CMS announces the release of $22 Million in Health Insurance Enforcement and Consumer Protections grant funding


On June 15, 2016, the Centers for Medicare and Medicaid (CMS) announced the release of $22 million in grant funding for State planning and implementing of the health insurance market reform provisions of the Affordable Care Act (ACA). The grants are aimed at helping States ensure their laws, regulations and procedures are in line with Federal requirements and that the States are able to effectively monitor and enforce health insurance market reforms and consumer protections under the ACA. States must submit a letter of intent by July 6th. Grant applications are due August 15th at 3:00 pm. [More]


KFF estimates significant increases in Exchange premiums for 2017


On June 15, 2016, the Henry J. Kaiser Family Foundation (KFF) released a report entitled, “Analysis of 2017 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces.” The report estimates that premiums on Federal and State-based Exchanges will rise in 2017 at about twice the rate of increase for 2016 and that insurer participation in Exchanges will decline. KFF compared final 2016 premiums versus proposed 2017 premiums for major cities in 13 states and the District of Columbia (the geographic areas for which KFF could access complete 2017 rate filings for all insurers planning to participate in Exchanges in 2017). Insurers’ proposed 2017 premiums will be subject to review by state insurance departments and may be adjusted following state review. [More]


CMS announces steps to protect ACA risk pools


On June 8, 2016, the Centers for Medicare and Medicaid Services (CMS) announced new steps to protect the integrity of health insurance “risk pools.” The integrity of those pools directly affects the accuracy and stability of health insurance premiums under the Affordable Care Act (ACA). CMS has outlined new steps pertaining to: controlling the abuse of “short-term” health plans, improving the accuracy of risk adjustments, reducing abuse of Exchanges’ special enrollment periods, improving Exchanges’ data matches, and transitioning consumers to Medicare as they approach age 65. [More]

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CMS finalizes changes to Medicare ACO rules


On June 6, 2016, the Centers for Medicare and Medicaid Services (CMS) issued final regulations on payment methods for accountable care organizations (ACOs) under the Medicare “shared savings” program (MSSP), which includes 434 ACOs serving 7.7 million Medicare beneficiaries in 49 states and the District of Columbia. Medicare Part A and Part B fiscal intermediaries and carriers pay ACOs on a fee-for-service (FFS) basis under the MSSP, but an ACO may qualify for a “shared savings” bonus if the ACO achieves CMS-specified Medicare savings targets while meeting CMS-specified quality of care performance metrics. Medicare ACOs achieved $411 million in Medicare savings in 2014; savings calculations for 2015 will be released this summer. [More]

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Lawsuits filed by health insurers over shortfalls in risk corridor payments under the ACA


On June 1, 2016, MODA Health Plan, Inc., one of the largest health insurers in the Pacific Northwest, filed a claim in the U.S. Court of Federal Claims, alleging that the Plan was entitled to risk corridor payments from the Federal Government of more than $89 million in 2014 and $102 million in 2015. [More]


Louisiana implements Medicaid expansion


On June 1, 2016, Louisiana became the 31st state to implement Medicaid expansion under the Affordable Care Act (ACA). Louisiana has obtained federal approval to use pre-existing data from its Supplemental Nutrition Assistance Program (SNAP) to adjudicate Medicaid eligibility in real time, both at initial Medicaid enrollment and upon re-enrollment; it is the first State to have won such approval via a Medicaid plan amendment rather than time-limited federal waivers. [More]


HHS finalizes ACA non-discrimination rules


On May 18, 2016, the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR), finalized rules in the Federal Register on non-discrimination under federally-funded health care programs and activities. The final rules implement section 1557 of the Affordable Care Act (ACA), which broadly prohibits discrimination based on race, color, national origin, sex, age, or disability, in order to advance health care equity and reduce health care disparities. The final rules reflect OCR’s evaluation of 24,875 public comments on proposed rules that were published on September 8, 2015. [More]


Supreme Court returns ACA contraceptive cases to lower courts in hope of compromise resolution


In an opinion issued on May 16, 2016, the U.S. Supreme Court remanded to the lower courts challenges by a number of nonprofit religious organizations to the contraceptive coverage requirement contained in the Affordable Care Act (ACA). Without expressing any “view on the merits of the case,” the Supreme Court vacated and sent back the cases to the Courts of Appeal indicating the possibility of the parties reaching a compromise, based upon supplemental briefs that were ordered to be submitted. The action was viewed as an attempt to avoid a 4-4 split decision by the Supreme Court, which would result in different outcomes in different states. [More]


U.S. District Court Judge rules in favor of the House against Administration’s funding of subsidies under the ACA


On May 12, 2016, Federal District Court Judge Rosemary M. Collyer of the District of Columbia District ruled in favor of the House of Representatives in its challenge against the Obama administration’s funding of subsidies under the Affordable Care Act (ACA). Judge Collyer ruled that Congress had not provided specific authority for the U.S. Department of Health and Human Services (HHS) to fund the subsidies provided under section 1402 of the ACA, which are intended to assist low-income individuals to pay for insurance premiums for coverage acquired under the exchanges. [More]


CMS extends Texas’ 1115 Medicaid waiver program for 15 months


The Center for Medicare and Medicaid Services (CMS) has agreed to grant the Texas Health and Human Services Commission (HHSC) a 15 month extension through December 2017 of its section 1115 Medicaid waiver program. The waiver relates to the state’s Uncompensated Care and Delivery System Reform Incentive Program (DSRP) and will continue existing program funding levels. [More]