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.
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 Department of Health Care Services (DHCS) and the California Department of Aging (CDA) will conduct a webinar on Oct. 23 from 3 p.m. to 5 p.m. (PT) to discuss the Community-Based Adult Services program (CBAS) stakeholder process that will run through April 2014. The webinar is the first in a series of webinars and meetings that DHCS and CDA will conduct to gather input from interested parties about the direction of the CBAS program. The process also includes stakeholder feedback on renewing the CBAS section of California’s 1115 “Bridge to Reform” Demonstration Waiver (1115 waiver), which expires in August 2014. The CBAS program became effective on April 1, 2012, under the 1115 waiver.
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.
Last week, the Centers for Medicare & Medicaid Services (CMS) issued the attached rule finalizing policies from its proposed rule titled “Program Integrity: Exchange, SHOP, Premium Stabilization Programs, and Market Standards,” published June 19. The rule also finalizes eligibility and Small Business Health Options Program (SHOP) appeals provisions from the proposed rule titled “Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Procedures for Medicaid and Exchange Eligibility Appeals,” published January 22.
The California Department of Health Care Services (DHCS) will conduct a stakeholder meeting to review its draft Behavioral Health Service Plan on Sept. 4 from 9 a.m. to 11 a.m. (PT). DHCS consultants — the Technical Assistance Collaborative, Inc. and the Human Services Research Institute — will discuss the plan and answer questions. DHCS will also provide an update on implementation planning and will welcome stakeholder feedback. The meeting will be stakeholders’ final opportunity to provide input before DHCS finalizes the document for submission to the Centers for Medicare & Medicaid Services (CMS).
The California Department of Health Care Services (DHCS) will offer an educational webinar on the Coordinated Care Initiative (CCI) for physicians and other providers on Aug. 21 at 5 p.m. The CCI integrates delivery of medical, behavioral and long-term care services, and includes the Cal MediConnect program. Cal MediConnect offers individuals with both Medicare and Medi-Cal – commonly referred to as “dual eligible” beneficiaries – the opportunity to benefit from more coordinated care. The webinar will include a 30-minute overview of Cal MediConnect, including continuity of care provisions and a 30-minute question-and-answer period.
On Aug. 19, the California Department of Health Care Services (DHCS) will conduct a stakeholder meeting to review its draft Behavioral Health Service Plan. DHCS consultants — the Technical Assistance Collaborative, Inc. and the Human Services Research Institute — will discuss the plan and answer questions. DHCS will also provide an update on implementation planning and will welcome stakeholder feedback.
DHCS is required by the section 1115 “Bridge to Reform” Waiver Special Terms and Conditions to submit the service plan to the Centers for Medicare & Medicaid Services (CMS). In the service plan, DHCS must describe California’s recommendations for serving the Medi-Cal expansion population and demonstrate the state’s readiness to meet its mental health and substance use disorder needs.
Last month, the California Department of Health Care Services (DHCS) announced it would convene a series of quarterly meetings to review the progress of the Coordinated Care Initiative (CCI). The first of the meetings will be held in Sacramento Aug. 27 from 1 p.m. to 4:30 p.m. at the Sheraton Grand Hotel. Because of limited seating at the Sheraton, registration will be on a first-come basis, but the meeting will offer a call-in option. To participate, register online for either the in-person meeting or the telephone meeting.
The CCI integrates delivery of medical, behavioral and long-term care services. It also includes the Cal MediConnect program, which is an opportunity for individuals with both Medicare and Medi-Cal – commonly referred to as “dual eligible” beneficiaries – to benefit from more coordinated care. Enrollment in Cal MediConnect is scheduled to begin no sooner than January 2014 in eight participating counties (Alameda, San Mateo, Santa Clara, Los Angeles, Orange, San Diego, Riverside and San Bernardino).
The agenda and other meeting materials will be available closer to the event date on calduals.org.
On Aug.15, the California Department of Health Care Services (DHCS) and the UCLA Center for Health Policy Research will conduct a conference in Sacramento to provide an overview of the Low Income Health Program (LIHP) transition and to solicit stakeholder feedback. The conference, also offered in webinar format, will be held from 9 a.m. to 4 p.m. at the Sacramento Convention Center. DHCS invites all LIHP stakeholders to participate, including those at the state, legislative, administration and county level, as well as LIHP advocates. Discussion items include the LIHP transition, including information on Covered California, Medi-Cal managed care plans, data sharing and more. Registration is free but space is limited. Visit the DHCS online registration site for more information.
The California Department of Health Care Services (DHCS), in partnership with the University of California, Los Angeles, and the University of California, Berkeley, will conduct a webinar on Aug. 7 to provide an update on the Low Income Health Program (LIHP) transition. As part of the webinar, DHCS will share its LIHP Transition Plan — including the communications and outreach plan — and its Continuity of Care Plan, both of which have been updated with stakeholders’ recommendations from previous LIHP webinars and in-person meetings. The webinar will take place from 3 p.m. – 4:30 p.m. (PT). To reserve a space, visit www1.gotomeeting.com/register/291213232. After registering, participants will receive a confirmation email with information about joining the webinar.
Last week the U.S. Department of Health and Human Services (HHS) released its long-awaited final rule related to affordable insurance exchanges, also called health insurance marketplaces. The final rule implements specific exchange functions, including determining eligibility for and granting certificates of exemption from the individual shared responsibility payment (IRS code section 5000A).
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 U.S. Supreme Court will hear oral arguments March 26-28 on provisions of the Affordable Care Act (ACA) that have been challenged by 26 states. On March 26, the court will hear arguments on whether the Anti-Injunction Act (AIA) bars individuals from suing over ACA’s minimum coverage provision. Under AIA, taxpayers may not challenge a tax before personal liability is determined by the Internal Revenue Service.
The California Health Benefit Exchange (CHBE) Board will hold its next meeting March 22 at the Fresno Convention Center, 848 M Street, Room 2015-2018, from 10 a.m. to 4 p.m. The meeting agenda is attached below. Additional meeting materials will be available on the CHBE website at www.hbex.ca.gov. A webcast will be available for the March 22 board meeting at www.cal-span.org/state_webcast/hbex/stream_index.htm. The call-in number for phone participation is (800) 553-0326.
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.