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232 Matching News Items

1.  OPM Issues Proposed Regs on Participation in Health Exchanges by Members of Congress
Timothy Jost, in Health Affairs Forefront Link to more items from this source
Aug. 7, 2013
"Only one group of Americans is required to purchase insurance through the exchanges: members of Congress and their personnel staffs (in Washington and in the districts, but not committee staff or other congressional employees).... The proposed rule provides, as expected, that the federal government will pay a share of exchange premiums, 72 percent of the cost of the weighted average of Federal Employee Health Benefit Program (FEHBP) plans or 75 percent of the premium of the chosen plan, whichever is less.... [T]he rule clarifies that plans that are certified as qualified health plans by an exchange will also qualify as 'health benefit plans' for FEHBP coverage. The federal government will, therefore, be able to make a contribution to cover a share of the premiums of an exchange plan."
2.  CMS Issues Guidance on Role of Agents and Brokers in Health Exchanges
Timothy Jost, in Health Affairs Forefront Link to more items from this source
May 2, 2013
"Agents and brokers will be able to assist consumers either through an insurer-based pathway, in which the agent or broker uses an insurer's website to assist consumers, or directly through the exchange website.... Web brokers are potentially problematic because they resemble and may be seen as a substitute for the exchange website itself. ... Unlike traditional brokers and agents, web brokers must display all QHPs, regardless of appointment or compensation arrangements. If a consumer wishes to enroll in a plan for which the web broker does not have an appointment, the web broker must direct the consumer to the exchange website for enrollment."
3.  Leading ACA Columnist Passes Baton to New Author
Chris Fleming, in Health Affairs Forefront Link to more items from this source
Jan. 5, 2018
"[Timothy Jost, in the Health Affairs Blog, chronicled] the development and eventual passage of the ACA. Then, he began doing [hundreds of] posts on the seemingly endless stream of rules, guidances, and other documents necessary to put the new law into action.... Tim will continue to write the monthly 'Eye on Health Reform' [column in] Health Affairs.... Katie Keith will [take over for Jost on the ACA column]."
4.  Implementing Health Reform: Data Hub Security and Other Issues
Timothy Jost, in Health Affairs Forefront Link to more items from this source
Sept. 13, 2013
"The hub will verify data provided by applicants against information in existing and secure federal and state databases, such as those of the [IRS], [SSA], the Department of Veterans Affairs, Medicare, and others. It will provide one highly secure connection to these databases rather than requiring each exchange to set up its own connections. The hub has several levels of protection to mitigate security risks. It employs a continuous monitoring model to rapidly identify and take action against irregular behavior and unauthorized system changes that could indicate a potential incident."
5.  Implementing Health Reform: Proposed Regs for Exchange 'Navigators'
Timothy Jost, in Health Affairs Forefront Link to more items from this source
Apr. 4, 2013
"The navigator program has become surprisingly controversial. Insurance agents and brokers have seen it as threatening their territory. Agents seem to be concerned that if navigators help consumers enroll in health insurance plans, agents will lose the commissions to which they are entitled when they themselves market insurance products.... Responding to lobbying by politically powerful agent organizations, states that have shown little interest in participating in any way in the implementation of the ACA have been enacting legislation to regulate the navigator program. Many of these states will have federal exchanges. The proposed regulations lay down standards for the navigator program in the federal exchange which will preempt more restrictive state standards. It also clarifies the extent to which states can license navigators in both the state and federal exchanges."
6.  GAO Issues Progress Report on Health Exchanges
Timothy Jost, in Health Affairs Forefront Link to more items from this source
June 20, 2013
"Under the best of circumstances, creating and implementing a program that will revolutionize the way in which individual and small group health insurance is underwritten and sold in the United States, providing financial assistance through the tax system and Medicaid to millions of Americans who cannot afford health insurance, and organizing health insurance markets to promote choice and competition -- and to do all this in the timeframe allowed by the ACA -- would have been a daunting task."
7.  HHS Letter to Health Insurers Describes Rate Reviews, 'Meaningful Difference' Requirement
Timothy Jost, in Health Affairs Forefront Link to more items from this source
Mar. 5, 2013
"Much of the information in this guidance can be found in already-released regulations or guidances, but the level of operational detail found in this letter -- including in particular implementation timelines -- is unprecedented. It is perhaps the clearest sign to date that the FFE is in fact going to happen, and will arrive on time."
8.  Progress, But Much Work Remains on Implementing Health Reform Rules: SBC FAQs for 2014
Timothy Jost, in Health Affairs Forefront Link to more items from this source
Apr. 25, 2013
"The agencies had stated earlier that they would also change the form for 2014 to reflect the statutory elimination of all annual dollar limits on essential health benefits. The agencies are not making this change, but insurers or plans must state that no annual dollar limits are in fact imposed on essential health benefits. In a major disappointment to consumers, the agencies are not adding any new coverage examples for 2014."
9.  Analyzing the January 2014 Health Exchange Enrollment Report
Timothy Jost, in Health Affairs Forefront Link to more items from this source
Feb. 13, 2014
"Ultimately, the goal of the ACA is to reduce the number of the uninsured, but this can happen by enrolling individuals who would otherwise have become uninsured as well as enrolling individuals who are currently uninsured. The January report does not tell us how many enrollees fit in each category. But a Gallup poll released on February 12 found that the rate of uninsured in the U.S. had dropped sharply from 17.1 in the fourth quarter of 2013 to 16 percent in the first quarter of 2014, while the rate of uninsured 26- to 34-year olds dropped from 30.2 to 25.7 percent."
10.  Aspects of Healthcare Reform: The Individual Market; Mental Health and Substance Abuse Parity
Timothy Jost, in Health Affairs Forefront Link to more items from this source
Nov. 10, 2013
"[It] seems that insurers have set their rates based on projections that the 2014 risk pool is going to be pretty expensive, and that state regulators have allowed them to do so.... [T]he proposed solutions may simply make matters worse... The basic rule is that where plans or issuers offer mental health or substance use disorder benefits in one of six classifications, they cannot impose financial requirements or quantitative treatment limitations on those benefits that are more restrictive than the predominant requirements or limitations that apply to substantially all medical surgical benefits in the same classification.... Plans or issuers are required to perform the parity analysis annually in years when a change in benefit design, cost-sharing structure, or utilization affects the analysis within a classification."
11.  Implementing Health Reform: Program Integrity Amendments and Other Issues
Timothy Jost, in Health Affairs Forefront Link to more items from this source
Oct. 27, 2013
"Under the guaranteed renewability requirement, a small (or large) employer has the right to renew or continue in force the coverage it purchased in the small (or large) group market, even though it has become a large (small) group because of an increase (or decrease) in employees. However, provisions of the ACA that apply only to groups of a particular size, such as the premium rating or single risk pool requirements that apply only to small groups, would not apply to a small group that becomes a large group, even if it renews a small group product."
12.  Implementing Health Reform: The Small Business Health Insurance Marketplace
Timothy Jost, in Health Affairs Forefront Link to more items from this source
June 2, 2013
"The amendments make changes in the earlier SHOP rules as to two issues: the nature of plan choice that will be permitted in the SHOP exchanges for 2014, and the length of time allowed for employees to enroll in SHOP coverage if they become eligible for special enrollment periods.... HHS also released ... simplified SHOP exchange enrollment forms. The employer form is only three pages long, the employee form only two. The forms, however, are obviously only intended to initiate contact with the employer or employee."
13.  Implementing Health Reform: Medicaid DSH Payments, Utah Exchanges and More
Timothy Jost, in Health Affairs Forefront Link to more items from this source
May 13, 2013
"The [CMS] FAQ, moreover, allows Utah to operate a SHOP navigator program in which navigators can only conduct consumer outreach and education activities and not assist with enrollment or perform other required navigator functions. CMS will operate the navigator program in the individual market, where navigators will be able to fulfill all required functions ... [I]t is disconcerting that CMS has folded on this issue in Utah."
14.  Implementing Health Reform: Benefit and Payment Parameters Proposed Regs
Timothy Jost, in Health Affairs Forefront Link to more items from this source
Dec. 3, 2012
"The notice of benefit and payment parameters proposal is one of the longest regulatory issuances yet to emerge from the ACA implementation process -- 372 pages of preamble and regulatory text.... Viewed as a whole, the proposal illuminates more clearly than anything that has so far emerged from the implementation process what a monumental task Congress has set for the nation in trying to reshape a private, market-based, health insurance system to make it accessible to all but the poorest Americans, regardless of health status."
15.  Senate GOP Leadership Unveils Latest Version of Health Reform Legislation
Timothy Jost, in Health Affairs Forefront Link to more items from this source
July 14, 2017
"The Cruz amendment provides that an insurer could offer 'skinny' plans that do not comply with ACA requirements in a rating area for a plan year, as long as the insurer certified to HHS that it would make available at least one gold plan (80 percent actuarial value), one silver plan (70 percent actuarial value), and one plan with an actuarial value of 58 percent (the new benchmark level for determining premium tax credits) in the entire rating period for the plan year.... The July 13 amendment provides $70 billion for state stability funds. For the years 2020 to 2026, the Cruz amendment would require HHS to pay these funds to insurers that offer ACA compliant plans ... States with skinny plans could use money they receive under the stability fund to reduce premiums for ACA compliant plans."
16.  Recent CMS Releases: Medicaid and CHIP Enrollment, Data Verification, and Applications for 2015 Qualified Health Plans
Timothy Jost, in Health Affairs Forefront Link to more items from this source
June 10, 2014
"The instructions cover the 13 areas of requirements that QHP applicants must meet, including, for example, licensure, accreditation, actuarial value, network adequacy, prescription drugs, plans and benefits, and others. Also included in the release are rating tables and rating business rules insurers must follow, as well as forms to be used for insurers to provide justifications if issues arise from their application, such as cost sharing or formulary outliers.... [T]he 65-page section on plans and benefits ... sets out the elements that CMS expects will be shown to consumers in 'plan compare' on healthcare.gov for 2015."
17.  The 2015 Health Insurance Marketplace Blueprints and More ACA News
Timothy Jost, in Health Affairs Forefront Link to more items from this source
Mar. 16, 2014
"The biggest change in the 2015 blueprint is that plan management state partnership exchanges are no longer available. States that decide to assist in plan management functions will do so on an ad hoc basis and are not required to file a blueprint.... The blueprint document, which is 167 pages long, includes separate blueprints for full state exchanges, consumer assistance partnerships, and SHOP only exchanges. Each blueprint addresses the full range of exchange functions and activities appropriate for each type of exchange."
18.  Tax-Favored Health Savings Arrangements, Medicaid DSH Payments, and Multiemployer Plans
Timothy Jost, in Health Affairs Forefront Link to more items from this source
Sept. 15, 2013
"[E]mployers are going to find it difficult or impossible to use before-tax dollars to purchase individual medical coverage in the individual market except for retirees. On the other hand, employers can use a number of approaches to offer excepted benefits to employees. Excepted benefits do not count toward minimum essential coverage, but they may be a way of getting pretax income to individuals that does not affect their eligibility for premium tax credits. Employers can always use account-based benefits to supplement comprehensive coverage, and can direct it in such a way so as to increase its minimum value or affordability."
19.  More Guidance on Health Insurance Marketplaces: Three Sets of FAQs Released by HHS
Timothy Jost, in Health Affairs Forefront Link to more items from this source
May 15, 2013
"The first set of section 1311 funding FAQs primarily summarizes earlier guidance on state activities in federally facilitated marketplace (FFM) and state partnership marketplace (SPM) states, but in some instances goes into greater detail.... The Consumer Partnership FAQ states again that section 1311 prohibits HHS from using such funding for state navigator programs.... The final ... FAQ set covers a number of topics. It begins with two questions on oversight of state-operated premium stabilization, advance payment of premium tax credits, and cost-sharing reduction payment programs."
20.  Implementing Health Reform: Waiting Periods and Enforcement of Market Reforms
Timothy Jost, in Health Affairs Forefront Link to more items from this source
Mar. 19, 2013
"On March 18, 2013, Gary Cohen, the Director of the Office of Consumer Information and Insurance Oversight, stated on a national stakeholder call that most of the final rules needed to implement the Affordable Care Act 2014 insurance reforms are now in place. HHS is now in the final stages of ACA implementation, and it is moving forward."
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