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]

 

DHHS Providing $100 Million in Collaborative Effort with States to Reform Medicaid Systems

 

On July 14, 2014, US Department of Health and Human Services (DHHS) Secretary Sylvia M. Burwell announced a new innovative collaboration with states to improve care for Medicaid beneficiaries by accelerating efforts to reform health care systems. The new initiative, entitled the Medicaid Innovation Accelerator Program, follows recommendations by the National Governors Association (NGA) that The Centers for Medicare & Medicaid Services (CMS) identify opportunities for care improvement and address high-priority areas, such as mental health and emergency department utilization. [More]

 

HHS Launches Medicaid Innovation Accelerator Program

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), announced the Medicaid Innovation Accelerator Program (IAP) on July 14, 2014. The IAP’s goals are to improve health care delivery and patient outcomes while controlling costs through accelerated payment and service delivery reform in state Medicaid programs. It incorporates many recommendations from states, the National Governors Association (NGA), and the National Association of Medicaid Directors (NAMD), such as improvements in: Medicaid data analytics; quality metric development; service delivery model development; rapid cycle model evaluation; and coordination among various HHS components (the Center for Medicare, the Center for Medicaid and CHIP Services (CMCS), the Center for Medicare and Medicaid Innovation (CMMI), the Medicare-Medicaid Coordination Office (MMCO), etc.). [More]

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Congress Reaches Bipartisan Support for Legislation

 

On June 26, the Senate and House introduced H.R. 4980 with bipartisan support and agreement. The legislation, “Preventing Sex Trafficking and Strengthening Families Act,” reconciles the differences in previous legislation – H.R. 1896, H.R. 3205, H.R. 4058, S. 1876, S. 1877 and S. 1878. The bill may be passed before Congress goes on break later this month. No scheduled hearings have been set for either the Ways and Means Committee or the Committee on the Budget. There are predictions that the legislation will pass both committees as the bill is cost neutral. [More]

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Categories:Health and Human Services

 

HHS/OIG Reports Inconsistencies in Health Insurance Eligibility Data

 

The U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG), released a report on July 1, 2014 describing challenges that health insurance Exchanges/Marketplaces faced in resolving inconsistencies between self-attested data in applications to Exchanges versus data that Exchanges accessed through the Federal Data Services Hub. Resolving such inconsistencies is a critical task necessary to verify individuals’ eligibility for advance premium tax credits (APTCs) and cost-sharing reductions (CSRs) under health plans available through the Exchange. [More]

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HHS/CMS Releases Proposed Rules on Exchange Eligibility Redeterminations

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), published proposed rules in the July 1, 2014 Federal Register on health insurance Exchange/Marketplace eligibility redeterminations and re-enrollments in health plans for 2015 and beyond. The new proposed rules would modify final rules published in 2012. They would allow more flexibility in Federal Exchanges, at HHS’ discretion, and would also allow State-based Exchanges (SBEs) to devise alternative procedures, subject to HHS approval. [More]

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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]

 

Child Welfare Finance Reform Introduced in Congress

 

In the fall of 2013, Annie E. Casey Foundation and Casey Family Programs gathered community stakeholders and experts in the field of finance reform and child protection. Following that introduction of the finance reform discussion with leaders in the field, staff from Casey made a presentation to Congress on October 13, 2013. The finance reform proposal addressed multiple issues related to the discrepancy between child welfare practice and how states are funded or reimbursed under Title IV-E. [More]

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