On November 7, 2013, the U.S. Department of Health and Human Services (DHHS) announced the award of $150 million of Affordable Care Act (ACA) funds to new primary care sites in 236 communities across the country. The funds are estimated to help provide care for approximately 1.25 million additional patients. [More]
The U.S. Department of Health and Human Services (HHS) published proposed rules in the September 25, 2013 Federal Register on state administration of optional “Basic Health Plans” (BHPs) authorized under section 1331 of the Affordable Care Act (ACA). This optional state program can be made available 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. States electing the BHP option may competitively procure two or more BHP plans, which may include fee-for-service or capitated plans. [More]
The U.S. Department of Health and Human Services (HHS) issued a draft final rule on July 5, 2013 on health insurance Exchange eligibility/enrollment procedures and Medicaid/CHIP eligibility notices, fair hearings, premiums, cost-sharing, and alternative benefit plans. The final rule is scheduled for official publication in the Federal Register on July 15, 2013. It allows State Medicaid agencies to delegate MAGI-related Medicaid eligibility determinations and appeals to the Exchange via a formal agreement if the Exchange is a government agency operating under a merit personnel system; and, if so, appellants must be given a choice whether to have their appeals heard at the State Medicaid agency or at the Exchange. [More]
The Centers for Medicare and Medicaid Services (CMS) issued a final rule on July 1, 2013 on determining eligibility for exemptions to the “individual mandate” under the Affordable Care Act. Individuals without exemptions will incur tax penalties beginning with their IRS tax filings in 2015 for tax year 2014 if they don’t maintain at least some form of “minimum essential coverage” after January 1, 2014. Tax penalties will be $95 for tax year 2014, $325 for 2015, and $695 annually for 2016 and subsequent years. [More]
Since the Supreme Court ruled that Medicaid expansion was optional, 23 states plus the District of Columbia have decided to go forward with the expansion and 21 have decided to pass, with six still debating the issue, according to a Kaiser Family Foundation report.
With respect to the six states still debating the issue, the Ohio legislature appears ready to sign off on a two-year budget that does not include plans for Medicaid expansion. In Pennsylvania, the Senate is expected to vote next week on the expansion issue, but state media reports indicate a lack of support for expansion in the House.
The Center for Medicare and Medicaid Innovation (CMMI) released on May 15, 2013 a $900 million funding opportunity announcement for health care innovation awards authorized under section 3021 of the Affordable Care Act. The purpose of these competitive awards is to fund applicants proposing new payment incentives and service delivery models to improve care and reduce costs under Medicare, Medicaid, and/or CHIP. Eligible applicants include state and local governments, public-private partnerships, health systems, academic/research organizations, and for-profit entities. Applicants must demonstrate the capacity to set up necessary infrastructure within 6 months of the initial award date and to achieve net savings within 3 years. [More]
The Engelberg Center for Health Care Reform at the Brookings Institution has released an April 2013 report entitled, “Person-Centered Health Care Reform: A Framework for Improving Care and Slowing Health Care Cost Growth.” The report notes that a “state-by-state, waiver-by-waiver approach” has become a hallmark of the Medicaid program over the last 20 years. [More]
On April 23, 2013, Governor Mike Beebe signed into law Senate Bill 1020, which authorizes the Arkansas Department of Human Services to explore design options that would reform the Medicaid program using private plans certified by the Department of Insurance that will offer coverage through the Exchange. Most persons aged 19-65 qualifying as newly eligible Medicaid recipients under the Affordable Care Act would have an opportunity to obtain coverage through such private plans, while persons with exceptional medical needs could still obtain coverage through programs addressing those needs under Arkansas Medicaid. S.B. 1020 authorizes the Department of Human Services to submit state Medicaid plan amendments, to seek federal waivers, and to pay premiums and supplemental cost-sharing directly to qualified health plans (a payment approach allowed under section 1906 of the federal Medicaid law on a case-by-case basis if such payments are cost-effective for each enrollee, and for children obtaining benchmark coverage under section 2103 of the Children’s Health Insurance Program law). [More]
The Centers for Medicare and Medicaid Services (CMS) released proposed rules on April 26, 2013 that would update Medicare payment methods and rates for federal fiscal year 2014 under the inpatient prospective payment system (PPS) for acute care hospitals and the long-term care hospital PPS. The proposed rules also expand quality of care and patient safety reporting requirements for acute care hospitals, PPS-exempt cancer hospitals, long-term care hospitals, and inpatient psychiatric facilities. [More]
A recent AP report discussed the current status of state decisions concerning the issue of Medicaid expansion. It was noted that 20 states, mostly democratic-leaning, and the District of Columbia have accepted expansion. Some 13 GOP-oriented states have declined, citing the cost of Medicaid and a lack of trust about federal funding. It is reported that Florida and Missouri appear unlikely to reach a consensus prior to the end of their current legislative sessions. [More]