CMMI Announces $666 Million in State Health Care Innovation Awards

 

The U.S. Department of Health and Human Services (HHS), Center for Medicare and Medicaid Innovation (CMMI) announced on December 16, 2014 that it is authorizing $623 million in “model testing” awards to 11 states and $43 million in “model design” awards to 17 states, three territories, and the District of Columbia. CMMI has approved the awards under section 3021 of the Affordable Care Act (ACA). These “model testing” and “model design” awards complete “round two” in CMMI’s State Innovation Models (SIM) initiative. [More]

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CMS Proposes Changes in Medicare ACO Rules

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published proposed rules in the December 8, 2014 Federal Register on accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) under section 3022 of the Affordable Care Act (ACA). Under the MSSP, Medicare providers and suppliers that participate in a qualifying ACO receive traditional Medicare Part A and Part B fee-for-service payments, the ACO drives collaboration, and the ACO has an opportunity to earn “shared savings” bonus payments for each ACO “performance period” if it achieves MSSP savings targets and performance standards under quality measures for that period. [More]

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D.C. Circuit Decides Not to Proceed with En Banc Review of ACA Subsidies Case Pending U.S. Supreme Court Decision in KING V. BURWELL

 

On November 10, 2014, the D.C Circuit Court of Appeals agreed not to proceed with its en banc review of HALBIG v. BURWELL, 758 F.3d 390 (D.C. Cir. 2014), which had held that subsidies provided for under the Affordable Care Act (ACA) were to be restricted to states which opted to establish their own Health Benefit Exchanges. [More]

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US Supreme Court to Review ACA Tax Credit Authority

 

The U.S. Supreme Court announced on November 7, 2014 that it will review King v. Burwell, in which the U.S. Court of Appeals for the Fourth Circuit upheld an Internal Revenue Service regulation allowing advance premium tax credits (APTCs) for low-income individuals and families enrolling in qualified health plans (QHPs) through “Federally-facilitated Exchanges (FFEs).” [More]

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CMS Issues Proposed Notice to Establish Methodology to Determine Federal Payments Under BHP in 2016

 

The Centers for Medicare & Medicaid Services (CMS) published in the October 23, 2014 Federal Register a proposed Notice (79 Fed. Reg. 63363) which would establish the methodology the agency intends to utilize to determine federal payments under the Basic Health Program (BHP) in 2016. Pursuant to Section 1331 of the Affordable Care Act (ACA), states can elect to operate a BHP, which would provide affordable health coverage to individuals under age 65 with household incomes between 133% and 200% of the federal poverty level who are not otherwise eligible for Medicaid, CHIP, or affordable employer-sponsored coverage. [More]

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HHS Report Updates ACA Impact on Medicaid Enrollments

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), released on October 17, 2014 a report showing that 26 jurisdictions (25 states and the District of Columbia) which implemented Medicaid expansion under the Affordable Care Act (ACA) by August 2014 saw on average a 22.09 percent increase in Medicaid/CHIP enrollments for August 2014, as compared to their average monthly enrollments in a July – September 2013 baseline period. [More]

 

OK Federal District Court Judge Issues Adverse Decision in ACA Tax Credit Controversy

 

On September 30, 2014, Judge Ronald White of the U.S. District Court for the Eastern District of Oklahoma ruled that language in the Affordable Care Act (ACA) rendered invalid an IRS regulation that authorizes tax credits in federal exchanges as well as state exchanges. [More]

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HHS-OIG Issues First Report on Exchange Data Security

 

The U.S. Department of Health and Human Services (HHS), Office of the Inspector General (OIG) issued on September 22, 2014 the first in what will be a series of reports on information security controls in federal and state-based health insurance Exchanges under the Affordable Care Act (ACA). The OIG reviews are based on HHS regulations on administrative, technical, and physical safeguards to safeguard the confidentiality, integrity, and availability of personally identifiable information (PII) obtained and used by Exchanges. The OIG reviews also apply standards developed by the National Institute of Standards and Technology (NIST) which HHS has adopted in instructions to Exchanges about steps necessary to protect PII. [More]

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GAO Confirms That Most of the Largest Health Insurers Are Participating in Most Exchanges

 

The Government Accountability Office (GAO) issued a report on September 29, 2014 which offers a remarkable comparative overview of the individual and small-group health insurance markets in each state. Most but not all of the largest issuers of health coverage in 2012 in those markets participated in health insurance Exchanges under the Affordable Care Act (ACA) in 2014. [More]

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Report Shows ACA Impact on Uncompensated Care

 

The U.S. Department of Health and Human Services (HHS), Assistant Secretary for Planning and Evaluation (ASPE) released a report on September 24, 2014 showing the impact of the Affordable Care Act (ACA) on hospitals’ uncompensated care (bad debts and charity care for the uninsured). The report offers the first evidence that 2014 enrollments in qualified health plans (QHPs) through health insurance Exchanges along with Medicaid expansions in 25 states and the District of Columbia are starting to reverse the growth in the cost of uncompensated care. [More]