The CCIIO has released information for entities to qualify for grant money ($54 million over the next year) for the establishment of navigators to the health insurance exchanges in 33 states. Here is a link to the grant application.
Archive for the ‘Health Care Reform’ Category
The Affordable Care Act mandated that Medicare advantage plans maintain an 85% loss ratio for claims and “activities that promote member health”. CMS issued proposed rules on implementing this ACA requirement. Here is a link to the press release from CMS. Here is a link to the proposed rule.
This rule would impact both Medicare advantage and Medicare Part D plans. The proposed rule indicated that CMS would grade the 85% loss ratio requirement on a “contract” basis (this is the “H” number or “S” number assigned by CMS), as opposed to a county/state/regional basis which is what is being used for the commercial, small group and individual markets.
Of the 605 MA and PDP contracts (544 MA contracts and 61 PDP contracts), CMS is estimating that approximately 14% would be required to pay remittances based on proposed regulations. They estimated that $717 million would be due from MA plans and $141 million would be due from PDP plans, based on historical data.
HHS has closed enrollment to it’s Pre-Existing Condition Insurance Plans. This was a high risk pool for individuals who were denied coverage in the individual market. Congress allocated $5 billion to fund this in the Affordable Care Act, however, HHS is closing enrollment 10 months early due to high claims experience. This is in spite of the fact that the plan has only enrolled about 25% of the membership it had originally projected to enroll (about 100,000 compared to a projection of 400,000).
Plans have until March 2nd to enroll new members.
Here is the story as reported by Robert Pear of the New York Times. Scott now joins 6 other Republican governors who have decided to accept the Federal Government’s subsidies to expand Medicaid in their states. A massive expansion of Medicaid was a cornerstone the Affordable Care Act to cover more of the low income population with Health coverage. The Supreme Court ruled that the states have the option of rejecting the Medicaid expansion subsidy without losing ALL of their Medicaid funding which was initially the hammer to force Medicaid expansion.
The downside of accepting the expansion is that the federal subsidies decline over time, leaving the states with more financial responsibility to fund the expansion going forward. In the early years, the federal subsidy is extremely generous, which makes it difficult turn down. Currently, there are 22 states who have accepted the subsidy, 17 who have rejected it and 11 who are undecided.
Here is a link to the article in Forbes. The article highlights the alliance announced late last year between Blue Cross and Blue Shield of Montana and Health Care Services (a non-profit which holds Blue Cross plans in IL, TX, NM and OK). The article also discusses Blue Cross Blue Shield of Michigan’s plans to move to a Mutual non-profit. The Michigan legislature passed enabling legislation recently to allow for this.
Currently, there are 38 independent Blue Cross Blue Shield organizations which operate in the United States and Puerto Rico.
In unveiling his budget, PA Governor Tom Corbett revealed that PA will not participate in Medicaid expansion in its current form, but seemed open to compromise on this issue. Here is the story for the Patriot News in Harrisburg, PA.
Snyder is the sixth Republican governor to support the expansion of Medicaid in their state. The other states with Republican governors who supported expansion include: Ohio, Arizona, New Mexico, Nevada and North Dakota.
This past Wednesday, Kaiser Family Foundation hosted 3 former directors of Health and Human Services (formerly called Health Care Financing Administration) to discuss Medicare. They were asked, “If you could change one thing about Medicare, what would it be?“
Here is the press release from CMS. CMS will begin paying approximately 500 providers in “bundled” payments for treatment of conditions as opposed to a “fee for service” approach. This model could begin as soon as April 2013.
Here is a link on the CMS website which describes the program in more detail including a link to a map where you can locate the providers who are participating.
This opinion piece appears in The Hill by Sally C. Pipes, President of the Pacific Research Institute. Ms. Pipes discusses the cuts to Hospital reimbursement which were used to offset the cuts to the Physician’s Fee Schedule which were scheduled to take affect on January 1st, 2013. She also discusses the possible impacts on Medicare providers if the government tightens reimbursements in the future.