Below are key health care reform developments from the week of May 15th: ACA Repeal Efforts. Efforts to repeal and replace the Affordable Care Act (ACA) continue despite slowing down as the House of Representatives’...more
Physician groups and American Enterprise Institute authors come out against ACA repeal without a replacement; Hawaii’s 1332 waiver is the first to receive federal approval; and North Carolina’s Governor moves to expand...more
Study finds that Marketplace premiums are lower than employer-based premiums, even without federal subsidies; New York regulators move to shield insurers from outsized federal risk adjustment payments; and Missouri will seek...more
CMS’s risk adjustment program data signals an improving risk pool while the agency announces plans to modify the program; California enrolls 134,000 undocumented immigrant children into Medicaid; and Oregon approves increases...more
Funding for Arkansas' Medicaid expansion hangs in limbo; Tennessee's House Speaker appoints Medicaid reform task force in light of public groundswell; and CMS delays requirement for State-based SHOP online enrollment....more
Vermont posted a draft 1332 waiver proposal for public comment on February 8, 2016. Vermont proposes to eliminate the ACA requirement that small employers enroll through a Small Business Health Options Program (SHOP) web...more
Alabama receives federal approval for its Medicaid transformation waiver, while Michigan's Governor submits a Medicaid waiver on behalf of Flint residents; CMS announces $7.7 billion in reinsurance payments; and Vermont seeks...more
On September 25, 2015, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule entitled “Medicare Program: Medicare Clinical Diagnostic Laboratory Tests Payment System”. This proposed rule would...more
The GAO reports an increase in choice of plans both on and off Marketplaces; Hawaii submits the first 1332 waiver application, with a focus on substituting the employer mandate and SHOP provisions with pre-existing State...more
Ohio’s Medicaid expenditures came in $2 billion below estimates despite enrollment growth after Medicaid expansion; California extends full Medicaid benefits to more pregnant women; and nearly one million have enrolled in...more
Montana’s Medicaid expansion waiver seeks monthly premiums and a “third party administrator”; Rhode Island’s Medicaid working group recommends pursuing a DSRIP waiver; and Utah’s Medicaid expansion discussions are put on hold...more
This week, a federal Issuer Bulletin describes how issuers in the Federally Facilitated Marketplace will identify their existing enrollees who are switching plans for 2015 coverage. The Exchange Board in New Mexico proposes a...more
In this week’s highlights, new proposed guidance from the feds would allow default renewals to lower cost plans and bring enhanced transparency to Qualified Health Plan rate increases; open Enrollment hits its stride –...more
Over the past several days, the second open enrollment period through the Affordable Care Act’s (ACA’s) health insurance exchanges began; Republican lawmakers, now with majorities in both the House and the Senate, explored...more
Final regulations required for October 1, 2013 open enrollment are largely unchanged from the proposed rule. On August 30, the Centers for Medicare & Medicaid Services (CMS) of the Department of Health and Human...more
New marketing integrity and oversight provisions warrant review and comment. On June 14, the Centers for Medicare and Medicaid Services (CMS) in the U.S. Department of Health and Human Services (HHS) published its...more
While Congress was in recess, the Centers for Medicare and Medicaid Services (CMS) surprised many when it changed course on Medicare Advantage payment rates – switching from a 2.3 percent reduction to a 3.3 percent increase,...more
On March 1, 2013, CMS released a proposed rule, an interim final rule and a final rule—set for publication in the Federal Register on March 11, 2013—that implement the risk adjustment, reinsurance and risk corridor programs...more