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Archive for February, 2013

Final Rule Implements Consumer Protections

Friday, February 22nd, 2013

The Department of Health and Human Services (HHS) issued a final rule that implements five key consumer protections from the Affordable Care Act (ACA), and makes the health insurance market work better for individuals, families, and small businesses.

Under these reforms, all individuals and employers have the right to purchase health insurance coverage regardless of health status. In addition, insurers are prevented from charging discriminatory rates to individuals and small employers based on factors such as health status or gender, and young adults have additional affordable coverage options under catastrophic plans.

The press release can be found at http://www.hhs.gov/news/press/2013pres/02/20130222a.html


Final EHB Rule Released By HHS

Thursday, February 21st, 2013

The Department of Health and Human Services (HHS) has released a final rule that will make purchasing health coverage easier for consumers. The policies will give consumers a consistent way to compare and enroll in health coverage in the individual and small group markets, while giving states and insurers more flexibility and freedom to implement the Affordable Care Act (ACA).

The rule outlines health insurance issuer standards for a core package of benefits, called essential health benefits (EHB), that health insurance issuers must cover both inside and outside the Health Insurance Marketplace. Through its standards for EHB, the final rule released also expands coverage of mental health and substance use disorder services, including behavioral health treatment, for millions of Americans.

For more information, go to http://www.ofr.gov/OFRUpload/OFRData/2013-04084_PI.pdf

Enrollment Suspended in PCIP

Tuesday, February 19th, 2013

Beginning February 16, the federally-run Pre-existing Condition Insurance Plan (PCIP) suspended acceptance of new enrollment applications until further notice. The state-based PCIPs also will suspend new applications after March 2. According to the Centers for Medicare & Medicaid (CMS), the suspension will help ensure that funds are available through 2013 to continuously cover the more than 100,000 people currently enrolled in the program. The Affordable Care Act (ACA) created the temporary program as a bridge to 2014, when the law prohibits insurance companies from discriminating against Americans because of a pre-existing condition.

For further details, visit http://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/index.html

Proposed MLR Rule Issued

Tuesday, February 19th, 2013

A proposed rule was issued by the Centers for Medicare & Medicaid Services (CMS) implementing medical loss ratio (MLR) requirements for Medicare Advantage (MA) and Medicare prescription drug plans under the Affordable Care Act (ACA). The law requires Medicare health and drug plans to spend at least 85% of revenue on clinical services, prescription drugs, quality improvements or direct benefits, or face financial and other penalties beginning in 2014. CMS will accept comments on the proposed rule for 60 days.

The proposed rule can be found at http://www.ofr.gov/OFRUpload/OFRData/2013-03921_PI.pdf

Physician Payments Sunshine Final Rule Released

Monday, February 4th, 2013

On February 1, the Centers for Medicare & Medicaid Services (CMS) announced a final rule requiring makers of drugs, devices, biological and medical supplies covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) to report payments or other transfers of value made to physicians and teaching hospitals to CMS. The rule, called the National Physician Payment Transparency Program: Open Payments, is part of the Affordable Care Act (ACA) designed to create greater transparency in the health care market.  The rule requires manufacturers and group purchasing organizations (GPOs) to disclose to CMS physician ownership or investment interests. The rule requires reports for calendar year 2013 to contain data collected during the period from August 2013 through December 2013, and to be submitted by March 31, 2014. Organizations and physicians will be able to review and correct the data before it’s published on a public website by September 30, 2014.

The final rule can be viewed at http://www.ofr.gov/OFRUpload/OFRData/2013-02572_PI.pdf.