109 Sable Trace Lane
Acworth Ga, 30102-7621


Phone/Fax: 678-574-8421

ACA weekly update April 20, 2015

Week of April 20, 2015

The Equal Employment Opportunity Commission (EEOC) and the Departments of Health and Human Services (HHS), Labor, and Treasury released guidance and proposed rules last week meant to head off confusion over the use of incentives for employer-sponsored wellness programs under the Affordable Care Act (ACA). According to the announcement, wellness programs subject to the EEOC rules must be voluntary. Employees cannot be required to participate or otherwise be subject to a penalty if they do not enroll. For example, health coverage may not be withheld if the employee refuses to take a health risk assessment. Incentives for participation in the wellness program or programs may not exceed 30 percent of the total cost of employee-only coverage under the employer's group health plan. Comments are due 60 days after publication in the Federal Register on April 20.


President Obama signed into law last week the "Medicare Access and CHIP Reauthorization Act of 2015", which passed in both the House and Senate in recent weeks with strong bipartisan support. The core provisions establish a new Medicare physician payment system and provide for a two-year extension of federal funding for the Children's Health Insurance Program (CHIP). Other provisions prohibit Medigap policies from covering the Medicare Part B deductible, but not until 2020 (with a grandfathering provision for Medigap policies sold before that date). Authority for Medicare Advantage Special Needs Plans will be extended through December 2018. The legislation also calls for the Secretary of Health and Human Services (HHS) to develop a draft plan for the development of quality measures, to be posted on the CMS website no later than January 1, 2016. The plan must be finalized by May 1, 2016.
A number of House and Senate committees held hearings last week to examine issues relating to the ACA. The House Ways and Means Subcommittee on Health held a hearing on the ACA's individual mandate and employer responsibility requirements. Subcommittee Chairman Kevin Brady (R-TX) expressed concern that the ACA is making health coverage more expensive and forcing people "to choose from a list of plans that Washington picks for them." Ranking Member Jim McDermott (D-WA) defended the individual mandate, emphasizing that it has helped to reduce adverse selection in the health insurance market. Rep. Bill Pascrell (D-NJ) said that the individual mandate prevents "free-riders" from forcing everyone else to pay for their health care costs.
A House Education and Workforce Subcommittee on Health, Employment, Labor, and Pensions hearing last week focused on "How the President's Health Care Law is Affecting America's Workplaces." This hearing included discussion about the ACA's employer responsibility requirements and the excise tax on certain "high-cost" employer-sponsored health coverage. Rep. Brett Guthrie (R-KY) highlighted legislation he has introduced proposing to strike an ACA provision that, beginning in January 2016, will expand the definition of a small employer to include companies with 51 to 100 employees.

From Aetna health reform weekly


ACA weekly update April 13, 2015

Week of April 13, 2015

A coalition that includes Aetna, consumer groups and health care providers last week launched the Clear Choices Campaign to advocate for greater transparency in health care pricing. The goal of the campaign is to provide better tools, and drive better data, that consumers can use to make informed health decisions. The campaign also is focused on better measures of quality and driving more transparency on the federal and state-based exchanges, including searchable online prescription drug formularies and detailed provider directories.


The Centers for Medicare & Medicaid Services (CMS) issued a memorandum last week announcing the release of the 2016 Medicare Advantage (MA) capitation rates and MA and Part D payment policies. The notice suggests that the "expected revenue change" from the Final MA Rate Notice will be 1.25 percent in 2016 – compared to a 0.95 percent reduction announced in the advance notice). In the weeks leading up to the April 6 announcement, 348 members of Congress – including both Republicans and Democrats – addressed letters to CMS expressing support for the MA program and concerns about proposed payment cuts.

From Aetna health reform weekly


ACA weekly update April 6, 2015

Week of April 6, 2015

A new poll has found that seniors are more satisfied with Medicare Advantage coverage than seniors with traditional Medicare. Research released by the Morning Consult found that 88 percent of older Americans polled are satisfied with their Medicare Advantage plan compared to 85 percent of those with traditional Medicare. But when it comes to the cost of their plans, 80 percent of those with Medicare Advantage are satisfied compared to 68 percent with traditional Medicare. More than 16 million older Americans today have Medicare Advantage coverage, but the private Medicare plan program has been the target of rate cuts in recent years. A majority of House members recently joined together in sending a letter to the Centers for Medicare and Medicaid Services (CMS) urging that it maintain current payment levels in 2016.


CMS announced last week that roughly 36,000 people have signed up for coverage on HealthCare.gov so far during the special tax enrollment period that began on March 15. The special enrollment period allows individuals to avoid paying a tax penalty for not having insurance in 2015 by signing up for coverage. The special enrollment window will run through April 30 for the 37 states using Healthcare.gov. Several states running their own exchanges have also announced special enrollment periods.

The U.S. Supreme Court ruled last week that health care providers cannot bring lawsuits under the Supremacy Clause of the U.S. Constitution against states to challenge low Medicaid reimbursements. The case, Armstrong v. Exceptional Child Center, was filed in 2009. In a 5-4 ruling, the court decided that providers must initially seek relief from the Department of Health and Human Services (HHS). Justice Antonin Scalia wrote the majority opinion, which found that HHS can withhold funds if it determines that a state is not complying with the law.

GEORGIA: The General Assembly last week passed a bill mandating coverage for autism treatment therapy. The legislation contains a mandate for Applied Behavioral Analysis treatment up to age six, an annual cap of $30,000, and a repeal provision should a constitutional amendment creating a sales tax to cover ABA therapy for all be adopted by the voters.

From Aetna health reform weekly