The Affordable Care Act aims to provide health care coverage to more than 30 million Americans by 2014. In California, more than 2 million people are expected to become newly eligible for the Medi-Cal program and several million more people will be required to purchase coverage through the California Health Benefit Exchange. Many people may have access to health coverage sooner as a result of California’s “Bridge to Reform” waiver that was approved by the federal government in 2010. One of the key activities to increasing coverage through government programs is the planning for a streamlined eligibility and enrollment process along with outreach and educational activities.
The California Department of Health Care Services (DHCS) has produced a series of one-page fact sheets titled Health Disparities in the Medi-Cal Population. The fact sheets provide a snapshot of the health of Medi-Cal members from various backgrounds compared to the overall state population, allowing health organizations, government officials, policymakers and advocates to better understand possible disparities. DHCS elected to use the 39 health indicators presented in the California Health and Human Services Agency’sLet’s Get Healthy California Task Force Final Report as a starting point for the fact sheets.
The California Department of Health Care Services (DHCS) has released the attached updated Strategy for Quality Improvement in Health Care (the DHCS Quality Strategy). The initial DHCSQuality Strategy was developed in November 2012, using the National Strategy for Quality Improvement in Health Care (National Quality Strategy, or NQS) as a foundation, while tailoring to the needs of the diverse California population and health care delivery system. The DHCS strategy is anchored by three goals modeled after the Institute for Healthcare Improvement’s “triple aim:” 1) Improve the health of all Californians; 2) Enhance quality, including the patient care experience, in all DHCS programs; and 3) Reduce the Department’s per capita health care program costs.
The American Hospital Association today released the attached member advisory titled Understanding and Monitoring New Insurance Coverage Issues. The advisory highlights potential issues related to uncertainty that may occur as newly covered individuals begin to seek coverage under the Affordable Care Act (ACA) and suggests how hospitals may respond. Important areas of focus are eligibility, including presumptive eligibility under the ACA; benefits; networks; and financial considerations.
President Obama announced yesterday that health insurers and HMOs are not required by federal law to cancel existing policies. In the White House’s fact sheet on this issue, HHS indicates it is using its administrative authority to:
Allow insurers to renew their current policies for current enrollees without adopting the 2014 market rule changes. This will give consumers in the individual and small group markets the choice of staying in their plan or joining a new marketplace plan next year. HHS will consider the impact of this transitional policy in assessing whether to extend it beyond 2014.
Require insurers offering such renewals to ensure consumers are informed about their options. Specifically, insurers offering these renewals must inform all consumers who either already have or will receive cancellation letters about the protections their renewed plan will not include and how they can learn about the new options available to them through the marketplaces, which will offer better protections and possible financial assistance.
Last week, the U.S. Department of Health and Human Services (HHS) released the attached rule finalizing parts of the Affordable Care Act (ACA), including provisions regarding marketplaces (exchanges). The rule outlines program integrity standards for advance payments of the premium tax credit, cost-sharing reductions, premium stabilization programs, and state marketplaces, as well as oversight of insurers offering coverage in the federally facilitated marketplaces and standards for HHS-approved enrollee satisfaction survey vendors.
Yesterday, the U.S. Department of Health and Human Services (HHS) issued guidance regarding whether qualified health plans (QHPs) are considered federal health care programs under section 1128B of the Social Security Act. HHS concluded that it does not consider QHPs, other programs related to the federally facilitated marketplace, and programs under Title I of the Affordable Care Act to be federal health care programs.
Because the federal anti-kickback statute only applies to federal health care programs, it will not apply to qualified health plans and, as a result, will not be a barrier for hospitals or health systems that wish to subsidize premiums for health plans purchased on the exchanges for individuals in need of assistance. However, California providers may still face risks under state law if they offer premium assistance programs. It is possible that this risk may be addressed by participating in a properly structured foundation; hospitals should seek the advice of counsel. The rules are more clear when applied to a Certified Enrollment Entity (CEE) and Certified Enrollment Counselor (CEC). Recent regulations adopted by Covered California prohibit a CEE or CEC from paying any part of the premium to or on behalf of an enrollee. These regulations would apply to a hospital that is a CEE.
The U.S. Department of Health & Human Services (HHS) has released guidance regarding the penalty dates related to the individual shared responsibility provision under the Affordable Care Act (ACA). The length of the initial open enrollment period and the coverage effective dates, in tandem with the terms of the short coverage gap exemption, inadvertently created the possibility that an individual who enrolled in coverage through a marketplace (exchange) during an initial open enrollment period could be liable for a shared responsibility payment for months prior to the effective date of that coverage, if the individual was not otherwise exempt. According to the new guidance, HHS recognizes that the duration of the initial open enrollment period implies that individuals have until the end of the initial open enrollment period to enroll in coverage through a marketplace while avoiding liability for the shared responsibility payment.
The California Department of Health Care Services (DHCS) has submitted to the Centers for Medicare & Medicaid Services the required Behavioral Health Service Plan, as part of the state’s 1115 Waiver Bridge to Reform Demonstration. The demonstration’s special terms and conditions (STCs) required the state to submit the service plan by Oct. 1, describing California’s plans for providing services to the Medi-Cal expansion population and demonstrating readiness to meet the population’s mental health and substance use disorder needs. DHCS reports that stakeholder comments were invaluable in developing the final document. The final plan and more information about the process are available at the DHCS website.
The Congressional Budget Office (CBO) has issued a new report that estimates the effects of the Affordable Care Act (ACA) on the number of people receiving employment-based health insurance. The report indicates that, due to ACA, approximately 3 million to 5 million fewer people will obtain coverage through their employer each year from 2019 through 2022.
The RAND Corporation has developed a model to simulate the impact of the Affordable Care Act without the individual mandate. The attached analysis shows that 12.5 million people who would have otherwise signed up for coverage will continue to be uninsured. The report also predicts that premium prices for people who buy policies through a health benefit exchange will increase by 2.4 percent. The study also finds that total government spending will increase, caused by higher premiums, loss of revenue from mandate penalties and increased spending on care for the uninsured.
Last week, the Centers for Medicare & Medicaid Services (CMS) issued a list of frequently asked questions (FAQs) to provide additional information on the intended approach to defining essential health benefits (EHBs). These FAQs follow a Dec.16, 2011, bulletin released by the U.S. Department of Health and Human Services that outlined proposed policies related to EHBs. The FAQs are intended to be responsive to states and to give stakeholders timely information as they work toward establishing exchanges and making decisions for 2014. The FAQs are attached.
The California Health Benefit Exchange (CHBE) Board met Jan. 17 in Sacramento to discuss the California Healthcare Eligibility, Enrollment and Retention System (CalHEERS), jointly sponsored by CHBE, the Department of Health Care Services and Managed Risk Medical Insurance Board, with assistance from the Office of Systems Integration.
The California HealthCare Foundation has updated its annual publication that offers a picture of those who lack health insurance coverage, providing data on their income, age, ethnicity, eligibility for public insurance and work status. The California Health Care Almanac, attached, asserts that while the ranks of the uninsured may grow in the short term if more individuals lose their employer-based coverage, changes under the Affordable Care Act scheduled to take effect in 2014 would allow more Californians to gain coverage.
The California Health Benefit Exchange (CHBE) Board met Dec. 20 to review and discuss a number of issues, including a report on small business owner behavior and decision making in offering and purchasing health insurance benefits for employees. The report was presented by Pacific Community Ventures (PCV), which conducted research with funding from the California Endowment. PCV reported that although small business owners in the state are not very aware of CHBE, they are likely to participate in the exchange once they learn more about it.
The U.S. Department of Health and Human Services (HHS) issued a 15-page document last week that provides guidance on the essential health benefits that must be included in the scope of coverage that insurance plans must meet in 2014 to sell in state-based health insurance exchanges. The guidance provides states with a choice of benchmark plans instead of dictating a single approach. The HHS guidance puts choice and flexibility in the hands of the states as they work to build their insurance exchanges.
The state’s Pre-Existing Condition Insurance Plan (PCIP) has received an additional $118 million in federal funding to expand coverage and keep up with the costs of claims. Without the added funds, PCIP would have been capped at 6,800 enrollees through December 2013. The new funding will help provide coverage to individuals with pre-existing conditions until 2014 when the Affordable Care Act mandates that private insurers accept all applicants regardless of pre-existing conditions. To qualify for PCIP coverage, individuals must be U.S.
The Affordable Care Act (ACA) established the Early Retiree Reinsurance Program (ERRP) to help cover the health costs for retirees older than age 55 who do not yet qualify for Medicare. ERRP is also designed to help prevent employers from discontinuing retiree health coverage before ACA provisions that prohibit insurers from denying coverage based on pre-existing conditions become effective in 2014.
The U.S. Department of Health and Human Services has announced the Health Care Innovation Challenge, a program to provide $1 billion in grants for innovation in workforce development and deployment. The money will be awarded to organizations that propose projects to improve the quality of care for patients enrolled in Medicare, Medicaid and the Children’s Health Insurance Program, while lowering costs.
Individual grants will range from $1 million to $30 million over three years to providers, payers, local government, public-private partnerships and multi-payer collaboratives.