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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Kaiser Reports on 2015 QHP Premium Changes

 

The Henry J. Kaiser Family Foundation (Kaiser) released on November 17, 2014 a report on changes in premiums for qualified health plans (QHPs) offered through Health Benefit Exchanges (Exchanges) in all 50 states and the District of Columbia. The report shows modest increases in 2015 premiums, as compared with 2014, on average for all QHPs across all geographic rating areas in the United States. Premiums for “silver” level coverage (medium cost-sharing, medium premiums) will increase about two percent on average, while premiums for “bronze” level coverage (higher cost-sharing, lower premiums) will increase about four percent on average. [More]

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GAO Issues Report on Transparency of CMS Websites for Consumers

 

The U.S. Government Accountability Office (GAO) released a report on November 18, 2014 entitled, “Health Care Transparency: Actions Needed to Improve Cost and Quality Information for Consumers.” GAO found that five Centers for Medicare and Medicaid Services (CMS) websites launched over 12 years – Nursing Home Compare (1998), Dialysis Compare (2001), Home Health Compare (2005), Hospital Compare (2005), and Physician Compare (2010) – do not use language consumers understand, do not present data in ways meaningful to consumers, and do not help consumers collect information they need to make informed, value-based decisions about their care. While the CMS websites can motivate providers to improve quality of care, research shows that providers and consumers look at data differently. [More]

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HHS OIG Releases Work Plan for Federal Fiscal Year 2015

 

As the new Federal Fiscal Year began on October 1, 2014, a work plan was released that outlines the engagements planned throughout the year. The Office of Inspector General (OIG) was created was created “to protect the integrity of US Department of Health and Human Services (HHS) programs and operations and the well-being of beneficiaries by detecting and preventing fraud, waste, and abuse; identifying opportunities to improve program economy, efficiency, and effectiveness; and holding accountable those who do not meet program requirements or who violate Federal health care laws.” [More]

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HHS Revises Exchange Enrollment Projections for Upcoming Enrollment Period

 

The U.S. Department of Health and Human Services (HHS), Assistant Secretary for Planning and Evaluation (ASPE) released an analysis on November 10, 2014 projecting that 9.0 – 9.9 million persons will have coverage through Exchanges by the end of the upcoming November 15, 2014 – February 15, 2015 open enrollment period. The Congressional Budget Office (CBO) had estimated in April 2014 that the number of persons covered through Exchanges would reach 13 million persons in 2015, 24 million persons in 2016, and a plateau of 25 million persons by 2017. [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 Launches $840 Million Quality Improvement Initiative

 

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) issued two funding opportunity announcements on the Transforming Clinical Practices Initiative (TCPI) on October 23, 2014. The two announcements describe opportunities for applicants to compete for up to $840 million in federal funding under cooperative agreements with CMS over a May 1, 2015 - April 30, 2019 performance period. Applicants may seek funding under cooperative agreements as Practice Transformation Networks (PTNs) or as Support and Alignment Networks (SANs). [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-ONC Releases Health IT Progress Report

 

The U.S. Department of Health and Human Services (HHS), Office of the National Coordinator for Health Information Technology (ONC) has released an October 2014 report to Congress which describes progress toward the development of a nationwide system for the electronic use and exchange of health information. The report shows that, as of June 2014, 75 percent (over 403,000) of the nation’s eligible health professionals and 92 percent (over 4,500) of eligible hospitals had received Medicare or Medicaid incentive payments for the adoption and meaningful use of certified electronic health record (EHR) technology authorized under the American Recovery and Reinvestment Act of 2009 (ARRA). [More]

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U.S. Court of Appeals Finds Written Authorization Form Required by FL Medical Negligence Law Does Not Violate HIPAA

 

On October 10, 2014, a three-judge panel of the 11th U.S. Court of Appeals vacated a decision of a lower federal court and held that a Florida statute requiring a plaintiff to execute a written authorization form for release of protected health information prior to filing a negligence claim in Florida state court does not violate HIPAA. (GLEN MURPHY v. DULAY, No. 13-14637). [More]

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