CMS Report Shows February Growth in Medicaid/CHIP Enrollment

 

The Centers for Medicare and Medicaid Services (CMS) released on April 4, 2014 a report showing that 25 states which implemented Medicaid expansion under the Affordable Care Act (ACA) by February 2014 saw on average an 8.3 percent increase in Medicaid/CHIP enrollment for February 2014, as compared to those states’ average monthly enrollments in a July – September 2013 baseline period. The largest percentage increases were in Oregon (34.8 percent), West Virginia (33.5 percent), Vermont (32.3 percent), Nevada (21.7 percent), and Maryland (20.8 percent). The ACA created as of January 1, 2014 a new Medicaid eligibility category of non-disabled, childless adults with incomes up to 133 percent of the Federal poverty level, but exact data are not yet available from CMS on how many January – February 2014 enrollees are in that new ACA category. [More]

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New Hampshire Agrees to Medicaid Expansion Plan under ACA

 

On March 26, 2014, New Hampshire Governor Maggie Hassan signed Senate Bill 413 into law, joining 25 other states in expanding Medicaid eligibility under the Affordable Care Act (ACA). The New Hampshire law will provide health insurance to 50,000 low-income adults in a 2 ½-year pilot program paid for with federal Medicaid funding. [More]

 

HHS Finalizes Exchange Rules for 2015

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published final rules in the March 11, 2014 Federal Register as part of the HHS Notice of Benefit and Payment Parameters for 2015 related to the risk adjustment, reinsurance, and risk corridors programs under the Affordable Care Act (ACA). The Notice of Benefit and Payment Parameters for 2015 deals mainly with health insurance issuer contributions into risk pools and disbursements from risk pools to health insurance issuers to maintain stability in the health insurance marketplace as coverage expands as a result of the ACA. [More]

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HHS Proposes Revisions to Health Insurance Rules

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published proposed rules in the March 21, 2014 Federal Register to update and clarify a wide range of health insurance rules under the Affordable Care Act (ACA). The proposed rules would adjust requirements for health insurance in the individual and group health insurance markets; standards for health insurance Exchanges; standards for health insurance issuers offering qualified health plans (QHPs) through Exchanges; reporting requirements for health insurance issuers on health care quality, medical loss ratios (MLRs), and rebates to consumers from issuers that do not meet MLR requirements; and standards under the ACA reinsurance, risk corridor, and risk adjustment programs. The proposed rules require Exchanges to display prominently on their web sites QHP quality rating and enrollee satisfaction survey results, and that QHPs participate in quality improvement strategies. The proposed rules also set forth revised procedures applicable to Navigators and other consumer assistance entities, privacy and security of personally identifiable information, program integrity, non-discrimination among consumers, investigation of complaints, and potentially severe civil monetary penalties (CMPs) that can be imposed as a result of improper use or disclosure of information, fraudulent practices, and other violations of Exchange standards. Under a new exception to Exchange non-discrimination standards, an organization receiving Federal funds to provide services to a defined population (e.g., the Ryan White HIV/AIDS program or an Indian health provider) may limit its provision of certified application counselor services to that population as long as it agrees to offer referral services to others seeking assistance. The proposed rules would circumscribe State requirements that might unduly restrict Exchange functions, such as requirements that Navigators carry errors and omissions insurance or hold agent or brokers licenses, and would explicitly prohibit improper activities such as charging applicants for application assistance or accepting remuneration from applicants or kickbacks from insurers. The proposed rules make clear that State-based Exchanges may, and Federal Exchanges will, require consumers to make payment of the first month’s premium in order to effectuate the consumer’s enrollment in a QHP. Comments on the proposed rules are due April 21, 2014. [More]

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HHS Finalizes Rules on State Operated Basic Health Programs

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published final rules in the March 12, 2014 Federal Register on state administration of optional “Basic Health Programs” (BHPs) authorized under section 1331 of the Affordable Care Act (ACA). This optional state program will be available mainly for state residents with household incomes between 133 percent and 200 percent of the Federal poverty level (FPL) who would otherwise be eligible to enroll in qualified health plans (QHPs) offered through Exchanges. Certain lawfully present non-citizens with incomes under 133 percent of the FPL can qualify under the BHP option also. This optional state program will be available in 2015. [More]

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HHS Releases Progress Report on Exchanges

 

The U.S. Department of Health and Human Services (HHS) Assistant Secretary for Planning and Evaluation (ASPE) released a monthly progress report on March 11, 2014 showing that 4,242,325 individuals selected a qualified health plan (QHP) through Exchanges by March 1, 2014. This includes 1,621,239 individuals selecting QHPs through State-based Exchanges and 2,621,086 individuals selecting QHPs through Federally-facilitated Exchanges. [More]

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VA Federal Judge Dismisses Lawsuit Dealing with Subsidies Under ACA

 

On Tuesday, February 18, 2014, U.S. District Court Judge James R. Spencer in the Eastern District of Virginia dismissed a lawsuit claiming that language in the Affordable Care Act (ACA) called for subsidies to be available only in states that run their own health insurance exchanges (Exchanges). [More]

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Report Outlines State Strategies to Promote Continuity of Care

 

The Center for Health Care Strategies (CHCS) released a January 2014 report outlining valuable recommendations and exemplary practices to avoid disruptions in care for individuals transitioning between Medicaid and Exchange health plans. Such transitions, often referred to as “churn”, can result from changes in beneficiary income, employment status, marital status, family composition, age, residency, consumer preferences among competing health plans, and other variables. Such transitions can affect coverage benefits, available provider networks, and service authorizations for the beneficiary -- critical factors especially for persons undergoing treatment for complex, high-risk, and high-cost health conditions. [More]

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CMS Issues Final Rule Affecting Home and Community-Based Services and Waivers

 

The Centers for Medicare and Medicaid Services (CMS) has issued a final rule, scheduled to be published in the Federal Register on January 16, 2014 and available online here, and on FDsys.gov, which amends the Medicaid regulations to define and describe state plan section 1915(i) home and community-based services (HCBS) under the Social Security Act as amended by the Affordable Care Act (ACA). [More]

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Federal Judge Upholds Subsidies Under ACA

 

On Wednesday, January 15, 2014, United States District Court Judge Paul L. Friedman of the District Court in Washington, D.C. rejected a challenge to the subsidies provisions of the Affordable Care Act (ACA), ruling that the health insurance subsidies could be obtained by qualifying low and moderate-income individuals regardless of whether they bought coverage through a federal insurance exchange or in marketplaces run solely by a state. [More]

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