Guidance

1/20/12 HHS announced a final rule requiring most health insurance plans to cover preventive services for women including recommended contraceptive services without charging a co-pay, co-insurance or a deductible in new private health plans in plan years that start on or after August 1, 2012. The rule allows certain non-profit religious employers that offer insurance to their employees the option of applying for an extra year to begin covering contraceptives. The final rule, which amends the interim rule issued in August 2011, is based largely on the Institute of Medicine's recommendation for preventive services for women, including all FDA -approved forms of contraception. Beginning August 1, 2012, most new and renewed health plans will be required to cover these services without cost sharing for women across the country.  

The final rule adds that nonprofit employers who, based on religious beliefs, do not currently provide contraceptive coverage in their insurance plan, will be provided an additional year, until August 1, 2013, to comply with the new law. Employers wishing to take advantage of the additional year must certify that they qualify for the delayed implementation. The additional year will allow these organizations more time and flexibility to adapt to this new rule while also providing notice to employees that contraceptive services are available at alternative sites such as community health centers, public clinics, and hospitals with income-based support. 

The final regulation keeps a narrow conscience clause, allowing faith-based nonprofits an extra year to begin covering contraceptives. Only organizations that are faith-based and primarily employ those of the same faith are eligible for the exemption. The transition will apply to religiously affiliated groups, such as hospitals, charities and universities that currently do not provide contraceptive services. Faith institutions such as churches, synagogues and mosques will continue to be exempt from the requirement, as well as primary or secondary schools closely tied to them, HHS said. HHS estimated one million to two million people work for nonprofits with religious affiliations and potentially would receive new contraceptive coverage under the rule.

Read the statement issued by HHS Secretary Kathleen Sebelius at:

http://www.hhs.gov/news/press/2012pres/01/20120120a.html

1/20/12 CMS issued an informational bulletin and a set of frequently asked questions which provided guidance on the implementation of §6501, Termination of Provider Participation under Medicaid if Terminated under Medicare or other State Plan. The bulletin clarifies earlier CMS guidance provided in a May 31, 2011, Informational Bulletin and accompanying Frequently Asked Questions (FAQs) on ACA §6501.

Read the 1/20/12 bulletin at:

http://www.medicaid.gov/Federal-Policy-Guidance/downloads/CIB-01-20-12.pdf Read the May 31, 2011 Bulletin at:

http://www.cms.gov/CMCSBulletins/downloads/6501-Term.pdf

Prior guidance can be viewed at www.healthcare.gov

News

1/24/11 Rick Gilfillan, Acting Director of the Center for Medicare & Medicaid Innovations (CMMI) posted a blog entry on healthcare.gov about how a January 2012 CBO report supports many of the initiatives underway at the CMMI. The CBO report reviews the outcomes of several major demonstrations aimed at enhancing the quality of health care and improving the efficiency of health care delivery in its fee-for-service program conducted in the past decade and concludes that evaluations have shown that they have not reduced Medicare spending. The report recommends collecting better data, encouraging providers to work together and focusing resources on the patients who need it most. The projects underway at the CMMI are already working to adopt many of the CBO report's recommendations including: The Pioneer ACO and ACO Shared Savings models, the Community-Based Care Transitions Program, the Comprehensive Primary Care Initiative, and the Bundled Payments for Care Initiatives.

Read the healthcare.gov blog at: 

http://www.healthcare.gov/blog/2012/01/innovations01242011.html