Final Rule: Notice of Benefit and Payment Parameters for 2014
Posted by Nikki Hurt on May 8, 2013
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…
IRS and EBSA issue next set of ACA FAQs
Posted by Nikki Hurt on April 30, 2013
In the 15th set of Affordable Care Act (ACA) FAQs, the Internal Revenue Service (IRS) and the Employee Benefit Security Administration (EBSA) answer questions posed by the public and stakeholders to demystify the implementation of various components of the ACA. This particular set discusses annual limit waivers, stating that an alteration to a health plan or policy year will not impact the expiration of an annual limit waiver. The FAQs also indicate that IRS, EBSA and the US Department of Health and Human Services (HHS) will not issue guidance on provider nondiscrimination prior to January 1st, 2014, because the statutory language on the topic is “self-implementing.” In regards to transparency reporting, the FAQs clarify that plans are not beholden to the transparency provisions of the ACA until the plans have been certified as a qualified health plan (QHP) for one benefit year.
HHS releases shorter Exchange enrollment application forms
Posted by Nikki Hurt on
In response to the comments received on the length and complexity of the 21-page health insurance application draft, the US Department of Health and Human Services (HHS) has shaved down the application and released their second iteration this morning. Under the Affordable Care Act’s (ACA) individual mandate, most Americans are required to have insurance by January 1st, 2014. The new application released by HHS is designed to make the enrollment process more streamlined and simple. Individuals wishing to enroll into the Exchange will submit a 5-page document entitled “Application for Health Coverage and Help Paying Costs (Short Form).” The family application, “Application for Health Coverage and Help Paying Costs” comes in at 12-pages in length. HHS has also provided a 5-page application titled “Application for Health Coverage” for anyone wishing to enter the Exchange, but is unsure of their eligibility.
CMS extends QHP application deadline
Posted by Nikki Hurt on April 29, 2013
Today, the Centers for Medicare and Medicaid Service (CMS) announced a 3-day extension for insurers submitting a qualified health plan (QHP) on the Federally-Facilitated Exchanges (FFE). Insurers will have until May 3rd at 8:00 pm, after which CMS will provide the opportunity for a 3-day Limited Correction Window. The window will permit insurers to make minor application adjustments deemed appropriate by CMS.
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…