The Obama Administration announced changes in the implementation of the Affordable Care Act provisions related to the employer mandate for "medium-sized" businesses. The provisions were originally drafted to go into effect this year.
The changes in implementation deadlines do not affect most businesses. Companies with fewer than 50 workers remain exempt from the mandate.
First, the deadline to meet the coverage requirements under the mandate for medium-sized businesses, companies that employ between 50 and 99 workers, has been delayed until January 1, 2016. The delay is conditional and requires companies to promise that the employer will neither cut an employees' hours nor let go of employees for the purpose of making their business qualify as a "medium-sized" business with 50-99 workers. Officials describe the verification process of this promise as "self-attestation" and the IRS has not provided information on how it will determine the companies' veracity.
White House advisor Phil Schiliro explained the reasoning behind the change, "For the two-percent of American businesses that have between 50 and 99 employees, the Treasury Department concluded that a phase-in was the most common-sense way to implement the law."
The employer provisions will go into effect for companies that do fall into categories covered by the employer mandate that do not have 50-99 workers. However, the requirement that the employers offer coverage to 95% of their full-time employees by January 1, 2015 has been reduced by 25%. The employers will now be required to offer coverage to 70% of their full-time employees by January 1, 2015. The Treasury Department's final rules state that the requirement for employers to offer coverage to 95% of their full-time employees has been delayed until 2016.
Other changes affect seasonal workforces, adjunct faculty and volunteer firefighters and paramedics. Seasonal workers that work less than six months will not be considered full-time employees. The changes include a method for estimating the hours of adjunct faculty that accounts for hours spent working outside the classroom. The Administration's promise that volunteer firefighters and paramedics would not be considered full-time employees was formally implemented in the most recent changes.
Many commentators are suggesting that the adjustments in implementation deadlines and requirements for businesses will increase pressure on the Obama Administration to extend deadlines for individuals so that they are not subject to the $95 or 1% of income fine for failing to purchase health insurance this year. Other experts counter that extending the deadline for individuals would result in fewer healthy individuals signing up now which could drastically shift the ratio of sick-to-healthy individuals enrolled. If too many individuals with significant health problems enroll without the balance of healthy individuals it could make the price of coverage more expensive.
Showing posts with label Health Reform. Show all posts
Showing posts with label Health Reform. Show all posts
Tuesday, February 11, 2014
Monday, March 26, 2012
Health Insurance Rate Hikes in 9 States Deemed Excessive by HHS
Health and Human Services (HHS) Secretary Kathleen Sebelius announced that health insurance premium increases in nine states have been deemed “unreasonable” under the rate review authority granted by the Affordable Care Act.
"Thanks to the Affordable Care Act consumers are no longer in the dark about their health insurance premiums," said Secretary Sebelius. "Now, insurance companies are required to justify rate increases of 10 percent or higher. It’s time for these companies to immediately rescind these unreasonable rate hikes, issue refunds to consumers or publicly explain their refusal to do so."
Secretary Sebelius also released a new report showing that, six months after HHS began reviewing proposed health insurance rate increases, consumers are already seeing results. Since the rate review program took effect in 2011, health insurers have proposed fewer double-digit rate increases. Furthermore, more states have taken an active role in reducing rate increases, and consumers in all states are getting straight answers from their insurance companies when their rates are raised by 10 percent or more. As of March 10, 2012, the justifications and analysis of 186 double-digit rate increases for plans covering 1.3 million people have been posted at HealthCare.gov, resulting in a decline in rate increases. According to the report, in the last quarter of 2011 alone, states reported that premium increases dropped by 4.5 percent, and in states like Nevada, premiums actually declined.
HHS determined, after independent expert review, that two insurance companies have proposed unreasonable health insurance premium increases in nine states—Arizona, Idaho, Louisiana, Missouri, Montana, Nebraska, Virginia, Wisconsin, and Wyoming. The excessive rate hikes would affect over 42,000 residents across these nine states.
In these nine states, the insurers have requested rate increases as high as 24 percent. These increases were reviewed by independent experts to determine whether they are reasonable. In this case, HHS determined that the rate increases were unreasonable, because the insurer would be spending a low percentage of premium dollars on actual medical care and quality improvements, and because the justifications were based on unreasonable assumptions.
Most rates are reviewed by states and many states have the authority to reject unreasonable premium increases. Since the passage of the health care law, the number of states with this authority increased from 30 to 37, with several states extending existing “prior authority” to new markets.
The report released today shows that:
* States like Texas, Kentucky, Nevada and Indiana are reporting fewer requests for rate increases over 10 percent.
* States like California, New York, Oregon, and many others, have proactively lowered rate increases for their residents.
* The rate review program has made insurance companies explain their increases, and more than 180 have been posted publicly and are open for consumer comment on companyprofiles.healthcare.gov.
This initiative is one of many in the health care law to ensure that insurance companies play by the rules, prohibiting them from dropping coverage when a person gets sick, billing consumers into bankruptcy through annual or lifetime limits, and, soon, discriminating against anyone with a pre-existing condition.
Information on the specific determinations made today is available at: http://companyprofiles.healthcare.gov/
The rate review report released today is available at: http://www.healthcare.gov/law/resources/reports/rate-review03222012a.html
General information about rate review is available at: http://www.healthcare.gov/law/features/costs/rate-review/
Source: HHS News Release
"Thanks to the Affordable Care Act consumers are no longer in the dark about their health insurance premiums," said Secretary Sebelius. "Now, insurance companies are required to justify rate increases of 10 percent or higher. It’s time for these companies to immediately rescind these unreasonable rate hikes, issue refunds to consumers or publicly explain their refusal to do so."
Secretary Sebelius also released a new report showing that, six months after HHS began reviewing proposed health insurance rate increases, consumers are already seeing results. Since the rate review program took effect in 2011, health insurers have proposed fewer double-digit rate increases. Furthermore, more states have taken an active role in reducing rate increases, and consumers in all states are getting straight answers from their insurance companies when their rates are raised by 10 percent or more. As of March 10, 2012, the justifications and analysis of 186 double-digit rate increases for plans covering 1.3 million people have been posted at HealthCare.gov, resulting in a decline in rate increases. According to the report, in the last quarter of 2011 alone, states reported that premium increases dropped by 4.5 percent, and in states like Nevada, premiums actually declined.
HHS determined, after independent expert review, that two insurance companies have proposed unreasonable health insurance premium increases in nine states—Arizona, Idaho, Louisiana, Missouri, Montana, Nebraska, Virginia, Wisconsin, and Wyoming. The excessive rate hikes would affect over 42,000 residents across these nine states.
In these nine states, the insurers have requested rate increases as high as 24 percent. These increases were reviewed by independent experts to determine whether they are reasonable. In this case, HHS determined that the rate increases were unreasonable, because the insurer would be spending a low percentage of premium dollars on actual medical care and quality improvements, and because the justifications were based on unreasonable assumptions.
Most rates are reviewed by states and many states have the authority to reject unreasonable premium increases. Since the passage of the health care law, the number of states with this authority increased from 30 to 37, with several states extending existing “prior authority” to new markets.
The report released today shows that:
* States like Texas, Kentucky, Nevada and Indiana are reporting fewer requests for rate increases over 10 percent.
* States like California, New York, Oregon, and many others, have proactively lowered rate increases for their residents.
* The rate review program has made insurance companies explain their increases, and more than 180 have been posted publicly and are open for consumer comment on companyprofiles.healthcare.gov.
This initiative is one of many in the health care law to ensure that insurance companies play by the rules, prohibiting them from dropping coverage when a person gets sick, billing consumers into bankruptcy through annual or lifetime limits, and, soon, discriminating against anyone with a pre-existing condition.
Information on the specific determinations made today is available at: http://companyprofiles.healthcare.gov/
The rate review report released today is available at: http://www.healthcare.gov/law/resources/reports/rate-review03222012a.html
General information about rate review is available at: http://www.healthcare.gov/law/features/costs/rate-review/
Source: HHS News Release
Graduate Nurse Education Demonstration Announced
The Centers for Medicare & Medicaid Services (CMS) announced a call for applications for a new Affordable Care Act initiative designed to strengthen primary care in the United States.
Under the Graduate Nurse Education Demonstration, CMS will provide hospitals working with nursing schools to train advanced practice registered nurses (APRNs) with payments of up to $50 million annually over four years to cover the costs of APRNs’ clinical training.
Growing the ranks of APRNs is an important way to increase the base of primary care providers in this country. In the past, the cost of clinical training has limited the ability of hospitals and other healthcare providers to accept more APRN students into their settings for clinical training.
Under the Graduate Nurse Education Demonstration, CMS will provide reimbursement to up to five eligible hospitals for the reasonable cost of providing clinical training to APRN students added as a result of the demonstration. Hospitals participating in the demonstration must partner with accredited schools of nursing and non-hospital community-based care settings.
Payments to the participating hospitals will be linked directly to the number of additional APRNs that the hospitals and their partnering entities are able to train as a result of their participation in the demonstration. The payment will be calculated on a per-student basis, comparing previous enrollment levels in APRN training programs with enrollment under the demonstration.
For more information, or to view the solicitation, visit: innovation.cms.gov/initiatives/gne.
Source: CMS News Release
Under the Graduate Nurse Education Demonstration, CMS will provide hospitals working with nursing schools to train advanced practice registered nurses (APRNs) with payments of up to $50 million annually over four years to cover the costs of APRNs’ clinical training.
Growing the ranks of APRNs is an important way to increase the base of primary care providers in this country. In the past, the cost of clinical training has limited the ability of hospitals and other healthcare providers to accept more APRN students into their settings for clinical training.
Under the Graduate Nurse Education Demonstration, CMS will provide reimbursement to up to five eligible hospitals for the reasonable cost of providing clinical training to APRN students added as a result of the demonstration. Hospitals participating in the demonstration must partner with accredited schools of nursing and non-hospital community-based care settings.
Payments to the participating hospitals will be linked directly to the number of additional APRNs that the hospitals and their partnering entities are able to train as a result of their participation in the demonstration. The payment will be calculated on a per-student basis, comparing previous enrollment levels in APRN training programs with enrollment under the demonstration.
For more information, or to view the solicitation, visit: innovation.cms.gov/initiatives/gne.
Source: CMS News Release
Thursday, March 15, 2012
Policies Give States Flexibility to Establish Affordable Insurance Exchanges
Health and Human Services Secretary Kathleen Sebelius announced policies to assist states in building Affordable Insurance Exchanges. Starting in 2014, these one-stop marketplaces will allow consumers and small businesses to choose a private health insurance plan and offer the public the same kinds of insurance choices as members of Congress.
The policies released will help states in designing their Exchanges to best meet the needs of their consumers. They offer states substantial flexibility as they design a marketplace that works for their residents.
“These policies give states the flexibility they need to design an Exchange that works for them,” said HHS Secretary Kathleen Sebelius. “These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business. More competition will drive down costs and Exchanges will give individuals and small businesses the same purchasing power big businesses have today.”
The policies provide states with the guidance and certainty they need as they continue to work to build these marketplaces for their residents for operation in 2014. The policies offer guidance about the options on how to structure Exchanges in two key areas:
- Setting standards for establishing Exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an Exchange, and certifying health plans for participation in the Exchange;
- Establishing a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.
The final rule builds on the flexibility and resources provided by HHS already to build state-based Exchanges. A majority of states have taken significant steps in building Exchanges. Previously, HHS awarded 49 states and the District of Columbia $50 million to begin planning their Exchanges, and as announced recently, 33 states and the District of Columbia have received over $667 million in Establishment Grants to begin building their Exchanges.
The announcement builds on over two years’ worth of work with states, small businesses, consumers, and health insurance plans. The administration examined models of Exchanges; convened numerous meetings and regional listening sessions across the country with stakeholders; and consulted closely with state leaders, consumer advocates, employers and insurers. To finalize the rules announced today, HHS accepted public comment over 75 days to learn from states, consumers, and other stakeholders on how the rules could be improved, and HHS modified the proposals based on feedback from the American people.
For more information, visit:
http://www.healthcare.gov/news/factsheets/2011/07/exchanges07112011a.html
For more information on Exchanges, including fact sheets, visit http://www.healthcare.gov/exchanges.
Source: HHS News Release
The policies released will help states in designing their Exchanges to best meet the needs of their consumers. They offer states substantial flexibility as they design a marketplace that works for their residents.
“These policies give states the flexibility they need to design an Exchange that works for them,” said HHS Secretary Kathleen Sebelius. “These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business. More competition will drive down costs and Exchanges will give individuals and small businesses the same purchasing power big businesses have today.”
The policies provide states with the guidance and certainty they need as they continue to work to build these marketplaces for their residents for operation in 2014. The policies offer guidance about the options on how to structure Exchanges in two key areas:
- Setting standards for establishing Exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an Exchange, and certifying health plans for participation in the Exchange;
- Establishing a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.
The final rule builds on the flexibility and resources provided by HHS already to build state-based Exchanges. A majority of states have taken significant steps in building Exchanges. Previously, HHS awarded 49 states and the District of Columbia $50 million to begin planning their Exchanges, and as announced recently, 33 states and the District of Columbia have received over $667 million in Establishment Grants to begin building their Exchanges.
The announcement builds on over two years’ worth of work with states, small businesses, consumers, and health insurance plans. The administration examined models of Exchanges; convened numerous meetings and regional listening sessions across the country with stakeholders; and consulted closely with state leaders, consumer advocates, employers and insurers. To finalize the rules announced today, HHS accepted public comment over 75 days to learn from states, consumers, and other stakeholders on how the rules could be improved, and HHS modified the proposals based on feedback from the American people.
For more information, visit:
http://www.healthcare.gov/news/factsheets/2011/07/exchanges07112011a.html
For more information on Exchanges, including fact sheets, visit http://www.healthcare.gov/exchanges.
Source: HHS News Release
NeHC CEO Discusses National HIE Evolution
National eHealth Collaborative (NeHC) CEO Kate Berry was recently interviewed by FierceEMR about her views on the changing national HIE landscape. The article, written by contributing editor Marla Durben Hirsch, provided a summary of the recent NeHC University roundtable Implications of a Shifting National HIE Architecture and shared Berry's views the topic.
Click here to read the article.
Source: NeHC News Release
Click here to read the article.
Source: NeHC News Release
Monday, March 12, 2012
Policies Give States More Flexibility to Establish Affordable Insurance Exchanges
Health and Human Services Secretary Kathleen Sebelius announced policies to assist States in building Affordable Insurance Exchanges. Starting in 2014, these one-stop marketplaces will allow consumers and small businesses to choose a private health insurance plan and offer the public the same kinds of insurance choices as members of Congress.
The policies released will help States in designing their Exchanges to best meet the needs of their consumers. They offer States substantial flexibility as they design a marketplace that works for their residents.
“These policies give States the flexibility they need to design an Exchange that works for them,” said HHS Secretary Kathleen Sebelius. “These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business. More competition will drive down costs and Exchanges will give individuals and small businesses the same purchasing power big businesses have today.”
The policies provide States with the guidance and certainty they need as they continue to work to build these marketplaces for their residents for operation in 2014. The policies offer guidance about the options on how to structure Exchanges in two key areas:
-Setting standards for establishing Exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an Exchange, and certifying health plans for participation in the Exchange;
-Establishing a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.
The final rule builds on the flexibility and resources provided by HHS already to build State-based Exchanges. A majority of States have taken significant steps in building Exchanges. Previously, HHS awarded 49 States and the District of Columbia $50 million to begin planning their Exchanges, and as announced recently, 33 States and the District of Columbia have received over $667 million in Establishment Grants to begin building their Exchanges.
The announcement builds on over two years’ worth of work with States, small businesses, consumers, and health insurance plans. The administration examined models of Exchanges; convened numerous meetings and regional listening sessions across the country with stakeholders; and consulted closely with State leaders, consumer advocates, employers and insurers. To finalize the rules , HHS accepted public comment over 75 days to learn from States, consumers, and other stakeholders on how the rules could be improved, and HHS modified the proposals based on feedback from the American people.
For more information on the announcement, visit:
http://www.healthcare.gov/news/factsheets/2011/07/exchanges07112011a.html
For more information on Exchanges, including fact sheets, visit http://www.healthcare.gov/exchanges.
Source: HHS News Release
The policies released will help States in designing their Exchanges to best meet the needs of their consumers. They offer States substantial flexibility as they design a marketplace that works for their residents.
“These policies give States the flexibility they need to design an Exchange that works for them,” said HHS Secretary Kathleen Sebelius. “These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business. More competition will drive down costs and Exchanges will give individuals and small businesses the same purchasing power big businesses have today.”
The policies provide States with the guidance and certainty they need as they continue to work to build these marketplaces for their residents for operation in 2014. The policies offer guidance about the options on how to structure Exchanges in two key areas:
-Setting standards for establishing Exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an Exchange, and certifying health plans for participation in the Exchange;
-Establishing a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.
The final rule builds on the flexibility and resources provided by HHS already to build State-based Exchanges. A majority of States have taken significant steps in building Exchanges. Previously, HHS awarded 49 States and the District of Columbia $50 million to begin planning their Exchanges, and as announced recently, 33 States and the District of Columbia have received over $667 million in Establishment Grants to begin building their Exchanges.
The announcement builds on over two years’ worth of work with States, small businesses, consumers, and health insurance plans. The administration examined models of Exchanges; convened numerous meetings and regional listening sessions across the country with stakeholders; and consulted closely with State leaders, consumer advocates, employers and insurers. To finalize the rules , HHS accepted public comment over 75 days to learn from States, consumers, and other stakeholders on how the rules could be improved, and HHS modified the proposals based on feedback from the American people.
For more information on the announcement, visit:
http://www.healthcare.gov/news/factsheets/2011/07/exchanges07112011a.html
For more information on Exchanges, including fact sheets, visit http://www.healthcare.gov/exchanges.
Source: HHS News Release
Monday, February 27, 2012
HHS Announces New Assistance to States for Innovation Projects
U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced more assistance to states as it implements three new provisions of the Affordable Care Act. The announcement gives states help by:
-Providing a new round of Affordable Insurance Exchange Establishment Grants, totaling $229 million to 10 states, to help states build new health insurance marketplaces;
- Promoting transparency and meaningful public input into the Medicaid demonstration process, and streamlining the federal-state consideration process as states test new models of care.
“We’re taking important actions that will give states more resources and more flexibility, and ensure transparency thanks to the Affordable Care Act,” said Secretary Sebelius. “All Americans will have access to quality, affordable health care once the Affordable Care Act is fully implemented, and today’s steps are important measures that ensure that States have the help they need to administer their Medicaid programs and oversee their insurance markets while assuring meaningful input for consumers and beneficiaries.”
Thanks to the Affordable Care Act, starting in 2014 Americans will have improved health coverage. Americans who do not have health care through their employer will be able to buy insurance from qualified health plans directly in an Affordable Insurance Exchange and may receive tax credits to help make coverage more affordable. In addition, all individuals under 65 years of age with incomes below 133 percent of the federal poverty level ($14,500 for an individual and $29,700 for a family of four in 2011) will be eligible for Medicaid. Today’s announcements will help States make this transition by giving more assistance to States as they make improvements to their Medicaid programs and insurance markets.
“As a former state health official, I know how important it is to have the right resources to ensure the health and well-being of our residents,” said Marilyn Tavenner, acting administrator of the Centers for Medicare & Medicaid Services (CMS). “These announcements are good news for states and good news for millions of Americans who will enjoy better health care as the Affordable Care Act is fully implemented.”
HHS is providing more resources to States to help them build their open health insurance marketplaces known as Exchanges. HHS announced the award of $229 million in Affordable Insurance Exchange grants to 10 states to help them create Exchanges, giving these states more flexibility and resources to implement the Affordable Care Act. The health care reform law gives states the freedom to design Affordable Insurance Exchanges – one-stop marketplaces where consumers will be able to choose a private qualified health plan that fits their health needs and will have the same kinds of insurance choices as members of Congress. The awards bring to 34 (including the District of Columbia) the number of states that are making significant progress in creating Affordable Insurance Exchanges. States receiving funding today include: Arkansas, Colorado, Kentucky, Massachusetts, Minnesota, Nevada, New Jersey, New York, Pennsylvania, and Tennessee.
More information on the Affordable Insurance Exchanges can be found here: http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html
More Transparency
The Affordable Care Act requires transparency and meaningful public input in the development, review, and approval (or renewal) of Medicaid and CHIP demonstrations. These demonstrations allow States to undertake experimental, pilot, or demonstration projects, to run all or parts of their Medicaid programs in ways that would not otherwise be consistent with federal rules, and can have significant implications for beneficiaries, providers, and states. The final rule ensures transparency at each stage of the demonstration development and review process without impeding the timely submission and review of demonstration applications, ensuring public input while supporting ongoing innovation. Transparency and public input help to ensure that as these changes are being proposed at the state level and reviewed at the federal level, stakeholders have an opportunity to inform the decision-making process.
For more information, please visit: http://www.cms.gov/apps/media/fact_sheets.asp
More Flexibility
HHS along with the Department of Treasury finalized a rule providing more flexibility to States to find the health care solutions that work best for them. The Affordable Care Act gives states the option to receive a State Innovation Waiver so they may pursue their own innovative strategies to ensure their residents have access to high quality, affordable health insurance. Under the law, State Innovation Waivers are available in 2017, and today’s final rules provide detail how States can work with HHS to ensure their residents have the protections provided in the Affordable Care Act and access to innovative State approaches.
In addition, states will have more flexibility to apply for the Exchange Establishment Grants under an amended Funding Opportunity Announcement with additional application opportunities due out later this spring.
More information on the State Innovation Waivers can be found here: http://www.healthcare.gov/news/factsheets/2012/02/state-innovation02222012a.html
Final rules were placed on display at the Federal Register, and may be found at:
https://www.federalregister.gov/public-inspection
Source: HHS News Release
-Providing a new round of Affordable Insurance Exchange Establishment Grants, totaling $229 million to 10 states, to help states build new health insurance marketplaces;
- Promoting transparency and meaningful public input into the Medicaid demonstration process, and streamlining the federal-state consideration process as states test new models of care.
“We’re taking important actions that will give states more resources and more flexibility, and ensure transparency thanks to the Affordable Care Act,” said Secretary Sebelius. “All Americans will have access to quality, affordable health care once the Affordable Care Act is fully implemented, and today’s steps are important measures that ensure that States have the help they need to administer their Medicaid programs and oversee their insurance markets while assuring meaningful input for consumers and beneficiaries.”
Thanks to the Affordable Care Act, starting in 2014 Americans will have improved health coverage. Americans who do not have health care through their employer will be able to buy insurance from qualified health plans directly in an Affordable Insurance Exchange and may receive tax credits to help make coverage more affordable. In addition, all individuals under 65 years of age with incomes below 133 percent of the federal poverty level ($14,500 for an individual and $29,700 for a family of four in 2011) will be eligible for Medicaid. Today’s announcements will help States make this transition by giving more assistance to States as they make improvements to their Medicaid programs and insurance markets.
“As a former state health official, I know how important it is to have the right resources to ensure the health and well-being of our residents,” said Marilyn Tavenner, acting administrator of the Centers for Medicare & Medicaid Services (CMS). “These announcements are good news for states and good news for millions of Americans who will enjoy better health care as the Affordable Care Act is fully implemented.”
HHS is providing more resources to States to help them build their open health insurance marketplaces known as Exchanges. HHS announced the award of $229 million in Affordable Insurance Exchange grants to 10 states to help them create Exchanges, giving these states more flexibility and resources to implement the Affordable Care Act. The health care reform law gives states the freedom to design Affordable Insurance Exchanges – one-stop marketplaces where consumers will be able to choose a private qualified health plan that fits their health needs and will have the same kinds of insurance choices as members of Congress. The awards bring to 34 (including the District of Columbia) the number of states that are making significant progress in creating Affordable Insurance Exchanges. States receiving funding today include: Arkansas, Colorado, Kentucky, Massachusetts, Minnesota, Nevada, New Jersey, New York, Pennsylvania, and Tennessee.
More information on the Affordable Insurance Exchanges can be found here: http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html
More Transparency
The Affordable Care Act requires transparency and meaningful public input in the development, review, and approval (or renewal) of Medicaid and CHIP demonstrations. These demonstrations allow States to undertake experimental, pilot, or demonstration projects, to run all or parts of their Medicaid programs in ways that would not otherwise be consistent with federal rules, and can have significant implications for beneficiaries, providers, and states. The final rule ensures transparency at each stage of the demonstration development and review process without impeding the timely submission and review of demonstration applications, ensuring public input while supporting ongoing innovation. Transparency and public input help to ensure that as these changes are being proposed at the state level and reviewed at the federal level, stakeholders have an opportunity to inform the decision-making process.
For more information, please visit: http://www.cms.gov/apps/media/fact_sheets.asp
More Flexibility
HHS along with the Department of Treasury finalized a rule providing more flexibility to States to find the health care solutions that work best for them. The Affordable Care Act gives states the option to receive a State Innovation Waiver so they may pursue their own innovative strategies to ensure their residents have access to high quality, affordable health insurance. Under the law, State Innovation Waivers are available in 2017, and today’s final rules provide detail how States can work with HHS to ensure their residents have the protections provided in the Affordable Care Act and access to innovative State approaches.
In addition, states will have more flexibility to apply for the Exchange Establishment Grants under an amended Funding Opportunity Announcement with additional application opportunities due out later this spring.
More information on the State Innovation Waivers can be found here: http://www.healthcare.gov/news/factsheets/2012/02/state-innovation02222012a.html
Final rules were placed on display at the Federal Register, and may be found at:
https://www.federalregister.gov/public-inspection
Source: HHS News Release
Thursday, February 23, 2012
Health Reform Law Provides Coverage for Nearly 50,000 Americans With Pre-existing Conditions
U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced that the new health care law’s Pre-Existing Condition Insurance Plan (PCIP) program is providing insurance to nearly 50,000 people with high-risk pre-existing conditions nationwide.
The Department released a new report demonstrating how PCIP is helping to fill a void in the insurance market for consumers with pre-existing conditions who are denied insurance coverage and are ineligible for Medicare or Medicaid coverage.
“For too long, Americans with pre-existing conditions were locked out of the health care system and their health suffered,” said HHS Secretary Kathleen Sebelius. “Thanks to health reform, our most vulnerable Americans across the country have the care they need.”
Under the Affordable Care Act, in 2014, insurers will be prohibited from denying coverage to any American with a pre-existing condition. Until then, the PCIP program will continue to provide enrollees with affordable insurance coverage.
In many cases, PCIP participants have been diagnosed with and need treatment for serious health care conditions such as cancer, ischemic heart disease, degenerative bone diseases and hemophilia. As a result of the new law, PCIP enrollees are receiving health services for their conditions on the first day their insurance coverage begins. Their critical need for treatment, combined with their lack of prior health coverage has led to higher overall per-member claims costs in state-based PCIPs of approximately $29,000 per year, which is more than double the per member cost that traditional State High Risk Pools have experienced in recent years.
Enrollment in PCIP has seen a nearly 400 percent increase from November 2010 to November 2011. PCIP enrollment is anticipated to trend upwards of 50,000 enrollees within the coming month.
People who enroll in the PCIP program are not charged a higher premium because of their medical condition. Program participants pay comparable premium rates to healthy people in the individual insurance market. By law, premiums may vary only on the basis of age, geographic area and tobacco use.
PCIP provides comprehensive health coverage, including primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care, preventive health and maternity care. The program is available in 50 states and the District of Columbia and open to U.S. citizens and people who reside in the U.S. legally (regardless of income) who have been without insurance coverage for at least six months, and have a pre-existing condition, or have been denied health insurance coverage because of a health condition.
The Affordable Care Act directed the Secretary of HHS to carry out PCIP either directly or through a contract with a state or nonprofit entity. In 27 states, a state or nonprofit entity elected to administer PCIP, while HHS operates the program in the remaining 23 states and the District of Columbia.
The new report can be found at: http://www.cciio.cms.gov/resources/files/Files2/02242012/pcip-annual-report.pdf
For more information, including eligibility, plan benefits and rates, as well as information on how to apply, visit www.pcip.gov and click on “Find Your State.” Then select your state from a map of the United States or from the drop-down menu.
The PCIP call center is open from 8 a.m. to 11 p.m. Eastern Time. Call toll-free 1-866-717-5826 (TTY 1-866-561-1604).
Source: HHS News Release
The Department released a new report demonstrating how PCIP is helping to fill a void in the insurance market for consumers with pre-existing conditions who are denied insurance coverage and are ineligible for Medicare or Medicaid coverage.
“For too long, Americans with pre-existing conditions were locked out of the health care system and their health suffered,” said HHS Secretary Kathleen Sebelius. “Thanks to health reform, our most vulnerable Americans across the country have the care they need.”
Under the Affordable Care Act, in 2014, insurers will be prohibited from denying coverage to any American with a pre-existing condition. Until then, the PCIP program will continue to provide enrollees with affordable insurance coverage.
In many cases, PCIP participants have been diagnosed with and need treatment for serious health care conditions such as cancer, ischemic heart disease, degenerative bone diseases and hemophilia. As a result of the new law, PCIP enrollees are receiving health services for their conditions on the first day their insurance coverage begins. Their critical need for treatment, combined with their lack of prior health coverage has led to higher overall per-member claims costs in state-based PCIPs of approximately $29,000 per year, which is more than double the per member cost that traditional State High Risk Pools have experienced in recent years.
Enrollment in PCIP has seen a nearly 400 percent increase from November 2010 to November 2011. PCIP enrollment is anticipated to trend upwards of 50,000 enrollees within the coming month.
People who enroll in the PCIP program are not charged a higher premium because of their medical condition. Program participants pay comparable premium rates to healthy people in the individual insurance market. By law, premiums may vary only on the basis of age, geographic area and tobacco use.
PCIP provides comprehensive health coverage, including primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care, preventive health and maternity care. The program is available in 50 states and the District of Columbia and open to U.S. citizens and people who reside in the U.S. legally (regardless of income) who have been without insurance coverage for at least six months, and have a pre-existing condition, or have been denied health insurance coverage because of a health condition.
The Affordable Care Act directed the Secretary of HHS to carry out PCIP either directly or through a contract with a state or nonprofit entity. In 27 states, a state or nonprofit entity elected to administer PCIP, while HHS operates the program in the remaining 23 states and the District of Columbia.
The new report can be found at: http://www.cciio.cms.gov/resources/files/Files2/02242012/pcip-annual-report.pdf
For more information, including eligibility, plan benefits and rates, as well as information on how to apply, visit www.pcip.gov and click on “Find Your State.” Then select your state from a map of the United States or from the drop-down menu.
The PCIP call center is open from 8 a.m. to 11 p.m. Eastern Time. Call toll-free 1-866-717-5826 (TTY 1-866-561-1604).
Source: HHS News Release
Friday, February 17, 2012
HHS: Progress With HIT
The U.S. Department of Health and Human Services’ (HHS) Secretary Kathleen Sebelius announced the number of hospitals using health information technology (IT) has more than doubled in the last two years. She also announced new data showing nearly 2,000 hospitals and more than 41,000 doctors have received $3.1 billion in incentive payments for ensuring meaningful use of health IT, particularly certified Electronic Health Records (EHR).
Secretary Sebelius is in Kansas City, Missouri visiting Metropolitan Community College-Penn Valley Health Science Institute to make this announcement and discuss the growth of professional jobs in the health information technology field.
“Health IT is the foundation for a truly 21st century health system where we pay for the right care, not just more care,” said Secretary Sebelius. “Health care professionals and hospitals are taking advantage of this unprecedented opportunity to begin using smarter, new technology that improves care and creates the jobs we need for an economy built to last.”
The announcement details information from a new survey conducted by the American Hospital Association and reported by the HHS Office of the National Coordinator for Health IT which found that the percentage of U.S. hospitals that had adopted EHRs has more than doubled from 16 to 35 percent between 2009 and 2011. And, 85 percent of hospitals now report that by 2015 they intend to take advantage of the incentive payments made available through the Medicare and Medicaid EHR Incentive Programs.
The announcement also highlights new data from the Centers for Medicare & Medicaid Services (CMS) detailing $3.12 billion in incentive payments the agency has made to physicians, hospitals, and other health care providers who have started to meaningfully use EHRs to improve the quality of patient care. In January alone, CMS provided $519 million to eligible providers. EHR incentive payments can total as much as $44,000 under the Medicare EHR Incentive Program and $63,750 under the Medicaid EHR Incentive Program.
According to the Bureau of Labor Statistics, the number of health IT jobs across the country is expected to increase by 20 percent from 2008 to 2018, a pace much faster than the average for all occupations through 2018. In conjunction with her announcement, Secretary Sebelius will tour the Penn Valley Community College Health Science Institute, which trains students for careers in this growing industry. She will also participate in a roundtable discussion with Community College leaders, students training in the health IT field, health care providers, patients and area employers about the importance of health information technology training in both improving patient outcomes and creating jobs.
The Obama administration provides financial support to eligible health care professionals and hospitals to make the switch to health IT and certified EHRs through the Medicare and Medicaid EHR Incentive Programs. These programs are funded by the HITECH Act provisions of the 2009 Recovery Act. The administration has also created a nationwide network of 62 Regional Extension Centers to provide technical guidance and resources to help eligible health care providers participate in the EHR Incentive Programs and meaningfully use certified EHRs.
To meet the demand for workers with health IT experience and training, the Obama Administration has also launched four workforce training programs. Training is provided through 82 community colleges and nine universities nationwide. As of January 2012, over 9,000 community college students have been trained for health IT careers and another 8,706 students have enrolled. And as of February 2012, participating universities have enrolled over 1,200 students and graduated nearly 600 post-graduate and masters-level health IT professionals, with over 1,700 expected to graduate by the summer of 2013.
Two other workforce training programs have resulted in the development of a health IT workforce curriculum and a health IT worker competency examination. The health IT workforce curriculum offers colleges and universities in all 50 states innovative health IT teaching materials at no cost to instructors. And, since its release in May, 2011, over 2,000 individuals have taken the HIT Pro Exam, a competency examination designed to show employers that job-seekers have attained a proficient level of knowledge and skills in health IT.
Health IT can help keep information private and secure. In addition, federal laws require key persons and organizations that handle health information to have policies and security safeguards in place to protect health information—whether it is stored on paper or electronically.
For more information on how health IT can lead to safer, better, and more efficient care, visit http://www.healthit.gov/
For more information about the Medicare and Medicaid EHR Incentive Programs, see http://www.cms.gov/EHRIncentivePrograms
For more information about the HHS Recovery Act health IT programs see http://www.hhs.gov/recovery/announcements/by_topic.html#hit
Source: HHS News Release
Secretary Sebelius is in Kansas City, Missouri visiting Metropolitan Community College-Penn Valley Health Science Institute to make this announcement and discuss the growth of professional jobs in the health information technology field.
“Health IT is the foundation for a truly 21st century health system where we pay for the right care, not just more care,” said Secretary Sebelius. “Health care professionals and hospitals are taking advantage of this unprecedented opportunity to begin using smarter, new technology that improves care and creates the jobs we need for an economy built to last.”
The announcement details information from a new survey conducted by the American Hospital Association and reported by the HHS Office of the National Coordinator for Health IT which found that the percentage of U.S. hospitals that had adopted EHRs has more than doubled from 16 to 35 percent between 2009 and 2011. And, 85 percent of hospitals now report that by 2015 they intend to take advantage of the incentive payments made available through the Medicare and Medicaid EHR Incentive Programs.
The announcement also highlights new data from the Centers for Medicare & Medicaid Services (CMS) detailing $3.12 billion in incentive payments the agency has made to physicians, hospitals, and other health care providers who have started to meaningfully use EHRs to improve the quality of patient care. In January alone, CMS provided $519 million to eligible providers. EHR incentive payments can total as much as $44,000 under the Medicare EHR Incentive Program and $63,750 under the Medicaid EHR Incentive Program.
According to the Bureau of Labor Statistics, the number of health IT jobs across the country is expected to increase by 20 percent from 2008 to 2018, a pace much faster than the average for all occupations through 2018. In conjunction with her announcement, Secretary Sebelius will tour the Penn Valley Community College Health Science Institute, which trains students for careers in this growing industry. She will also participate in a roundtable discussion with Community College leaders, students training in the health IT field, health care providers, patients and area employers about the importance of health information technology training in both improving patient outcomes and creating jobs.
The Obama administration provides financial support to eligible health care professionals and hospitals to make the switch to health IT and certified EHRs through the Medicare and Medicaid EHR Incentive Programs. These programs are funded by the HITECH Act provisions of the 2009 Recovery Act. The administration has also created a nationwide network of 62 Regional Extension Centers to provide technical guidance and resources to help eligible health care providers participate in the EHR Incentive Programs and meaningfully use certified EHRs.
To meet the demand for workers with health IT experience and training, the Obama Administration has also launched four workforce training programs. Training is provided through 82 community colleges and nine universities nationwide. As of January 2012, over 9,000 community college students have been trained for health IT careers and another 8,706 students have enrolled. And as of February 2012, participating universities have enrolled over 1,200 students and graduated nearly 600 post-graduate and masters-level health IT professionals, with over 1,700 expected to graduate by the summer of 2013.
Two other workforce training programs have resulted in the development of a health IT workforce curriculum and a health IT worker competency examination. The health IT workforce curriculum offers colleges and universities in all 50 states innovative health IT teaching materials at no cost to instructors. And, since its release in May, 2011, over 2,000 individuals have taken the HIT Pro Exam, a competency examination designed to show employers that job-seekers have attained a proficient level of knowledge and skills in health IT.
Health IT can help keep information private and secure. In addition, federal laws require key persons and organizations that handle health information to have policies and security safeguards in place to protect health information—whether it is stored on paper or electronically.
For more information on how health IT can lead to safer, better, and more efficient care, visit http://www.healthit.gov/
For more information about the Medicare and Medicaid EHR Incentive Programs, see http://www.cms.gov/EHRIncentivePrograms
For more information about the HHS Recovery Act health IT programs see http://www.hhs.gov/recovery/announcements/by_topic.html#hit
Source: HHS News Release
Health Reform to Require Insurers to Use Plain Language in Describing Health Plan Benefits, Coverage
People in the market for health insurance will soon have clear, understandable and straightforward information on what health plans will cover, what limitations or conditions will apply, and what they will pay for services thanks to the Affordable Care Act – the health reform law – according to final regulations published.
The marketing materials that insurers use can sometimes make it difficult for consumers to understand exactly what they are buying. The new rules, published jointly by the Departments of Health and Human Services, Labor and Treasury, require health insurers and group health plans to provide concise and comprehensible information about health plan benefits and coverage to the millions of Americans with private health coverage. The new rules will also make it easier for people and employers to directly compare one plan to another.
“All consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing,” said HHS Secretary Kathleen Sebelius. “This will give them a new edge in deciding which plan will best suit their needs and those of their families or employees.”
Under the rule, health insurers must provide consumers with clear, consistent and comparable summary information about their health plan benefits and coverage. The new explanations, which will be available beginning, or soon after, September 23, 2012 will be a critical resource for the roughly 150 million Americans with private health insurance today.
Specifically, these rules will ensure consumers have access to two key documents that will help them understand and evaluate their health insurance choices:
- A short, easy-to-understand Summary of Benefits and Coverage ( or “SBC”); and
- A uniform glossary of terms commonly used in health insurance coverage, such as “deductible” and “co-payment.”
All health plans and insurers will provide an SBC to shoppers and enrollees at important points in the enrollment process, such as upon application and at renewal.
A key feature of the SBC is a new, standardized plan comparison tool called “coverage examples,” similar to the Nutrition Facts label required for packaged foods. The coverage examples will illustrate sample medical situations and describe how much coverage the plan would provide in an event such as having a baby (normal delivery) or managing Type II diabetes (routine maintenance, well-controlled) These examples will help consumers understand and compare what they would have to pay under each plan they are considering.
The rules finalize the proposed rules issued in August 2011. Input was received from such stakeholders as the National Association of Insurance Commissioners (NAIC) and a working group composed of health insurance-related consumer advocacy organizations, health insurers, health care professionals, patient advocates including those representing people with limited English proficiency, and others. The final rules aim to ensure strong consumer information while minimizing paperwork and cost.
To view the template for the Summary of Benefits and Coverage and the glossary, visit: http://cciio.cms.gov/resources/other/index.html#sbcug
To view the Final Rule, visit: http://www.ofr.gov/inspection.aspx
For more information on the rules announced today, visit: http://www.healthcare.gov/news/factsheets/2011/08/labels08172011a.html
Source: HHS News Release
The marketing materials that insurers use can sometimes make it difficult for consumers to understand exactly what they are buying. The new rules, published jointly by the Departments of Health and Human Services, Labor and Treasury, require health insurers and group health plans to provide concise and comprehensible information about health plan benefits and coverage to the millions of Americans with private health coverage. The new rules will also make it easier for people and employers to directly compare one plan to another.
“All consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing,” said HHS Secretary Kathleen Sebelius. “This will give them a new edge in deciding which plan will best suit their needs and those of their families or employees.”
Under the rule, health insurers must provide consumers with clear, consistent and comparable summary information about their health plan benefits and coverage. The new explanations, which will be available beginning, or soon after, September 23, 2012 will be a critical resource for the roughly 150 million Americans with private health insurance today.
Specifically, these rules will ensure consumers have access to two key documents that will help them understand and evaluate their health insurance choices:
- A short, easy-to-understand Summary of Benefits and Coverage ( or “SBC”); and
- A uniform glossary of terms commonly used in health insurance coverage, such as “deductible” and “co-payment.”
All health plans and insurers will provide an SBC to shoppers and enrollees at important points in the enrollment process, such as upon application and at renewal.
A key feature of the SBC is a new, standardized plan comparison tool called “coverage examples,” similar to the Nutrition Facts label required for packaged foods. The coverage examples will illustrate sample medical situations and describe how much coverage the plan would provide in an event such as having a baby (normal delivery) or managing Type II diabetes (routine maintenance, well-controlled) These examples will help consumers understand and compare what they would have to pay under each plan they are considering.
The rules finalize the proposed rules issued in August 2011. Input was received from such stakeholders as the National Association of Insurance Commissioners (NAIC) and a working group composed of health insurance-related consumer advocacy organizations, health insurers, health care professionals, patient advocates including those representing people with limited English proficiency, and others. The final rules aim to ensure strong consumer information while minimizing paperwork and cost.
To view the template for the Summary of Benefits and Coverage and the glossary, visit: http://cciio.cms.gov/resources/other/index.html#sbcug
To view the Final Rule, visit: http://www.ofr.gov/inspection.aspx
For more information on the rules announced today, visit: http://www.healthcare.gov/news/factsheets/2011/08/labels08172011a.html
Source: HHS News Release
New Health care Law Helps Expand Primary Care Physician Workforce
The National Health Service Corps (NHSC) awarded $9.1 million in funding to medical students in 30 States and the District of Columbia who will serve as primary care doctors and help strengthen the health care workforce, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced at the Eisner Pediatric and Family Medical Center, a community health center in Los Angeles, Calif.
Made possible by the Affordable Care Act (the new health care law), the National Health Service Corps’ Students to Service Loan Repayment Program provides financial support to fourth year medical students who are committed to a career in primary care in exchange for their service in communities with limited access to care.
“This new program is an innovative approach to encouraging more medical students to work as primary care doctors,” said Secretary Sebelius. “This is an important part of the Administration’s commitment to building the future health care workforce.”
Administered by HHS’ Health Resources and Services Administration (HRSA), Students to Service is a pilot program that provides loan repayment assistance of up to $120,000 to medical students (MDs and DOs) in their last year of education. In return, they commit to serve in a health professional shortage area upon completion of a primary care residency program.
“The average medical school debt of the students receiving these awards is more than $200,000,” said HRSA Administrator Mary K. Wakefield, Ph.D., R.N. “The Students to Service program relieves a tremendous debt burden, allowing them to follow their passion for primary care and serve some of the country’s most underserved rural and urban communities.”
These newest NHSC providers must serve three years of full-time service or six years of half-time service in rural and urban areas of greatest need.
Alongside current NHSC members, Secretary Sebelius spoke with Eric Schluederberg, one of the awardees announced today and a 4th year medical student at Western University of Health Sciences in Pomona, Calif. He was always attracted to the field of primary care, but the story of his fiancé, Nancy, who has Spina Bifida, has helped inspire him to serve in the NHSC and ensure that women get the pre-natal care they need.
“I always knew my calling was primary care, “Mr. Schluederberg said. “I’m not a social researcher, and I’m not an economist. But it seems that there are a lot of underserved people in this nation, and that providing sound primary care is a good economic investment. For example, ensuring that pregnant women know to take folic acid supplements is one way to prevent the cost of the numerous surgeries required to help someone with Spina Bifida become an independent member of society.”
With significant investment from the Affordable Care Act, thousands of new primary health care providers have been added to the ranks of the NHSC. The awardees will join the many NHSC providers already serving and providing culturally competent primary care at more than 14,000 health care sites in urban, rural, and frontier areas.
The NHSC provides financial, professional, and educational resources to medical, dental, and mental and behavioral health care providers who bring their skills to areas of the United States with limited access to health care. The NHSC was established in 1972 and has connected over 41,000 primary health care practitioners to communities all over America.
For more information about NHSC programs, please visit http://www.NHSC.hrsa.gov.
Source: HHS News Release
Made possible by the Affordable Care Act (the new health care law), the National Health Service Corps’ Students to Service Loan Repayment Program provides financial support to fourth year medical students who are committed to a career in primary care in exchange for their service in communities with limited access to care.
“This new program is an innovative approach to encouraging more medical students to work as primary care doctors,” said Secretary Sebelius. “This is an important part of the Administration’s commitment to building the future health care workforce.”
Administered by HHS’ Health Resources and Services Administration (HRSA), Students to Service is a pilot program that provides loan repayment assistance of up to $120,000 to medical students (MDs and DOs) in their last year of education. In return, they commit to serve in a health professional shortage area upon completion of a primary care residency program.
“The average medical school debt of the students receiving these awards is more than $200,000,” said HRSA Administrator Mary K. Wakefield, Ph.D., R.N. “The Students to Service program relieves a tremendous debt burden, allowing them to follow their passion for primary care and serve some of the country’s most underserved rural and urban communities.”
These newest NHSC providers must serve three years of full-time service or six years of half-time service in rural and urban areas of greatest need.
Alongside current NHSC members, Secretary Sebelius spoke with Eric Schluederberg, one of the awardees announced today and a 4th year medical student at Western University of Health Sciences in Pomona, Calif. He was always attracted to the field of primary care, but the story of his fiancé, Nancy, who has Spina Bifida, has helped inspire him to serve in the NHSC and ensure that women get the pre-natal care they need.
“I always knew my calling was primary care, “Mr. Schluederberg said. “I’m not a social researcher, and I’m not an economist. But it seems that there are a lot of underserved people in this nation, and that providing sound primary care is a good economic investment. For example, ensuring that pregnant women know to take folic acid supplements is one way to prevent the cost of the numerous surgeries required to help someone with Spina Bifida become an independent member of society.”
With significant investment from the Affordable Care Act, thousands of new primary health care providers have been added to the ranks of the NHSC. The awardees will join the many NHSC providers already serving and providing culturally competent primary care at more than 14,000 health care sites in urban, rural, and frontier areas.
The NHSC provides financial, professional, and educational resources to medical, dental, and mental and behavioral health care providers who bring their skills to areas of the United States with limited access to health care. The NHSC was established in 1972 and has connected over 41,000 primary health care practitioners to communities all over America.
For more information about NHSC programs, please visit http://www.NHSC.hrsa.gov.
Source: HHS News Release
Health Care Fraud Prevention and Enforcement Efforts Result in Record-Breaking Recoveries Totaling Nearly $4.1 Billion
Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius released a new report showing that the government’s health care fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in Fiscal Year (FY) 2011. This is the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers or who sought payments to which they were not entitled.
These findings, released today, in the annual Health Care Fraud and Abuse Control Program (HCFAC) report, are a result of President Obama making the elimination of fraud, waste and abuse a top priority in his administration. The success of this joint Department of Justice and HHS effort would not have been possible without the Health Care Fraud Prevention & Enforcement Action Team (HEAT), created in 2009 to prevent fraud, waste and abuse in the Medicare and Medicaid programs, and to crack down on the fraud perpetrators who are abusing the system and costing American taxpayers billions of dollars. These efforts to reduce fraud will continue to improve with the new tools and resources provided by the Affordable Care Act.
“This report reflects unprecedented successes by the Departments of Justice and Health and Human Services in aggressively preventing and combating health care fraud, safeguarding precious taxpayer dollars and ensuring the strength of our essential health care programs,” said Attorney General Holder. “We can all be proud of what's been achieved in the last fiscal year by the Department’s prosecutors, analysts and investigators – and by our partners at HHS. These efforts reflect a strong, ongoing commitment to fiscal accountability and to helping the American people at a time when budgets are tight.”
“Fighting fraud is one of our top priorities and we have recovered an unprecedented number of taxpayer dollars,” said Secretary Sebelius. “Our efforts strengthen the integrity of our health care programs, and meet the President’s call for a return to American values that ensure everyone gets a fair shot, everyone does their fair share, and everyone plays by the same rules.”
Approximately $4.1 billion stolen or otherwise improperly obtained from federal health care programs was recovered and returned to the Medicare Trust Funds, the Treasury and others in FY 2011. This is an unprecedented achievement for HCFAC, a joint effort of the two departments to coordinate federal, state and local law enforcement activities to fight health care fraud and abuse.
The recently-enacted Affordable Care Act provides additional tools and resources to help fight fraud that will help boost these efforts, including an additional $350 million for HCFAC activities. The administration is already using tools authorized by the Affordable Care Act, including enhanced screenings and enrollment requirements, increased data sharing across government, expanded overpayment recovery efforts and greater oversight of private insurance abuses.
Since 2009, the Departments of Justice and HHS have enhanced their coordination through HEAT and have increased the number of Medicare Fraud Strike Force teams. During FY 2011, HEAT and the Medicare Fraud Strike Force expanded local partnerships and helped educate Medicare beneficiaries about how to protect themselves against fraud. The departments hosted a series of regional fraud prevention summits around the country, provided free compliance training for providers and other stakeholders and sent letters to state attorneys general urging them to work with HHS and federal, state and local law enforcement officials to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud.
In FY 2011, the total number of cities with strike force prosecution teams was increased to nine, all of which have teams of investigators and prosecutors from the Justice Department, the FBI, and the HHS Office of Inspector General, dedicated to fighting fraud. The strike force teams use advanced data analysis techniques to identify high-billing levels in health care fraud hot spots so that interagency teams can target emerging or migrating schemes along with chronic fraud by criminals masquerading as health care providers or suppliers. In FY 2011, strike force operations charged a record number of 323 defendants, who allegedly collectively billed the Medicare program more than $1 billion. Strike force teams secured 172 guilty pleas, convicted 26 defendants at trial and sentenced 175 defendants to prison. The average prison sentence in strike force cases in FY 2011 was more than 47 months.
Including strike force matters, federal prosecutors filed criminal charges against a total of 1,430 defendants for health care fraud related crimes. This is the highest number of health care fraud defendants charged in a single year in the department’s history. Including strike force matters, a total of 743 defendants were convicted for health care fraud-related crimes during the year.
In criminal matters involving the pharmaceutical and device manufacturing industry, the department obtained 21 criminal convictions and $1.3 billion in criminal fines, forfeitures, restitution and disgorgement under the Food, Drug and Cosmetic Act. These matters included the illegal marketing of medical devices and pharmaceutical products for uses not approved by the Food and Drug Administration (FDA) or the distribution of products that failed to conform to the strength, purity or quality required by the FDA.
The departments also continued their successes in civil health care fraud enforcement during FY 2011. Approximately $2.4 billion was recovered through civil health care fraud cases brought under the False Claims Act (FCA). These matters included unlawful pricing by pharmaceutical manufacturers, illegal marketing of medical devices and pharmaceutical products for uses not approved by the FDA, Medicare fraud by hospitals and other institutional providers, and violations of laws against self-referrals and kickbacks. This marked the second year in a row that more than $2 billion has been recovered in FCA health care matters and, since January 2009, the department has used the False Claims Act to recover more than $6.6 billion in federal health care dollars.
The fraud prevention and enforcement report coincides with the announcement of a proposed rule from the Centers for Medicare and Medicaid Services aimed at recollecting overpayments in the Medicare program. Before the Affordable Care Act, providers and suppliers did not face a deadline for returning taxpayers’ money. Thanks to the Affordable Care Act, there will be a specific timeframe by which self-identified overpayments must be returned. The Obama Administration has made prevention and recollection of overpayments a government-wide priority. These announcements are just the latest in a series of steps that the administration is taking to protect taxpayer dollars and keep money in the pockets of Americans.
The HCFAC annual report can be found here, oig.hhs.gov/publications/hcfac.asp. For more information on the joint DOJ-HHS Strike Force activities, visit: www.StopMedicareFraud.gov/.
For more information on the fraud prevention accomplishments under the Affordable Care Act visit: http://www.healthcare.gov/news/factsheets/2012/02/medicare-fraud02142012a.html
Source: HHS News Release
These findings, released today, in the annual Health Care Fraud and Abuse Control Program (HCFAC) report, are a result of President Obama making the elimination of fraud, waste and abuse a top priority in his administration. The success of this joint Department of Justice and HHS effort would not have been possible without the Health Care Fraud Prevention & Enforcement Action Team (HEAT), created in 2009 to prevent fraud, waste and abuse in the Medicare and Medicaid programs, and to crack down on the fraud perpetrators who are abusing the system and costing American taxpayers billions of dollars. These efforts to reduce fraud will continue to improve with the new tools and resources provided by the Affordable Care Act.
“This report reflects unprecedented successes by the Departments of Justice and Health and Human Services in aggressively preventing and combating health care fraud, safeguarding precious taxpayer dollars and ensuring the strength of our essential health care programs,” said Attorney General Holder. “We can all be proud of what's been achieved in the last fiscal year by the Department’s prosecutors, analysts and investigators – and by our partners at HHS. These efforts reflect a strong, ongoing commitment to fiscal accountability and to helping the American people at a time when budgets are tight.”
“Fighting fraud is one of our top priorities and we have recovered an unprecedented number of taxpayer dollars,” said Secretary Sebelius. “Our efforts strengthen the integrity of our health care programs, and meet the President’s call for a return to American values that ensure everyone gets a fair shot, everyone does their fair share, and everyone plays by the same rules.”
Approximately $4.1 billion stolen or otherwise improperly obtained from federal health care programs was recovered and returned to the Medicare Trust Funds, the Treasury and others in FY 2011. This is an unprecedented achievement for HCFAC, a joint effort of the two departments to coordinate federal, state and local law enforcement activities to fight health care fraud and abuse.
The recently-enacted Affordable Care Act provides additional tools and resources to help fight fraud that will help boost these efforts, including an additional $350 million for HCFAC activities. The administration is already using tools authorized by the Affordable Care Act, including enhanced screenings and enrollment requirements, increased data sharing across government, expanded overpayment recovery efforts and greater oversight of private insurance abuses.
Since 2009, the Departments of Justice and HHS have enhanced their coordination through HEAT and have increased the number of Medicare Fraud Strike Force teams. During FY 2011, HEAT and the Medicare Fraud Strike Force expanded local partnerships and helped educate Medicare beneficiaries about how to protect themselves against fraud. The departments hosted a series of regional fraud prevention summits around the country, provided free compliance training for providers and other stakeholders and sent letters to state attorneys general urging them to work with HHS and federal, state and local law enforcement officials to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud.
In FY 2011, the total number of cities with strike force prosecution teams was increased to nine, all of which have teams of investigators and prosecutors from the Justice Department, the FBI, and the HHS Office of Inspector General, dedicated to fighting fraud. The strike force teams use advanced data analysis techniques to identify high-billing levels in health care fraud hot spots so that interagency teams can target emerging or migrating schemes along with chronic fraud by criminals masquerading as health care providers or suppliers. In FY 2011, strike force operations charged a record number of 323 defendants, who allegedly collectively billed the Medicare program more than $1 billion. Strike force teams secured 172 guilty pleas, convicted 26 defendants at trial and sentenced 175 defendants to prison. The average prison sentence in strike force cases in FY 2011 was more than 47 months.
Including strike force matters, federal prosecutors filed criminal charges against a total of 1,430 defendants for health care fraud related crimes. This is the highest number of health care fraud defendants charged in a single year in the department’s history. Including strike force matters, a total of 743 defendants were convicted for health care fraud-related crimes during the year.
In criminal matters involving the pharmaceutical and device manufacturing industry, the department obtained 21 criminal convictions and $1.3 billion in criminal fines, forfeitures, restitution and disgorgement under the Food, Drug and Cosmetic Act. These matters included the illegal marketing of medical devices and pharmaceutical products for uses not approved by the Food and Drug Administration (FDA) or the distribution of products that failed to conform to the strength, purity or quality required by the FDA.
The departments also continued their successes in civil health care fraud enforcement during FY 2011. Approximately $2.4 billion was recovered through civil health care fraud cases brought under the False Claims Act (FCA). These matters included unlawful pricing by pharmaceutical manufacturers, illegal marketing of medical devices and pharmaceutical products for uses not approved by the FDA, Medicare fraud by hospitals and other institutional providers, and violations of laws against self-referrals and kickbacks. This marked the second year in a row that more than $2 billion has been recovered in FCA health care matters and, since January 2009, the department has used the False Claims Act to recover more than $6.6 billion in federal health care dollars.
The fraud prevention and enforcement report coincides with the announcement of a proposed rule from the Centers for Medicare and Medicaid Services aimed at recollecting overpayments in the Medicare program. Before the Affordable Care Act, providers and suppliers did not face a deadline for returning taxpayers’ money. Thanks to the Affordable Care Act, there will be a specific timeframe by which self-identified overpayments must be returned. The Obama Administration has made prevention and recollection of overpayments a government-wide priority. These announcements are just the latest in a series of steps that the administration is taking to protect taxpayer dollars and keep money in the pockets of Americans.
The HCFAC annual report can be found here, oig.hhs.gov/publications/hcfac.asp. For more information on the joint DOJ-HHS Strike Force activities, visit: www.StopMedicareFraud.gov/.
For more information on the fraud prevention accomplishments under the Affordable Care Act visit: http://www.healthcare.gov/news/factsheets/2012/02/medicare-fraud02142012a.html
Source: HHS News Release
HHS Says Consumers Get Better Value for Their Health Insurance Dollar
Health and Human Services Secretary Kathleen Sebelius announced that consumers will soon begin receiving unprecedented information on the value of their health insurance coverage, and some will receive rebates from insurance companies that spend less than 80 percent of their premium dollars on health care.
The Affordable Care Act requires that insurance companies this year begin notifying customers how much of their premiums they have spent on medical care and quality improvement. Beginning in 2011, insurers were required to spend at least 80 percent of total premium dollars they collect on medical care and quality improvement. Insurance companies that do not meet the 80/20 standard (also known as the Medical Loss Ratio) are required to pay rebates to their customers this year.
"Before the Affordable Care Act, insurance companies could spend your premium dollars on administrative red tape and marketing," said Secretary Sebelius. "With today's notice, we're taking a big step toward making insurers accountable to consumers. Some of these insurance companies have already changed their behavior by lowering premiums or spending more on medical care and quality improvement, while the remainder will need to refund this money to their customers this year."
The proposed consumer notices about whether their insurance company has met the new standard have been posted on HealthCare.gov, and HHS is seeking public comment to help ensure the notices are useful transparency tools for consumers.
In the individual market, the Affordable Care Act allows the Secretary to adjust the medical loss ratio standard for a state if it is determined that meeting that standard may destabilize the state’s individual insurance market. HHS has concluded its review of 18 state requests for adjustments to the medical loss ratio rule. As a result of HHS’ decision to deny insurance companies the ability to spend more premium dollars on administrative overhead costs rather than on medical claims, consumers will receive up to $323 million in rebates this year compared to what would have been owed if all state adjustment requests were fully granted, according to data from state regulators and issuer reports.
These adjustment request determinations were made as a result of a transparent and data-driven process, and the documentation related to each state’s request has been publicly posted.
In total, HHS determined that no adjustment was necessary in ten states, approved an altered adjustment in six states, and approved the request sought by one state. This includes a denied adjustment for Wisconsin, and an altered adjustment for North Carolina.
The announcement is part of the Obama Administration’s effort to increase transparency in the health insurance marketplace. The notification will let consumers know if their insurer did not meet the 80/20 standard -- and that they or their employer will receive a rebate. HHS is also considering requiring insurers notify consumers if their insurer did meet the 80/20 standard.
For the text of these proposed notifications, please visit: http://cciio.cms.gov/resources/other/index.html#mlr
For more information on the MLR provision in the Affordable Care Act, please visit: http://www.healthcare.gov/news/factsheets/2010/11/medical-loss-ratio.html
For documentation of state requests for MLR adjustments, including specific information on rebates saved by HHS’ MLR adjustment determinations, visit: http://cciio.cms.gov/programs/marketreforms/mlr/index.html
For more information on how the Affordable Care Act is creating a transparent market for health insurance, visit: http://www.healthcare.gov/news/factsheets/2010/12/increasing-transparency.html
Source: HHS News Release
The Affordable Care Act requires that insurance companies this year begin notifying customers how much of their premiums they have spent on medical care and quality improvement. Beginning in 2011, insurers were required to spend at least 80 percent of total premium dollars they collect on medical care and quality improvement. Insurance companies that do not meet the 80/20 standard (also known as the Medical Loss Ratio) are required to pay rebates to their customers this year.
"Before the Affordable Care Act, insurance companies could spend your premium dollars on administrative red tape and marketing," said Secretary Sebelius. "With today's notice, we're taking a big step toward making insurers accountable to consumers. Some of these insurance companies have already changed their behavior by lowering premiums or spending more on medical care and quality improvement, while the remainder will need to refund this money to their customers this year."
The proposed consumer notices about whether their insurance company has met the new standard have been posted on HealthCare.gov, and HHS is seeking public comment to help ensure the notices are useful transparency tools for consumers.
In the individual market, the Affordable Care Act allows the Secretary to adjust the medical loss ratio standard for a state if it is determined that meeting that standard may destabilize the state’s individual insurance market. HHS has concluded its review of 18 state requests for adjustments to the medical loss ratio rule. As a result of HHS’ decision to deny insurance companies the ability to spend more premium dollars on administrative overhead costs rather than on medical claims, consumers will receive up to $323 million in rebates this year compared to what would have been owed if all state adjustment requests were fully granted, according to data from state regulators and issuer reports.
These adjustment request determinations were made as a result of a transparent and data-driven process, and the documentation related to each state’s request has been publicly posted.
In total, HHS determined that no adjustment was necessary in ten states, approved an altered adjustment in six states, and approved the request sought by one state. This includes a denied adjustment for Wisconsin, and an altered adjustment for North Carolina.
The announcement is part of the Obama Administration’s effort to increase transparency in the health insurance marketplace. The notification will let consumers know if their insurer did not meet the 80/20 standard -- and that they or their employer will receive a rebate. HHS is also considering requiring insurers notify consumers if their insurer did meet the 80/20 standard.
For the text of these proposed notifications, please visit: http://cciio.cms.gov/resources/other/index.html#mlr
For more information on the MLR provision in the Affordable Care Act, please visit: http://www.healthcare.gov/news/factsheets/2010/11/medical-loss-ratio.html
For documentation of state requests for MLR adjustments, including specific information on rebates saved by HHS’ MLR adjustment determinations, visit: http://cciio.cms.gov/programs/marketreforms/mlr/index.html
For more information on how the Affordable Care Act is creating a transparent market for health insurance, visit: http://www.healthcare.gov/news/factsheets/2010/12/increasing-transparency.html
Source: HHS News Release
Monday, February 6, 2012
Bipartisan Policy Center Task Force Recommends More and Better Use of Health IT to Improve Quality and Reduce Costs
Recognizing that health information technology (IT) plays a critical role in improving the quality and cost-effectiveness of care, the Bipartisan Policy Center’s (BPC) Task Force on Delivery System Reform and Health IT today released a set of recommendations for the most effective use of health IT dollars to support delivery system and payment reforms to achieve improved health, better health care, and reductions in the cost of care. Click here to read the full report.
Watch the event video here.
The recommendations range from realigning incentives and payments to support higher quality, more cost-effective care to increasing the use of electronic health records (EHR) and health information exchange to improve care coordination by enabling doctors, hospitals, and patients to securely share health information when patients receive their care in multiple settings.
“There is strong bipartisan support for health IT, and for moving away from a payment model that largely focuses on volume — rewarding providers for doing more — rather than on quality outcomes or value,” said Senator Daschle, Co-leader of BPC’s Health Project at today’s release.
Health IT is seen as critical to supporting this shift in payment models, and as an essential improvement tool in a system where a patient’s records can be scattered throughout various health care offices and facilities.
“To deliver high-quality, cost-effective care, a physician or hospital needs good information,” said Senator Frist, who also co-leads BPC’s Health Project, at today’s event. “Data about patients has to flow across primary care physicians, hospitals, labs, and anywhere that patients receive care.”
The Task Force’s recommendations come during a time of unprecedented public and private spending on health IT. A record investment of nearly $30 billion was triggered by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, spurring significant investments by the private sector. A majority of the federal investment is in the form of incentive payments through the Medicare and Medicaid EHR Incentive Programs, informally known as “Meaningful Use.” The Task Force recommendations aim to channel these investments into health IT capabilities shown to be most effective at improving quality and reducing cost.
The Task Force recommends actions for aligning incentives and payment with higher quality, more cost-effective care, along with the health IT-enabled, coordinated, accountable, patient-centered delivery models that support such outcomes.
To further accelerate health information exchange, the Task Force recommends that the next phase of Meaningful Use and related standards and certification programs support the more robust exchange of standards-based data across multiple settings; public-private sector agreement on and execution of a common set of principles, policies and methods for exchange in the near-term; and the development and execution of a long-term strategy for the data standards and interoperability needs associated with delivering care, empowering patients, and improving population health.
Educating consumers about the benefits of electronic tools, and promoting their use, is an additional focus of the Task Force’s recommendations. “We need a bold campaign to raise awareness among consumers about the benefits of using these tools,” said BPC Health Project State Co-Chair and former Governor Ted Strickland. “We need to make it easier for consumers to navigate the health care system and take control of their health.”
The Task Force also recommends several actions to promote the use of electronic tools to improve patient-provider communication, coordinate care, expand access and empower individuals to manage their health and health care. They include expanding considerably upon the current consumer awareness campaign; educating and supporting providers in the adoption of electronic tools to support patient engagement; and making tools widely available so that patients can easily download health information from their provider’s EHR into their own personal health record.
The Task Force also recognizes that it is necessary to issue consistent, comprehensive and clear guidance on federal privacy and security laws covering personal health information and calls for consistent protection of personal health information.
Additionally, the Task Force calls for an expansion of education and implementation assistance programs to help providers achieve Meaningful Use – with a particular focus on small physician practices and community hospitals and clinics that deliver care to rural and underserved populations.
Finally, the Task Force recommends further alignment of health IT requirements across federal health care programs so that common health IT solutions can meet the multiple needs of programs supporting delivery system transformation, payment, public health, coverage and access, and administrative improvement. The Task Force urges coordination of quality measurement programs and alignment of measurement specifications with federally adopted data standards.
“Coordinated, accountable, patient-centered models of care—previously implemented by only a handful of high-performing organizations—are poised for more widespread adoption,” said Janet Marchibroda, Chair of BPC’s Health IT Initiative. “Health IT not only plays a critical role in the success of these organizations, it also enables the rapid spread of the very functions that have made these models successful, to the rest of the U.S. health care system.”
The Task Force included 24 nationally recognized and respected health system experts and leaders. Findings were based on a review of the literature and in-depth interviews with nearly 40 high-performing health care organizations. For a full list of Task Force members, click here.
Source: Bipartisan Policy Center News Release
Watch the event video here.
The recommendations range from realigning incentives and payments to support higher quality, more cost-effective care to increasing the use of electronic health records (EHR) and health information exchange to improve care coordination by enabling doctors, hospitals, and patients to securely share health information when patients receive their care in multiple settings.
“There is strong bipartisan support for health IT, and for moving away from a payment model that largely focuses on volume — rewarding providers for doing more — rather than on quality outcomes or value,” said Senator Daschle, Co-leader of BPC’s Health Project at today’s release.
Health IT is seen as critical to supporting this shift in payment models, and as an essential improvement tool in a system where a patient’s records can be scattered throughout various health care offices and facilities.
“To deliver high-quality, cost-effective care, a physician or hospital needs good information,” said Senator Frist, who also co-leads BPC’s Health Project, at today’s event. “Data about patients has to flow across primary care physicians, hospitals, labs, and anywhere that patients receive care.”
The Task Force’s recommendations come during a time of unprecedented public and private spending on health IT. A record investment of nearly $30 billion was triggered by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, spurring significant investments by the private sector. A majority of the federal investment is in the form of incentive payments through the Medicare and Medicaid EHR Incentive Programs, informally known as “Meaningful Use.” The Task Force recommendations aim to channel these investments into health IT capabilities shown to be most effective at improving quality and reducing cost.
The Task Force recommends actions for aligning incentives and payment with higher quality, more cost-effective care, along with the health IT-enabled, coordinated, accountable, patient-centered delivery models that support such outcomes.
To further accelerate health information exchange, the Task Force recommends that the next phase of Meaningful Use and related standards and certification programs support the more robust exchange of standards-based data across multiple settings; public-private sector agreement on and execution of a common set of principles, policies and methods for exchange in the near-term; and the development and execution of a long-term strategy for the data standards and interoperability needs associated with delivering care, empowering patients, and improving population health.
Educating consumers about the benefits of electronic tools, and promoting their use, is an additional focus of the Task Force’s recommendations. “We need a bold campaign to raise awareness among consumers about the benefits of using these tools,” said BPC Health Project State Co-Chair and former Governor Ted Strickland. “We need to make it easier for consumers to navigate the health care system and take control of their health.”
The Task Force also recommends several actions to promote the use of electronic tools to improve patient-provider communication, coordinate care, expand access and empower individuals to manage their health and health care. They include expanding considerably upon the current consumer awareness campaign; educating and supporting providers in the adoption of electronic tools to support patient engagement; and making tools widely available so that patients can easily download health information from their provider’s EHR into their own personal health record.
The Task Force also recognizes that it is necessary to issue consistent, comprehensive and clear guidance on federal privacy and security laws covering personal health information and calls for consistent protection of personal health information.
Additionally, the Task Force calls for an expansion of education and implementation assistance programs to help providers achieve Meaningful Use – with a particular focus on small physician practices and community hospitals and clinics that deliver care to rural and underserved populations.
Finally, the Task Force recommends further alignment of health IT requirements across federal health care programs so that common health IT solutions can meet the multiple needs of programs supporting delivery system transformation, payment, public health, coverage and access, and administrative improvement. The Task Force urges coordination of quality measurement programs and alignment of measurement specifications with federally adopted data standards.
“Coordinated, accountable, patient-centered models of care—previously implemented by only a handful of high-performing organizations—are poised for more widespread adoption,” said Janet Marchibroda, Chair of BPC’s Health IT Initiative. “Health IT not only plays a critical role in the success of these organizations, it also enables the rapid spread of the very functions that have made these models successful, to the rest of the U.S. health care system.”
The Task Force included 24 nationally recognized and respected health system experts and leaders. Findings were based on a review of the literature and in-depth interviews with nearly 40 high-performing health care organizations. For a full list of Task Force members, click here.
Source: Bipartisan Policy Center News Release
Health Reform Saves $2.1b for 3.6m Americans With Medicare
Nearly 3.6 million people with Medicare saved $2.1 billion on their prescription drugs in 2011 thanks to the Affordable Care Act according to data issued by the Department of Health and Human Services (HHS). Savings for people with Medicare will increase over time. According to a new report issued today from HHS, the average person with Medicare will save nearly $4,200 by 2021 because of the new law.
“The Affordable Care Act is already saving money for millions of Americans with Medicare,” said HHS Secretary Kathleen Sebelius. “As we move forward, we will close the donut hole completely and save even more money for everyone with Medicare.”
The Affordable Care Act provides a 50 percent discount on brand-name prescription drugs and this year, a 14% discount on generics. Last year, it provided a seven percent discount on covered generic medications for people who hit the prescription drug coverage gap known as the donut hole, with 2,814,646 beneficiaries receiving $32.1 million in savings on generics.
In 2011, the 3.6 million Americans who hit the donut hole saved an average of $604 on the cost of their prescription drugs.
Data also show that women especially benefitted from the law’s provision with 2.05 million women saving $1.2 billion on their prescription drugs.
By 2020, the donut hole will be closed completely. The new report released today by the Department of Health and Human Services finds that this provision and other features of the health reform law will generate substantial savings for people with Medicare. Typical Medicare beneficiaries will save an average of nearly $4,200 from 2011 to 2021. People with high prescription drug costs could save as much as $16,000.
The savings are a product of provisions in the Affordable Care Act and other cost trends that:
-Decrease prescription drug costs for seniors
-Make preventive services like mammograms free for everyone in Medicare
-Reduce growth in Part B premiums (for physician services)
-Reduce growth in cost-sharing under both Parts A (hospital care) and Part B.
These announcements come after HHS announced that in 2012, Medicare Advantage premiums have fallen by seven percent on average and enrollment has risen by about 10 percent since last year. For more details on that announcement, visit http://www.hhs.gov/news/press/2012pres/02/20120201a.html
For state-by-state savings figures for donut hole announcement, visit: http://www.cms.gov/Plan-Payment/
For a fact sheet about donut hole savings, visit http://www.cms.gov/apps/media/fact_sheets.asp
F
or the report regarding savings those with Medicare will see over time, visit http://aspe.hhs.gov/hp/reports/2012/MedicareBeneficiarySavings/ib.shtml
Source: HHS News Release
“The Affordable Care Act is already saving money for millions of Americans with Medicare,” said HHS Secretary Kathleen Sebelius. “As we move forward, we will close the donut hole completely and save even more money for everyone with Medicare.”
The Affordable Care Act provides a 50 percent discount on brand-name prescription drugs and this year, a 14% discount on generics. Last year, it provided a seven percent discount on covered generic medications for people who hit the prescription drug coverage gap known as the donut hole, with 2,814,646 beneficiaries receiving $32.1 million in savings on generics.
In 2011, the 3.6 million Americans who hit the donut hole saved an average of $604 on the cost of their prescription drugs.
Data also show that women especially benefitted from the law’s provision with 2.05 million women saving $1.2 billion on their prescription drugs.
By 2020, the donut hole will be closed completely. The new report released today by the Department of Health and Human Services finds that this provision and other features of the health reform law will generate substantial savings for people with Medicare. Typical Medicare beneficiaries will save an average of nearly $4,200 from 2011 to 2021. People with high prescription drug costs could save as much as $16,000.
The savings are a product of provisions in the Affordable Care Act and other cost trends that:
-Decrease prescription drug costs for seniors
-Make preventive services like mammograms free for everyone in Medicare
-Reduce growth in Part B premiums (for physician services)
-Reduce growth in cost-sharing under both Parts A (hospital care) and Part B.
These announcements come after HHS announced that in 2012, Medicare Advantage premiums have fallen by seven percent on average and enrollment has risen by about 10 percent since last year. For more details on that announcement, visit http://www.hhs.gov/news/press/2012pres/02/20120201a.html
For state-by-state savings figures for donut hole announcement, visit: http://www.cms.gov/Plan-Payment/
For a fact sheet about donut hole savings, visit http://www.cms.gov/apps/media/fact_sheets.asp
F
or the report regarding savings those with Medicare will see over time, visit http://aspe.hhs.gov/hp/reports/2012/MedicareBeneficiarySavings/ib.shtml
Source: HHS News Release
Wednesday, February 1, 2012
Medicare Advantage Premiums Fall; Enrollment Up
Medicare Advantage premiums have fallen by 7 percent on average and enrollment has risen by about 10 percent since this time last year, HHS Secretary Kathleen Sebelius announced.
The enrollment numbers confirm projections from last September that enrollment in Medicare Advantage plans would continue to rise and average premiums would continue to fall. Average premiums have fallen from $33.97 in 2011, to $31.54 in 2012, while enrollment has risen from 11.7 million in 2011 to 12.8 million in 2012.
“The Medicare Advantage program is stronger than ever,” said Secretary Sebelius. “Premiums are down on average, enrollment is up, and thanks to the Affordable Care Act we have unprecedented new tools to ensure that seniors and people with disabilities are getting the best value out of their coverage.”
In addition to the enrollment and premium numbers, there is more evidence that the Medicare Advantage program remains strong:
- On average, there are 26 Medicare Advantage plans to choose from in nearly every county across the country;
- Access to Medicare Advantage remains strong: 99.7 percent of Medicare beneficiaries have access to a Medicare Advantage plan; and
- Since 2010, when the Affordable Care Act was passed, Medicare Advantage premiums have fallen by 16 percent and enrollment has climbed by 17 percent.
“Not only are average premiums lower, but plans are better, with more beneficiaries enrolled in 4 and 5 star plans,” said CMS Acting Administrator Marilyn Tavenner. “The Affordable Care Act has strengthened Medicare Advantage by motivating plans to improve the quality of their coverage.”
In 2012, thanks to the Affordable Care Act, Medicare Advantage plans will start receiving incentives to achieve high quality scores through the use of quality bonus payments. As an extra incentive for high quality performance, CMS is allowing Five-Star Medicare Advantage and Part D plans to continuously market and enroll beneficiaries throughout the year.
To find the most recent publicly available MA and Part D contract and enrollment data, visit: http://www.cms.gov/MCRAdvPartDEnrolData/MCESR/list.asp#TopOfPage
Source: HHS News Release
The enrollment numbers confirm projections from last September that enrollment in Medicare Advantage plans would continue to rise and average premiums would continue to fall. Average premiums have fallen from $33.97 in 2011, to $31.54 in 2012, while enrollment has risen from 11.7 million in 2011 to 12.8 million in 2012.
“The Medicare Advantage program is stronger than ever,” said Secretary Sebelius. “Premiums are down on average, enrollment is up, and thanks to the Affordable Care Act we have unprecedented new tools to ensure that seniors and people with disabilities are getting the best value out of their coverage.”
In addition to the enrollment and premium numbers, there is more evidence that the Medicare Advantage program remains strong:
- On average, there are 26 Medicare Advantage plans to choose from in nearly every county across the country;
- Access to Medicare Advantage remains strong: 99.7 percent of Medicare beneficiaries have access to a Medicare Advantage plan; and
- Since 2010, when the Affordable Care Act was passed, Medicare Advantage premiums have fallen by 16 percent and enrollment has climbed by 17 percent.
“Not only are average premiums lower, but plans are better, with more beneficiaries enrolled in 4 and 5 star plans,” said CMS Acting Administrator Marilyn Tavenner. “The Affordable Care Act has strengthened Medicare Advantage by motivating plans to improve the quality of their coverage.”
In 2012, thanks to the Affordable Care Act, Medicare Advantage plans will start receiving incentives to achieve high quality scores through the use of quality bonus payments. As an extra incentive for high quality performance, CMS is allowing Five-Star Medicare Advantage and Part D plans to continuously market and enroll beneficiaries throughout the year.
To find the most recent publicly available MA and Part D contract and enrollment data, visit: http://www.cms.gov/MCRAdvPartDEnrolData/MCESR/list.asp#TopOfPage
Source: HHS News Release
Monday, January 30, 2012
Innovation Center Report Released
A national center set up a year ago to test and implement new ways to improve patient care while cutting costs has delivered its first report. The Center for Medicare and Medicaid Innovation was created by the health care reform act.
It has funded 16 initiatives since it began operations, primarily focused on incentives for delivering care to Medicare, Medicaid, and the Chilren's Health Insurance Program (CHIP).
Source: The Washington Post Article
It has funded 16 initiatives since it began operations, primarily focused on incentives for delivering care to Medicare, Medicaid, and the Chilren's Health Insurance Program (CHIP).
Source: The Washington Post Article
Friday, January 13, 2012
Health Care Reform Law's Rate Review Provision Holding Insurance Rates Down
Health insurance premium increases in five states have been deemed “unreasonable” by the U.S. Department of Health and Human Services, HHS Secretary Kathleen Sebelius announced .
After independent expert review, HHS determined that Trustmark Life Insurance Company has proposed unreasonable health insurance premium increases in five states—Alabama, Arizona, Pennsylvania, Virginia, and Wyoming. The excessive rate hikes would affect nearly 10,000 residents across these five states.
To make these determinations, HHS used its “rate review” authority from the Affordable Care Act (the health care reform law of 2010) to determine whether premium increases of over 10 percent are reasonable.
"Before the Affordable Care Act, consumers were in the dark about their health insurance premiums because there was no nationwide transparency or accountability," said Secretary Kathleen Sebelius. "Now, insurance companies are required to disclose rate increases over 10 percent and justify these increases. It’s time for Trustmark to immediately rescind the rates, issue refunds to consumers or publicly explain their refusal to do so."
In these five states, Trustmark has raised rates by 13 percent. For small businesses in Alabama and Arizona, when combined with other rate hikes made over the last 12 months, rates have increased by 27.2 percent and 18.1 percent, respectively. These increases were reviewed by independent experts to determine whether they are reasonable. In this case, HHS determined that the rate increases were unreasonable because the insurer would be spending a low percent of premium dollars on actual medical care and quality improvements, and because the justifications were based on unreasonable assumptions.
In addition to the review of rate increases, many states have the authority to reject unreasonable premium increases. Since the passage of the health care reform law, the number of states with this authority increased from 30 to 37, with several states extending existing “prior authority” to new markets.
Examples of how states have used this authority include:
- In New Mexico, the state insurance division denied a request from Presbyterian Healthcare for a 9.7 percent rate hike, lowering it to 4.7 percent;
- In Connecticut, the state stopped Anthem Blue Cross Blue Shield, the state’s largest insurer, from hiking rates by a proposed 12.9 percent, instead limiting it to a 3.9 percent increase;
In Oregon, the state denied a proposed 22.1 percent rate hike by Regence, limiting it to 12.8 percent.
- In New York, the state denied rate increases from Emblem, Oxford, and Aetna that averaged 12.7 percent, instead holding them to an 8.2 percent increase.
- In Rhode Island, the state denied rate hikes from United Healthcare of New England ranging from 18 to 20.1 percent, instead seeing them cut to 9.6 to 10.6 percent.
- In Pennsylvania, the state held Highmark to rate hikes ranging from 4.9 to 8.3 percent, down from 9.9 percent.
HHS' announcement comes the same week that a report showed that health care spending has grown at remarkably low rates. According to an analysis done each year by the Centers for Medicare & Medicaid Services (CMS), U.S. health care spending experienced historically low rates of growth in 2009 and 2010. A recent study released by Mercer Consulting also showed a slow-down in the average employee health benefit cost to businesses.
The Affordable Care Act includes several policies, including rate review, to continue this slow growth. By fighting fraud, better coordinating care, preventing disease and illness before they happen and creating a new state-based insurance marketplace, it helps keep health care cost growth low.
For more information on the specific determinations made today, please visit http://companyprofiles.healthcare.gov/
For general information about rate review, visit: http://www.healthcare.gov/law/features/costs/rate-review/
Source: HHS News Release
After independent expert review, HHS determined that Trustmark Life Insurance Company has proposed unreasonable health insurance premium increases in five states—Alabama, Arizona, Pennsylvania, Virginia, and Wyoming. The excessive rate hikes would affect nearly 10,000 residents across these five states.
To make these determinations, HHS used its “rate review” authority from the Affordable Care Act (the health care reform law of 2010) to determine whether premium increases of over 10 percent are reasonable.
"Before the Affordable Care Act, consumers were in the dark about their health insurance premiums because there was no nationwide transparency or accountability," said Secretary Kathleen Sebelius. "Now, insurance companies are required to disclose rate increases over 10 percent and justify these increases. It’s time for Trustmark to immediately rescind the rates, issue refunds to consumers or publicly explain their refusal to do so."
In these five states, Trustmark has raised rates by 13 percent. For small businesses in Alabama and Arizona, when combined with other rate hikes made over the last 12 months, rates have increased by 27.2 percent and 18.1 percent, respectively. These increases were reviewed by independent experts to determine whether they are reasonable. In this case, HHS determined that the rate increases were unreasonable because the insurer would be spending a low percent of premium dollars on actual medical care and quality improvements, and because the justifications were based on unreasonable assumptions.
In addition to the review of rate increases, many states have the authority to reject unreasonable premium increases. Since the passage of the health care reform law, the number of states with this authority increased from 30 to 37, with several states extending existing “prior authority” to new markets.
Examples of how states have used this authority include:
- In New Mexico, the state insurance division denied a request from Presbyterian Healthcare for a 9.7 percent rate hike, lowering it to 4.7 percent;
- In Connecticut, the state stopped Anthem Blue Cross Blue Shield, the state’s largest insurer, from hiking rates by a proposed 12.9 percent, instead limiting it to a 3.9 percent increase;
In Oregon, the state denied a proposed 22.1 percent rate hike by Regence, limiting it to 12.8 percent.
- In New York, the state denied rate increases from Emblem, Oxford, and Aetna that averaged 12.7 percent, instead holding them to an 8.2 percent increase.
- In Rhode Island, the state denied rate hikes from United Healthcare of New England ranging from 18 to 20.1 percent, instead seeing them cut to 9.6 to 10.6 percent.
- In Pennsylvania, the state held Highmark to rate hikes ranging from 4.9 to 8.3 percent, down from 9.9 percent.
HHS' announcement comes the same week that a report showed that health care spending has grown at remarkably low rates. According to an analysis done each year by the Centers for Medicare & Medicaid Services (CMS), U.S. health care spending experienced historically low rates of growth in 2009 and 2010. A recent study released by Mercer Consulting also showed a slow-down in the average employee health benefit cost to businesses.
The Affordable Care Act includes several policies, including rate review, to continue this slow growth. By fighting fraud, better coordinating care, preventing disease and illness before they happen and creating a new state-based insurance marketplace, it helps keep health care cost growth low.
For more information on the specific determinations made today, please visit http://companyprofiles.healthcare.gov/
For general information about rate review, visit: http://www.healthcare.gov/law/features/costs/rate-review/
Source: HHS News Release
Tuesday, January 10, 2012
CMS Selects Innovation Advisors
The Centers for Medicare and Medicaid Services (CMS) announced that it has selected 73 individuals from 27 States and the District of Columbia for its Innovation Advisors program.
A list of Innovation Advisors can be found at http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4240.
The initiative, launched by the CMS Innovation Center in October 2011, will help health professionals deepen skills that will drive improvements to patient care and reduce costs. After an initial orientation phase, Innovation Advisors will work with the CMS Innovation Center to test new models of care delivery in their own organizations and communities. They will also create partnerships to find new ideas that work and share them regionally and across the United States.
Funding for this initiative was made possible by the Affordable Care Act.
“There has been an incredible groundswell of interest in becoming an Innovation Advisor. It’s clear that doctors, hospitals and health care providers are enthusiastic about implementing the Affordable Care Act and strengthening our health care system,” said CMS Acting Administrator Marilyn Tavenner.
The 73 individuals were selected from 920 applications through a competitive process, and include clinicians, allied health professionals, health administrators and others. By attending in-person meetings as well as remote sessions to expand their skills and applying what they learn, the Advisors will be able to deepen their knowledge in health care economics and finance, population health, systems analysis, and operations research.
“We’re looking to these Innovation Advisors to be our partners—we want them to discover and generate new ideas that will work and help us bring them to every corner of the United States,” said CMS Innovation Center Director Rick Gilfillan, M.D.
Among other duties, the Advisors will be expected to support the Innovation Center in testing new models of care delivery, to form partnerships with local organizations to drive delivery system reform, and to improve their own health systems so their communities will have better health and better care at a lower cost.
Each Innovation Advisor’s home organization will receive a stipend of up to $20,000. The stipend will support an individual’s activities while serving as an Innovation Advisor.
More information about the Innovation Advisors Program, including a fact sheet and list of participants and their home organization, can be found at: http://innovations.cms.gov/initiatives/innovation-advisors/index.html.
A list of Innovation Advisors can be found at http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4240.
The initiative, launched by the CMS Innovation Center in October 2011, will help health professionals deepen skills that will drive improvements to patient care and reduce costs. After an initial orientation phase, Innovation Advisors will work with the CMS Innovation Center to test new models of care delivery in their own organizations and communities. They will also create partnerships to find new ideas that work and share them regionally and across the United States.
Funding for this initiative was made possible by the Affordable Care Act.
“There has been an incredible groundswell of interest in becoming an Innovation Advisor. It’s clear that doctors, hospitals and health care providers are enthusiastic about implementing the Affordable Care Act and strengthening our health care system,” said CMS Acting Administrator Marilyn Tavenner.
The 73 individuals were selected from 920 applications through a competitive process, and include clinicians, allied health professionals, health administrators and others. By attending in-person meetings as well as remote sessions to expand their skills and applying what they learn, the Advisors will be able to deepen their knowledge in health care economics and finance, population health, systems analysis, and operations research.
“We’re looking to these Innovation Advisors to be our partners—we want them to discover and generate new ideas that will work and help us bring them to every corner of the United States,” said CMS Innovation Center Director Rick Gilfillan, M.D.
Among other duties, the Advisors will be expected to support the Innovation Center in testing new models of care delivery, to form partnerships with local organizations to drive delivery system reform, and to improve their own health systems so their communities will have better health and better care at a lower cost.
Each Innovation Advisor’s home organization will receive a stipend of up to $20,000. The stipend will support an individual’s activities while serving as an Innovation Advisor.
More information about the Innovation Advisors Program, including a fact sheet and list of participants and their home organization, can be found at: http://innovations.cms.gov/initiatives/innovation-advisors/index.html.
Report on Identifying Health Care Quality Measures in Medicaid-Eligible Adults Released
The Agency for Healthcare Research and Quality (AHRQ) released a background report documenting the process, deliberations, and results of AHRQ's National Advisory Council Subcommittee for Identifying Health Care Quality Measures for Medicaid-Eligible Adults.
The Affordable Care Act requires the Secretary of the Department of Health and Human Services to identify and publish a core set of health quality measures for Medicaid-eligible adults.
Source: AHRQ Release
The Affordable Care Act requires the Secretary of the Department of Health and Human Services to identify and publish a core set of health quality measures for Medicaid-eligible adults.
Source: AHRQ Release
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