Value Based Purchasing and Health Care Reform

HHS & IRS Release Insurance Exchange and Eligibility Proposed Rules

For additional information, see the following links:

Letter from Secretary of Health and Human Services Kathleen Sebelius to State Officials (Healthcare.gov) (8/12/2011)

Patient Protection and Affordable Care Act; Exchange Functions in the Individual Market: Eligibility Determinations; Exchange Standards for Employers - Proposed Rule (as published in the Federal Register 8/17/2011)

Medicaid Program; Eligibility Changes under the Affordable Care Act of 2010 - Proposed Rule (as published in the Federal Register 8/17/2011)

Health Insurance Premium Tax Credit - Notice of proposed rulemaking and notice of public hearing (as published in the Federal Register 8/17/2011)

 

HHS Releases Proposed Health Insurance Exchange Rules

For additional information, see the following:

After Much Scrutiny, HHS Releases Health Insurance Exchange Rules (Kaiser Health News 7/11/2011)

Affordable Insurance Exchange Announcement (HHS Speech 7/11/2011)

Read the Proposed Rules:

Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans (7/11/2011) 

Patient Protection and Affordable Care Act; Standards Related to Reinsurance; Risk Corridors and Risk Adjustment (7/11/2011)

Medical Loss Ratio Regulations Issued

HHS News Release: New Affordable Care Act rules give consumers better value for insurance premiums (11/22/2010)

Health Insurers face new federal rules on medical spending (Washington Post 11/23/2010)

Medical Loss Ratio Fact Sheet (HealthCare.gov)

See the regulation: Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements under the Patient Protection and Affordable Care Act; Interim Final Rule with request for comments (75 Fed. Reg. 74863) (12/1/2010)

 

Amendment to Interim Final Rules Relating to Grandfathered Health Plan Status

For additional information and to view the amendment to interim final rules (effective November 15, 2010) with request for comments, see the following link:

Amendment to the Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan Under the Patient Protection and Affordable Care Act (75 Fed. Reg. 70114) (11/16/2010)

Comments due by December 17, 2010 

DOL Posts Health Reform FAQs

For additional information, the FAQs can be viewed at the following links to the Department of Labor website:

FAQs About the Affordable Care Act Implementation - Part 1 (9/20/2010)

FAQs About the Affordable Care Act Implementation - Part 2 (10/8/2010)

FAQs About the Affordable Care Act Implementation - Part 3 (10/12/2010)

FAQs About the Affordable Care Act Implementation - Part 4 (10/29/2010)

AHIP's ACO White Paper Discusses Market Power; Antitrust Concerns

For a summary discussion of the white paper released last week by America's Health Insurance Plans ("AHIP"), see Experts warn ACOs may cause market power issues (Healthcare Finance News - 10/25)

See the AHIP white paper, Accountable Care Organizations and Market Power Issues

NAIC Approves MLR Regulations

The Patient Protection and Affordable Care Act (the “Affordable Care Act”) added Section 2718 of the Public Health Services Act (the "PHS Act"), which, among other provisions, requires health insurance issuers offering individual or group coverage to submit annual reports to the Secretary of the U.S. Department of Health and Human Services (the “Secretary”) on the percentages of premiums that the insurer spends on  reimbursement for clinical services and activities that improve health care quality.  Additionally, under the new law, insurers will be required to provide rebates to enrollees if this spending does not meet certain minimum standards for a given plan year.

As discussed in the IRS, DOL & HHS Request for Information (April 14, 2010), the PHS Act directs the National Association of Insurance Commissioners (NAIC) to establish uniform definitions of the activities being reported to the Secretary under the PHS Act, and standardized methodologies for calculating measures of these activities no later than December 31, 2010.  The uniform definitions and standardized methodologies developed by the NAIC are subject to the certification of the Secretary. 

This week, the NAIC voted to adopt a model regulation, which will be delivered to HHS for certification by the Secretary.

For additional information, see the following links:

REGULATION FOR UNIFORM DEFINITIONS AND STANDARDIZED REBATE CALCULATION METHODOLOGY FOR PLAN YEARS 2011, 2012 AND 2013 PER SECTION 2718 (b) OF THE PUBLIC HEALTH SERVICE ACT (draft released Sept. 23, 2010)

NAIC ADOPTS FINAL MEDICAL LOSS RATIO REGULATIONS Recommendations To Be Delivered To HHS (Oct. 21, 2010)

REGULATION FOR UNIFORM DEFINITIONS AND STANDARDIZED METHODOLOGIES FOR CALCULATION OF THE MEDICAL LOSS RATIO FOR PLAN YEARS 2011, 2012 AND 2013 PER SECTION 2718 (b) OF THE PUBLIC HEALTH SERVICE ACT (as adopted on Oct. 14, 2010)  

HHS Secretary Sebelius’ Statement on NAIC Recommendations on Medical Loss Ratio 

September 23, 2010 - Health Insurance Changes Take Effect Under Affordable Care Act

Today, September 23, 2010, marks six months since the Patient Protection and Affordable Care Act was signed in to law.  While several provisions of the new law are already effective (some upon enactment), certain insurance coverage rules go into effect today, including: 

 

·     Health plans must allow access to certain preventive services

·     No requirement for prior approval of out-of-network emergency services

·     Participants may choose primary care provider; children's pediatrician

·     Young adults may remain on a parent’s insurance plan until age 26

·     Children may not be denied coverage based on pre-existing conditions

·     No lifetime dollar limits on benefits; annual limits restricted

·     No rescission of health insurance coverage, absent fraud

·     Required internal claims appeals and external review processes

 

Please note that the list above is a brief summary and is subject to the specific terms of the law and applicable regulations.  For additional information and discussion regarding the new rules, see the following links:

 

Health Insurance Changes Take Effect - Washington Post (9/23/2010)

 

A New Era in Health Care Begins Today - Huffington Post (9/23/2010)

 

What the New Health Care Rules Will and Won't Do - Time (9/23/2010)

 

Big Changes to Your Health Insurance - CNN Money (9/23/2010)

 

A New Day for American Consumers - Healthcare.gov (9/23/2010)

 

Additional Health Care Reform Provisions Kick In - Changes Take Effect on Policies Renewing After Sept. 23, 2010 - National Association of Insurance Commissioners (9/2010)

 



Medical Loss Ratio Blanks Proposal Approved

This week, the National Association of Insurance Commissioners (NAIC) approved final implementation of the Medical Loss Ratio (MLR) Blanks Proposal, which insurance companies will use to report 2010 financial information to state regulators.  The Patient Protection and Affordable Care Act (the "Affordable Care Act") adds Section 2718 of the Public Health Service Act, which, among other provisions, requires health insurance issuers offering individual or group coverage to submit annual reports on the percentages of premiums that the coverage spends on reimbursement for clinical services and activities that improve health care quality.  Pursuant to the Affordable Care Act, if this spending does not meet minimum standards for a given plan year, insurers must provide rebates to enrollees.

According to the Insurancenewsnet article below, "the MLR blank -- this one specifically focused on 2010 figures -- will be forwarded to the U.S. Department of Health and Human Services for final certification."

For additional information on the MLR Blanks Proposal, see the following:

NAIC News Release (8/17/2010) 

NAIC Approves MLR Form, Completes Busy Seattle Meeting (Insurancenewsnet) (8/17/2010)

Insurance commissioners approve 2010 medical loss ratio form (Fierce Health Payer) (8/18/2010)

NAIC approves form for Medical Loss Ratio reporting requirements (Healthcare Finance News) (8/19/2010)

View the Medical Loss Ratio Blanks Proposal

See our May 18 post regarding the request for comments by the Departments of the Treasury, Labor, and Health and Human Services to aid in the development of regulations regarding Section 2718.

HHS Announces Grants for Health Insurance Exchange Planning

In a July 29th Press Release, the Department of Health and Human Services (HHS) announced the availability of "up to $1 million in grants per state" to help states conduct research and planning regarding the establishment of health insurance exchanges by 2014, as described in the Patient Protection and Affordable Care Act.  Applications for the grants are due by September 1, 2010.  HHS has also published a request for comments soliciting input relating to the development of "rules and standards exchanges should be required to meet."  Comments are due by October 4, 2010.