CMS offers higher reimbursement for Medicaid eligibility system update
Posted by Nikki Hurt on April 26, 2013
A provision in the Affordable Care Act (ACA) incentivized state Medicaid agencies to design and develop new eligibility systems by offering a 90% federal reimbursement for the associated costs. A set of FAQ released by the Centers for Medicare and Medicaid Services (CMS) explains that state Medicaid programs will be eligible for an increased federal match rate of 75% for using and maintaining these upgraded eligibility system by January 1st, 2014. To qualify for the enhanced rate for the upgraded systems, states must meet operation and maintenance standards in the following categories:
- personnel costs
- software maintenance
- data entry
- computer operators
- coding clerks
States that choose not to expand their Medicaid program under the ACA will still be eligible for the increased reimbursement if they meet the specified upgrade requirements.
In addition to these stipulations, the FAQ also stated they would not authorize 1115 demonstration waivers that placed enrollment caps or periods of ineligibility for the new Medicaid-eligible adult groups under the ACA.
HHS enhances CLAS standards
Posted by Nikki Hurt on April 24, 2013
The US Department of Health and Human Services (HHS) Office of Minority Health released enhanced standards on Culturally and Linguistically Appropriate Services (CLAS) in health care settings. There are many determinants that inhibit the achievement of health equity, and the implementation of CLAS is one mechanism by which disparities can begin to be whittled away. Building upon the original 2000 standards, National Standards for Culturally and Linguistically Appropriate Standards in Health and Health Care: A Blueprint for Advancing and Sustaining CLAS Policy and Practice is designed to provide an organization with the information and tools necessary to mitigate health care disparities and achieve health equity by using CLAS. The enhanced standards aim to improve health equality within health care settings by addressing the categories of (1) governance, leadership, and workforce, (2) communication and language assistance, and (3) engagement, continuous improvement, and accountability.
A synopsis of the enhanced CLAS standards is also available.
HHS releases BHP timeline
Posted by Nikki Hurt on April 19, 2013
The US Department of Health and Human Services (HHS) provided a timeline for the installation of the Basic Health Program (BHP) to Senator Maria Cantwell (D-WA), a champion of the model. Pursuant to Section 1331 of the Affordable Care Act (ACA), the BHP was intended to serve as a special state insurance option for low-income families and individuals, yet no deadline for HHS to create the BHP was stated in the statute. The timeline details key implementation events from now until January 1, 2015, the time at which the BHP is scheduled to become operational.
Impact of FY 2014 proposed budget on health
Posted by Nikki Hurt on April 15, 2013
Below is a brief outline regarding how the proposed budget for FY 2014 will impact health-related agencies, including the services and responsibilities therein. Specific line items provide the amount allocated to the agency or service, and in some instances, a justification for the rationale as to why that amount was proposed. Overall, the president allocated $949.9 billion to the US Department of Health and Human Services (HHS). Other key appropriations include funding for the Affordable Care Act’s (ACA) Exchanges, funds for mental health research and treatment, and changes in the delivery of Medicare and Medicaid to save hundreds of billions of dollars over the next decade.
Update: Using Medicaid to Provide Premium Assistance for Exchange Coverage
Posted by Nikki Hurt on April 10, 2013
This update to our previous Implementation Brief on states’ option to implement Medicaid coverage by enrolling beneficiaries into Qualified Health Plans sold in Exchanges examines Frequently Answered Questions on Medicaid and Premium Assistance (“FAQ”), released on March 29th by CMS. The FAQ answer some, but not all, questions raised by this approach to implementation of the ACA Medicaid expansion…
CMS releases Navigator FOA
Posted by Nikki Hurt on April 9, 2013
This afternoon, the Centers for Medicare and Medicaid Services (CMS) released a funding opportunity announcement (FOA) for Navigators in Federally-facilitated and State Partnership Marketplaces. Navigators are charged with providing impartial education and guidance to consumers about the public and private health insurance options available to them in their state health insurance Marketplaces, which are currently being created as a result of the Affordable Care Act (ACA). The FOA is available for self-employed individuals, as well as public and private organizations interested in becoming Navigators. The maximum amount of funding available is $54 million, and applications are due by June 7th, 2013.
CMS releases final Letter to Issuers on Exchanges
Posted by Nikki Hurt on
On April 5th, the Centers for Medicare and Medicaid Services (CMS) released a final letter regarding Federally-facilitated and State Partnership Exchanges. The draft version of this letter was made public at the beginning of March.
The Letter to Issuers reaffirms that states will be, for the most part, responsible for qualified health plan (QHP) certification, including network adequacy. Below are significant points discussed in the final letter:
- Plans that do not meet the minimum requirements for Essential Community Provider inclusion may still be considered a QHP.
- The letter gives a more specific interpretation of what constitutes a “meaningful difference” between QHPs.
- Large and small group QHPs have an additional year to comply with the single out-of-pocket limit for all services, and mental health services are not included in the major medical out-of-pocket limit.
- In non-partnership states, there is no deadline by which CMS must review state evaluations of QHP certification.
- CMS will create technology that allows individuals to enroll into the Exchange through an issuer’s website or a web-broker.
- Ancillary plans cannot be sold on the Exchange, but may be sold on non-Exchange programs within the same infrastructure.
OIG calls for increased oversight of HealthCare.gov Plan Finder
Posted by Nikki Hurt on
A recent report released by the US Department of Health and Human Services Office of Inspector General (OIG) finds that the Centers for Medicare and Medicaid Services (CMS) should better oversee the information provided by private insurers to HealthCare.gov Plan Finder to make certain that the information presented is accurate. The purpose of Plan Finder is to provide consumers in the individual and small group markets with information on various insurance coverage options. The OIG report denoted several reasons for additional oversight:
- 13% of insurers expected to provide pricing and benefit data to Plan Finder did not do so, and CMS did not follow-up with these insurers.
- CMS does not require the CEO or CFO of the insurance company to certify the submitted data.
- 14% of the plans sampled by OIG were not available for sale or the insurance representative could not identify the name of their product on Plan Finder.
Access to Pediatric Oral Health Benefits offered through Health Insurance Exchanges
Posted by Mark Dorley on April 4, 2013
This Implementation Brief examines current Administration policy regarding access to children’s oral health benefits among families who qualify both for Exchange coverage and for advance premium tax credits and cost-sharing reduction assistance. The Brief identifies an emerging set of policy issues that in turn may be creating a policy misalignment between children’s oral health coverage and the premium credits and…
CMS releases Navigator NPRM
Posted by Nikki Hurt on April 3, 2013
Today, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule regarding Navigator standards in Federally-facilitated and State Partnership Marketplaces. The rule also expanded upon previous guidance released about the program. Under the Affordable Care Act (ACA), Navigators are intended to provide unbiased information to consumers that will aid them in understanding and applying for the various types of coverage within their state Marketplaces. Specifically, the proposed rule outlines conflict-of-interest, training and certification, and meaningful access standards designed to ensure that Navigators in all Marketplaces remain impartial and accessible.