Week of June 1, 2015
New calculations released last week project that the Affordable Care Act (ACA) will add more than a quarter of a trillion dollars in administrative costs to the health care system through 2022. The new report projects that $273.6 billion in new administrative costs will be attributable to the ACA. An estimated $172.2 billion will go toward private insurance overhead. Much of the balance will go toward the cost of running public exchanges.
The Centers for Medicare & Medicaid Services (CMS) issued a bulletin clarifying when certain broker fees can be excluded from medical loss ratio (MLR) calculations. Also covered was how rebates should be handled for policyholders who have received advance premium tax credits, including how health plans would return premium rebates to them.
The Departments of Health and Human Services, Labor, and the Treasury released an FAQ document providing guidance on two ACA provisions related to health insurers and group health plans. The FAQs address whether coverage provided to large employer groups needs to comply with previously announced restrictions on the maximum out-of-pocket (MOOP) limits for family coverage. They also clarify the ACA provision that stipulates group health plans and health insurers offering individual or group coverage may not discriminate with respect to a provider's participation under the coverage or plan.
CMS has released the pre-publication version of the proposed rule: Medicaid and Children's Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability. The rule revises current federal regulations that affect the full range of Medicaid health plan operations. This includes actuarial soundness, provider access and directories, MLR, quality assurance and care coordination. Comments are due no later than July 27, 2015.
From Aetna health reform weekly