Courts Issue Conflicting Opinions on Federal Exchanges

 

The United States Court of Appeals for District of Columbia Circuit issued a ruling on July 22, 2014 stating that a regulation issued by the Internal Revenue Service allowing taxpayers to obtain advance premium tax credits (APTCs) for qualified health plans available through federal Exchanges was not authorized under section 36B(c)(2)(A)(i) of the Internal Revenue Code as established by section 1401 of the Affordable Care Act (ACA). The ruling (in Halbig v. Burwell) was handed down by a three judge appeals panel, not the Circuit Court’s full bench. The appeals panel’s ruling was 2-1, with comprehensive majority and dissenting opinions. The majority opinions in this ruling stressed that section 36B(c)(2)(A)(i) mentions APTCs available through Exchanges “established by the State” but fails to mention federal Exchanges. [More]

 

HHS Announces Health Care Innovation Awards

 

The U.S. Department of Health and Human Services (HHS), Center for Medicare and Medicaid Innovation (CMMI), announced a new batch of “round two” health care innovation awards on July 9, 2014. These are grants to applicants who have set forth compelling new ideas to improve care and control costs for persons enrolled in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). [More]

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Kaiser Commission Releases Report on Successful SBEs

 

The Kaiser Commission on Medicaid and the Uninsured released an excellent report on July 20, 2014 about the successful state-based health insurance Exchanges (SBEs) and Medicaid expansions in Colorado, Connecticut, Kentucky, and the State of Washington. The report, “What Worked and What’s Next? Strategies in Four States Leading ACA Enrollment Efforts,” includes interviews with stakeholders in each state about exemplary marketing, outreach and enrollment, consumer assistance, and systems/operations strategies, with insights on 2014 and lessons for 2015. It shows that each of the states marketed the coverage expansions as state-based initiatives; conducted statewide marketing via a wide range of methods, including social media and promotional materials; and emphasized the enrollment deadline in their marketing efforts. [More]

 

Federal Court Decision Expected Soon in Challenge to Subsidies Provision of ACA

 

The U.S. Court of Appeals for the D.C. Circuit appears ready to issue a ruling in the case of Halbig v. Burwell, dealing with the issue of whether language in the Affordable Care Act (ACA) concerning subsidies for people in need of financial assistance to purchase health insurance coverage applies only to individuals who purchase private health insurance on STATE-RUN exchanges. The issue arises because Section 36B(b) (A) of the ACA provides, “The monthly premiums for…health plans offered in the individual market within a state…cover the taxpayer…or any dependent of the taxpayer…enrolled in through an Exchange ESTABLISHED BY THE STATE under 1311(1) of the Patient Protection and Affordable Care Act…”. [More]

 

Report Shows ACA Impact on Affordability, Competition, and Choice

 

The U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation (ASPE) released a report on June 18, 2014 showing the impact of the Affordable Care Act (ACA) on health insurance premium affordability, competition, and consumer choice for individuals who obtained coverage through federally-facilitated and State Partnership Exchanges/Marketplaces in 36 states during the 2013-2014 open enrollment period. On affordability, the report shows that individuals who selected qualified health plans (QHPs) through the Exchanges and received advance premium tax credits (APTCs) owed a net premium liability 76 percent less than the full premium. They owed on average $82 per month to the QHP, after subtracting $264 in APTCs from the $346 per month average full premium, and 46 percent of individuals owed $50 or less after the APTCs. [More]

 

DHHS Announces Additional Funds to Expand Community Health Center Services

 

On June 3, 2014, the US Department of Health and Human Services (DHHS) announced an additional $300 million from the Affordable Care Act (ACA) for existing Health Center Program grantees under Section 330 of the Public Health Service Act. The funds are earmarked to help community health centers expand service hours, hire more medical providers, and add oral health, behavioral health, pharmacy, and vision services. [More]

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Reports Show Emerging ACA Impact on Medicaid Enrollments, Hospital Charges, and Payer Mix

 

The Centers for Medicare and Medicaid Services (CMS) released on June 4, 2014 a report showing that the 26 jurisdictions (25 states and the District of Columbia) which implemented Medicaid expansion under the Affordable Care Act (ACA) by April 2014 saw on average a 15.3 percent increase in Medicaid/CHIP enrollments for April 2014, as compared to their average monthly enrollments in a July – September 2013 baseline period. States which had not implemented Medicaid expansion by April 2014 saw on average a 3.3 percent increase as compared to their 2013 baselines. Total reported Medicaid/CHIP enrollments nation-wide as of April 2014 reached 65,016,775, an increase of 6,050,059 (10.3 percent) as compared to 2013 baselines. [More]

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HHS Updates Exchange and Insurance Market Standards for 2015 and Beyond

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), issued draft final rules on May 16, 2014 to update and clarify a wide range of health insurance rules under the Affordable Care Act (ACA). The final rules take into account public comments submitted by April 21, 2014 on proposed rules published in the Federal Register on March 21, 2014. The final rules address standards for health insurance issuers, including but not limited to issuers offering qualified health plans (QHPs) through Exchanges and the Small Business Health Options Program (SHOP); requirements on health care quality, medical loss ratios (MLRs), and rebates to consumers from issuers that do not meet MLRs; and requirements under the ACA reinsurance, risk corridor, and risk adjustment programs. [More]

 

DHHS Offers Hardship Exemption from Tax Penalty to Certain Individuals

 

On May 2, 2014, the U.S. Department of Health and Human Services (DHHS) issued new guidance, entitled “Special Enrollment Periods and Hardship Exemptions for Persons Meeting Certain Criteria.” Under section 5000A of the Internal Revenue Code, beginning January 2014, nonexempt individuals who do not have minimum essential (health care) coverage (MEC) or who are not otherwise exempt are required to make a shared responsibility payment with their federal income tax returns. Section 5000A(e)(5) of the Code authorizes the Secretary of DHHS to determine hardship exemptions. [More]

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HHS Releases Report on Improvements in Hospital Care

 

The U.S. Department of Health and Human Services (HHS) released a report on May 7, 2014 showing nationwide reductions in hospital-acquired conditions (HACs) and hospital readmission rates. The report indicates that HACs (adverse drug reactions, infections, injuries, and other incidents harming patients while they are in hospitals) fell 9 percent, from 145 per 1,000 discharges in 2010 to 133 per 1,000 discharges in 2012. HHS estimates that this reduction prevented 560,000 incidents, avoided 15,000 deaths, and saved $4.1 billion. [More]

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