109 Sable Trace Lane
Acworth Ga, 30102-7621


Phone/Fax: 678-574-8421

ACA update week of June 1, 2015

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


ACA weekly update May 25, 2015

Week of May 25, 2015

The typical American family that gets insurance through an employer pays nearly $25,000 a year for medical care, according to the 2015 Milliman Medical Index. The study shows that the annual cost of benefits through an employer-sponsored preferred provider organization (PPO) plan rose 6.3 percent, to $24,671 in 2015. Almost one-third of this year's cost increase was due to increases in prescription drug costs.


The House Energy and Commerce Committee passed a 21st Century Cures bill by a vote of 51-0. The legislation would provide $550 million in mandatory funding to support implementation of the bill's provisions, and an exemption from sequestration cuts for administrative expenses. One amendment includes a package of approximately $13 billion in budget offsets, including a proposal to delay Medicare Part D reinsurance payments.
The House Ways and Means Subcommittee on Oversight held a hearing last week on the use of administrative actions in the implementation of the Affordable Care Act (ACA). The hearing focused on, delay of the ACA's employer responsibility requirements, the payment of premium assistance tax credits in the federal exchange, the payment of the ACA's cost-sharing reduction subsidies without a congressional appropriation, and payments under the Medicare Advantage quality bonus demonstration program.
The Department of Health and Human Services (HHS) announced that roughly 147,000 people signed up for ACA coverage through HealthCare.gov during the March 15 - April 30 special enrollment period related to tax season. The six-week special enrollment period was intended for individuals who faced a penalty for not having 2014 coverage after regular enrollment ended. CMS has said the special enrollment period will not be implemented in subsequent years.

Senator Rob Portman (R-OH) announced that the Homeland Security and Governmental Affairs Permanent Subcommittee on Investigations is looking into concerns about the verification procedures surrounding subsidies paid through the ACA exchanges. Sen. Portman, who chairs the subcommittee, sent a letter to HHS Secretary Sylvia Burwell asking for clarification of verification procedures and related issues.

From Aetna health reform weekly



ACA weekly update May 18, 2015

Week of May 18, 2015

A new survey found that most companies that would have had to pay the excise or "Cadillac" tax in 2018 are changing their coverage. According to a survey of members of the International Foundation of Employee Benefit Plans, 62 percent of companies that would be hit by the tax have already taken action. Most report shifting toward higher deductible plans, reducing benefits or dropping high-cost plans altogether. The tax has come under fire not only from Republicans but from some House Democrats who argue it will adversely impact consumers in higher-cost areas of the country.


Senators Johnny Isakson (R-GA) and Mark Warner (D-VA) will lead a bipartisan Senate Finance Committee working group to explore legislative options to improve care for Medicare patients with chronic conditions. The committee soon will begin taking stakeholder input to develop bipartisan chronic condition legislation.
The House Energy and Commerce Health Subcommittee voted last week to move the 21st Century Cures bill to full committee for consideration. The full committee is expected to mark up the bill this week. The 300-plus-page bill includes $10 billion in additional funding for the National Institute of Health; gives new responsibilities to the FDA, including new drug and device approval duties; and contains a number of health IT provisions. Rep. Tim Murphy (R-PA) is working to include a special allowance for sharing alcohol- and drug-abuse treatment records.
Last week, HHS issued new guidance clarifying the ACA's covered preventive services, particularly contraception. The guidance stipulates that insurers must cover without cost sharing at least one form of contraception in each of the methods that the FDA has identified, such as the patch or intrauterine devices. The guidance also clarified which women may be covered for advanced preventive screening for breast cancer, coverage for transgender persons and coverage for dependent children

From Aetna health reform weekly