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EBSA and Centers for Medicare & Medicaid Services Announces Meeting of CHIP Working Group, Addressing Employer-Sponsored Group Health Plan Coverage Coordination

2 pages. Excerpt: The CHIP Working Group will meet ... to develop a model coverage coordination disclosure form for group health plan administrators to send to States upon request regarding benefits available under the plan.... The CHIP Working Group will identify and report on the impediments to the effective coordination of coverage available to families that include employees of employers that maintain group health plans and members who are eligible for medical assistance under title XIX of the [Social Security] Act or child health assistance or other health benefits coverage under title XXI of the [Social Security] Act.

Text of White Paper by Centers for Medicare & Medicaid Services: Retiree Drug Coverage (PDF)

10 pages. Excerpt: CMS is presenting multiple options for employers and unions to offer enhanced drug coverage to retirees at a lower cost ... [W]e are interested in hearing what employers are likely to do under the various proposed options.... Employers and unions can choose between two broad options in offering additional retiree drug coverage: offering coverage that qualifies for the retiree drug subsidy, or enhancing the basic Medicare drug benefit.

CMS Examines Inappropriate Steering of People Eligible for Medicare or Medicaid Into Marketplace Plans

"[CMS is] seeking public comment on concerns that some health care providers and provider-affiliated organizations may be steering people eligible for, or receiving, Medicare and/or Medicaid benefits into [ACA]-compliant individual market plans, including Health Insurance Marketplace plans, for the purpose of obtaining higher reimbursement rates. CMS also sent letters to all Medicare-enrolled dialysis facilities and centers informing them of this announcement."

Text of CMS Notice: Medicare Program Calendar Year 2025 Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts

12 pages. "For CY 2025, the inpatient hospital deductible will be $1,676. The daily coinsurance amounts for CY 2025 will be as follows: $419 for the 61st through 90th day of hospitalization in a benefit period; $838 for lifetime reserve days; and $209.50 for the 21st through 100th day of extended care services in a skilled nursing facility in a benefit period."

Text of CMS Final Regs Requiring Drug Pricing Transparency for Medicare and Medicaid Programs

102 pages. "This final rule [amends] regulations for the Medicare Parts A, B, C and D programs, as well as the Medicaid program, to require direct-to-consumer (DTC) television advertisements of prescription drugs and biological products for which payment is available through or under Medicare or Medicaid to include the Wholesale Acquisition Cost (WAC or list price) of that drug or biological product. This rule is intended to improve the efficient administration of the Medicare and Medicaid programs by ensuring that beneficiaries are provided with relevant information about the costs of prescription drugs and biological products so they can make informed decisions that minimize their out-of-pocket (OOP) costs and expenditures borne by Medicare and Medicaid, both of which are significant problems." [Editor's note: Includes over 80 pages of summary, analysis and response to the 147 comments received on the proposed regs. Also available: CMS Drug Pricing Transparency Fact Sheet.]

Text of CMS ANPRM on Civil Money Penalties Under the Medicare, Medicaid, and SCHIP Extension Act of 2007

"This advance notice of proposed rulemaking (ANPRM) solicits public comment on specific practices for which civil money penalties (CMPs) may or may not be imposed for failure to comply with Medicare Secondary Payer reporting requirements for certain group health and non-group health plans arrangements.... We are interested in comments and proposals to specifically define 'noncompliance' in the context of the phrase, 'for each day of noncompliance with respect to each claimant' in sections 1862(b)(7) or (b)(8) of the Act. We are seeking public comment and proposals on mechanisms and criteria that we would employ to evaluate whether and when the agency would impose CMPs. In addition, we are we are soliciting comments and proposals for methods to determine the dollar amount of a CMP that would be levied for each day that NGHP is a responsible reporting entity noncompliance under section 1862(b)(8) of the Act. We are also soliciting comments on how we might devise a method(s) and criteria to determine which actions would constitute 'good faith effort(s)' taken by an entity to identify a Medicare beneficiary for the purposes of reporting under section 1862(b)(8) of the Act. We are specifically soliciting comments and proposals from insurers, third party administrators for GHPs, other applicable plans, and the public."

Text of CMS Standard Form: 'Good Faith Estimate for Health Care Items and Services' Under the No Surprises Act (PDF)

12 pages. "This form may be used by the health care providers and facilities to inform uninsured (or self-pay) individuals of the expected charges for receiving certain health care items and services.... HHS considers use of the model notice to be good faith compliance with the good faith estimate requirements to inform an individual of expected charges. Use of this model notice is not required ... [A] good faith estimate that meets all of the requirements under 45 CFR 149.610 is necessary in order to begin the patient-provider dispute resolution process."

CMS Proposes 2017 Payment and Policy Updates for Medicare Health and Drug Plans

"[On February 25, 2016] CMS released proposed updates to the Medicare Advantage (MA) and Part D programs through the 2017 Advance Notice and Draft Call Letter.... Employer Group Waiver Plans (EGWPs) serve specific employer groups, and are either offered through negotiated arrangements between Medicare Advantage plans and employer groups or by the employer directly. Because of the nature of these unique agreements, EGWPs do not compete against other plans through the bidding process, and therefore have little incentive to submit lower bids. CMS has previously waived bidding requirements for Part D for EGWPs and set payment amounts for Part D plans based on the competitive bids submitted for non-EGWP Part D plans. CMS is proposing a similar waiver and payment policy for EGWP Part C plans for 2017."

Text of CMS FAQs on SHOP Enrollment and Eligibility: Broker Issues and Transactions

16 Q&As dated May 27, 2014, including: "When will 2015 training for Agent/Brokers be available? ... Will the Federally-facilitated Marketplace (FFM) validate if an Agent/Broker is licensed in the State that the Agent/Broker is selling and effectuating policies? ... Can an employer change the selected Agent/Broker after the point of sale or enrollment? ... Can the Centers for Medicare & Medicaid Services (CMS) explain how rates will be displayed to employers and employees in the Federally-facilitated Small Business Health Options Program (FF-SHOP) Marketplace? Will contribution options display as dollar amounts or percentage contribution amounts? Will employers be able to set one contribution amount per metal level? Can CMS set different contribution amounts per plan within a metal level? ... If an Agent is not certified with the Federally-facilitated Small Business Health Options Program (FF-SHOP), will he or she be able to access the the Centers for Medicare & Medicaid Services (CMS) Enterprise Portal?"

CMS Releases Report on Projected National Health Expenditures, 2008-2018

Excerpt: The Office of the Actuary in the Centers for Medicare & Medicaid Services annually produces projections of health care spending for categories within the National Health Expenditure Accounts, which track health spending by source of funds (for example, private, Medicare, Medicaid) and by type of service (hospital, physician, prescription drugs, etc.). The latest projections begin after the latest historical year (2007) and go through 2018.