On February 21, 2012, CMS announced its first award of repayable loans to seven Consumer Operated and Oriented Plans (CO-OPs). The awards will help CO-OPs establish private, non-profit, consumer-governed health insurance companies with the goal of expanding health insurance options for consumers and small businesses. The CO-OPs will eventually operate in each states’ health insurance exchange under the Affordable Care Act, but will also offer plans outside of the exchange. Starting on January 1, 2014, the first seven CO-OPs will become operational in eight states.
CMS Finalizes Rules Regarding Eligibility for Medicare Prescription Drug Subsidy
On January 17, 2012 the Centers for Medicare & Medicaid Services (“CMS”) adopted as a final rule changing Medicare’s Extra Help Program. The Extra Help Program is a prescription drug coverage low-income subsidy created through the Affordable Care Act (“ACA”). Effective January 18, 2012, the final rule incorporates the ACA’s changes to the Extra Help Program by extending eligibility for one year after the death of a beneficiary’s spouse that would otherwise decrease or eliminate the subsidy. The final rule also implements changes to the Medicare Improvements for Patients and Provider Act of 2008 by excluding from a resource (for purposes of Extra Help eligibility) the value of life insurance policies or income for food, shelter, and certain household bills.
Read the full notice from the federal register here.
HHS Awards Planning Grants to States to Establish Insurance Exchanges
The Department of Health & Human Services (“HHS”) Secretary Kathleen Sebelius recently announced the distribution of $220 million to states for the creation of private health-insurance exchanges. Alabama, Arizona, Delaware, Hawaii, Idaho, Iowa, Maine, Michigan, Nebraska, New Mexico, Rhode Island, Tennessee and Vermont were the state recipients in this latest funding effort, and Rhode Island is the first state to receive a Level Two grant geared towards states in more advanced planning stages. State health insurance exchanges are expected to start operating in 2014. Currently only 13 states have enacted legislation to establish insurance exchanges; though 49 states have received planning grants so far.
Read HHS’ full press release here.
Double-Digit Hikes in Insurance Rates Must Now Be Reviewed
The Affordable Care Act’s (ACA) health insurance review program has gone into effect, and this means that all insurers seeking to increase their health insurance rates by 10% or more must submit the proposed increase for review by state insurance experts. As part of the ACA’s emphasis on transparency and accountability, the rate review program allows state regulators to deny excessive rate increases and consumers will be able to see the reasons behind rate increases on a new Department of Health & Human Services website, HealthCare.gov. The ACA has also provided Health Insurance Premium Review Grants of $250 million over the next five years to the states, which will assist the states in improving their review of health insurance rates and their ability to hold insurance companies accountable for excessive premiums. For more information on the review program, see HHS’ website here.
Changes to the Hospital Outpatient Prospective Payment System (OPPS) and CY 2010 Payment Rates
Summary: This regulation was adopted in order to correct technical errors that were identified in two documents regarding hospital outpatient prospective payment: a final rule and its subsequent correction document. The final rule containing errors is titled “Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2010 Payment Rates; Changes to the Ambulatory Surgical Center Payment System and CY 2010 Payment Rates.” The subsequent correction document also containing errors is titled “Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2010 Payment Rates; Changes to the Ambulatory Surgical Center Payment System and CY 2010 Payment Rates” Continue reading “Changes to the Hospital Outpatient Prospective Payment System (OPPS) and CY 2010 Payment Rates”