Read the proposed rule (which was published in the Federal Register on February 1, 2013) at: http://www.gpo.gov/fdsys/pkg/FR-2013-02-01/pdf/2013-02139.pdf

Read the final rule (which was published in the Federal Register on July 1, 2013) at:

http://www.gpo.gov/fdsys/pkg/FR-2013-07-01/pdf/2013-15530.pdf

The notice provides guidance on whether or when, for purposes of the premium tax credits under §1401, §1411, an individual is eligible for minimum essential coverage under certain government-sponsored health programs or other coverage designated as minimum essential coverage. For example, according to IRS/Treasury, an individual who has applied to the Children's Health Insurance Program but faces a waiting period may receive a premium tax credit during that waiting period.

Read Notice 2013-41 at:http://www.irs.gov/pub/irs-drop/n-13-41.pdf

6/27/13 HHS/CMS issued a correction to a proposed rule called "Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Fiscal Year 2014 Rates; Quality Reporting Requirements for Specific Providers; Hospital Conditions of Participation." The correction fixes technical and typographical errors in the proposed rule which implements portions of the following sections of the ACA: 3008, 3025, 3313, 3401(f), 10309, 10322(a).

The proposed rule (which was published in the Federal Register on May 10,2013) updates Medicare payment policies and rates for inpatient stays to general acute care hospitals paid under the Inpatient Prospective Payment System (IPPS) and long-term care hospitals (LTCHs) paid under the LTCH Prospective Payment System (PPS) for FY2014. In addition to the annual Medicare hospital payment policy updates, the rule establishes new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. The rule also updates policies under the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. The proposed changes would be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in the rule.

Read the correction at:http://www.gpo.gov/fdsys/pkg/FR-2013-06-27/pdf/2013-15321.pdf

Prior guidance can be found at: http://www.hhs.gov/healthcare/index.html

News

6/25/13 The U.S. Preventive Services Task Force (USPSTF) issued a final recommendation statement on screening for hepatitis C virus (HCV) infection in adults. The statement recommends HCV screening for adults at high risk of infection, including those with any history of intravenous drug use and people who received blood transfusions prior to 1992. In addition, the task force recommended that health care providers offer one-time screening for the infection in all adults born between 1945 and 1965.

The USPSTF is an independent panel of non-federal government experts that conduct reviews of scientific evidence of preventive health care services. The USPSTF then develops and publishes recommendations for primary care clinicians and health systems in the form of recommendation statements. As part of their recommendations process, the USPSTF will assign definitions to the services they review based on the certainty that a patient will receive a substantial benefit from receiving the benefit. Services that are graded "A" and "B" are highly recommended and the USPSTF believes there is a high certainty that patient will receive a substantial or moderate benefit. 

Under ACA §1001, all of the recommended services receiving grades of "A" or "B" must be provided without cost-sharing when delivered by an in-network health insurance provider in the plan years (or, in the individual market, policy years) that begin on or after September 23, 2010. The USPSTF has assigned a "B" rating to both recommendations for HCV screening in adults.

Read the news bulletin on the final recommendation at:

http://www.uspreventiveservicestaskforce.org/bulletins/hepcbulletin.pdf

Read the final recommendation at:

http://www.uspreventiveservicestaskforce.org/uspstf12/hepc/hepcfinalrs.htm

Learn more about preventive services covered under the ACA at: http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html

Learn more about the USPSTF at: http://www.uspreventiveservicestaskforce.org/  

6/24/2013 HHS announced the launch of new educational tools related to the National Health Insurance Marketplace (Exchange). Moving forward the HealthCare.gov website will be consumer-driven and allow consumers nationwide to learn about the benefits and health insurance options under the ACA. The website will be accessible from computers, smart-phones and other devices. In addition, the website will include the integration of social media and include web chat functionality for consumers to obtain additional information. Spanish speaking consumers will be able to access the same information on CuidadoDeSalud.gov. 

Visit the new website at: HealthCare.gov

For more information, view the press release: http://www.hhs.gov/news/press/2013pres/06/20130624a.html

The content previously found on HealthCare.gov can be found at: http://www.hhs.gov/healthcare/index.html

6/20/13 HHS announced that insurance companies will provide 8.5 million Americans with $500 million in rebates this summer due to the ACA's medical loss ratio (MLR) requirements. According to HHS' national estimates, rebates will be an average of $100 for each eligible family. Data released by HHS shows that, in Massachusetts, 173,454 consumers will receive an average rebate per family of $457.

The ACA's MLR rules establish the minimum dollar percentage that health insurance companies must spend of consumers' health insurance premiums on medical care, not on income, overhead or marketing. Starting with the 2011 reporting year, the ACA required insurance companies in the individual and small group markets to spend at least 80% of collected premium dollars on medical care and quality improvement activities; insurance companies in the large group market are required to spend at least 85%. Insurance companies must report their MLR data to HHS on an annual basis so that residents of every state will have information on the value of the health plans offered by insurance companies in their state. Under §10101, insurance companies that do not meet the MLR standard are required to provide rebates to their consumers. Rebates must be paid by August 1st each year and insurers distributed the first round of rebates to consumers in 2012. 

Consumers owed a rebate will receive the rebate in one of the following ways: a rebate check in the mail; a lump-sum reimbursement to the same account that they used to pay the premium if by credit card or debit card; a reduction in their future premiums; or their employer providing one of the above, or applying the rebate in a manner that benefits its employees.

For a detailed breakdown of the rebates by State and by market, visit: http://www.cms.gov/CCIIO/Resources/Data-Resources/mlr.html

Read the report at: http://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/2012-medical-loss-ratio-report.pdf

Read the final MLR rule at: http://www.gpo.gov/fdsys/pkg/FR-2012-05-16/pdf/2012-11753.pdf

EOHHS News

Integrating Medicare and Medicaid for Dual Eligible Individuals Update

MassHealth and CMS are pleased to announce that three plans are moving into the final phase of readiness review and contracting for One Care: MassHealth plus Medicare. Commonwealth Care Alliance, Fallon Total Care, and Network Health have completed their submissions for the desk review and provider networks, and are preparing for the final site visit components of the readiness review. The desk review and the plans' provider network analysis are currently in process. We have finalized the 2013 capitated payment rates and will begin systems testing with all plans the second week in July.

We continue to work toward a One Care start date of October 1, beginning with a period of self-selected enrollment. The first wave of auto-assignment is tentatively scheduled to take effect on January 1, 2014.

MassHealth will be kicking off a broad public awareness and outreach effort in mid-July to ensure that consumers, their families, providers, and other community-based organizations are informed about One Care and prepared for the enrollment process this fall.

We look forward to One Care becoming a reality, in partnership with a solid group of plans that will ensure access to enhanced care coordination and quality for MassHealth members. 

Learn more about One Care at:

http://www.mass.gov/masshealth/duals