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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UCLA Publishes Study on Hospital Service Utilization in Demonstration Program

 

The UCLA Center for Health Policy Research published a landmark study on October 17, 2014 entitled, “Increased Service Use Following Medicaid Expansion Is Mostly Temporary: Evidence from California’s Low-Income Health Program.” UCLA analyzed hospital emergency room (ER) use, hospital inpatient admissions, and other hospital outpatient department (OPD) service utilization for individuals who were enrolled in 2011-2013 in the Low-Income Health Program (LIHP) under California’s innovative “Bridge to Reform” Medicaid demonstration waiver. UCLA sorted 182,443 LIHP enrollees in eight counties into four distinct groups based on expected “pent-up demand” in each group (the 69,095 in the highest group had the least access to county funded indigent care before enrolling in LIHP), controlled for other differences such as demographic variables using regression models, and tracked service utilization from the July 1 – September 30, 2011 quarter through the April 1 – June 30, 2013 quarter. [More]

 

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]

 

California Exchange Offers Insights on 2014 Open Enrollment Period

 

Covered California, the nation’s largest state-based health insurance Exchange, released a comprehensive report on October 14, 2014 entitled, “Covered California Open Enrollment 2013 – 2014: Lessons Learned.” The report shows that many 2014 enrollees needed education about health insurance terminology, enrollment, and coverage through qualified health plans (QHPs); many persons contacting the Exchange in 2014 viewed cost as an enrollment barrier even after advance premium tax credits (APTCs) and cost-sharing reductions (CSRs); training, outreach and enrollment efforts were indispensable to address specific interests and needs of diverse communities; and the volume of consumer interactions on-line, on the phone, by mail and in person challenged many systems and service channels, including insurance agents, enrollment counselors, service center representatives, and county eligibility workers. [More]