE). Under the Affordable Care Act (ACA), open enrollment in all exchanges begins Oct. 1 for plans that take effect in 2014.
Comments on the proposal are due April 8.
CMS delays BHP until 2015
Posted by Michal McDowell on
According to a set of frequently asked questions (FAQs) released by the Centers for Medicare & Medicaid Services (CMS), federal officials are delaying until 2015 the Basic Health Program (BHP), a health care overhaul option that would enable states to use federal tax subsidies to cover low-income people (those with incomes between 139 and 200 percent of the federal poverty level) whose income is too high to qualify for Medicaid. The BHP is an alternative to offering this population coverage through the exchanges that will begin operation in January 2014. Consumers receiving insurance through the BHP would not have to reimburse the federal government if their income fluctuates during the year.
CMS officials intend to release BHP proposed rules for comment in 2013 and final guidance in 2014, in order for the program to begin operation in 2015.
The FAQ covers a number of other topics as well. The document provides information regarding the increased federal matching rate for consumers newly eligible for Medicaid in 2014 and addresses coverage for pregnant women and children.
UPDATE: Federal Health Insurance Marketplaces: A Conversation with CCIIO Director Gary Cohen
Posted by Mark Dorley on February 7, 2013
This Update begins with a summary of federal policy guidance on health insurance Marketplaces that has been issued to date. It then presents in its entirety an interview with Gary Cohen, conducted by Professor Sara Rosenbaum of GW on January 29, 2013. The Update concludes with some observations about key issues that will arise as implementation of the federal Marketplace proceeds.
CMS releases long-awaited Physician Payment final rule
Posted by Michal McDowell on February 4, 2013
The Centers for Medicare & Medicaid Services (CMS) released a final rule on Friday regarding the implementation of the Physician Payment Sunshine Act, which requires drug and device-makers to disclose financial relationships with doctors. Passed under the 2010 Affordable Care Act (ACA), the law was supposed to make a database describing these relationships available by September 2013. The final rule requires companies to begin collection of the information in August 2013, and to begin reporting it to the U.S. Department of Health and Human Services (HHS) by March 2014.