11/15/13 CMS/HHS published a notice under the Paperwork Reduction Act of 1995 (PRA) seeking comments on proposed information collection activities related to the evaluation of the rural community hospital demonstration (RCHD). ACA §10313 extended and expanded the RCHD.

The RCHD is a demonstration that aims to provide information that can be used to assess the feasibility of establishing a new category of rural community hospitals for reimbursement policy.

Originally created in 2003, the RCHD provides enhanced reimbursement for inpatient services to small rural hospitals that do not qualify as critical access hospitals (CAHs). The RCHD is intended to increase the capability of these hospitals to meet the health care needs of rural beneficiaries in their service areas. As of January 2013, 23 hospitals from 11 states were participating in the RCHD. The number includes seven hospitals from the original demonstration (as authorized in 2003) and 15 new hospitals that joined under the expansion authorized under the ACA.

In assessing the impact of the RCHD, the evaluation will examine how RCHD hospitals responded to payment options and assess how the costs to Medicare under RCHD compare to existing alternative payment options.

Comments are due January 14, 2014.

Read the notice at: http://www.gpo.gov/fdsys/pkg/FR-2013-11-15/pdf/2013-27305.pdf (see item #1)

11/15/13 CMS/HHS published a notice under the Paperwork Reduction Act of 1995 (PRA) seeking comments on proposed information collection activities related to the State-based Health Insurance Marketplace (or Exchange) Annual Report.

According to CMS, the annual report is the chief tool to insure compliance with all reporting requirements contained in the ACA. Specifically, §1313(a)(1) requires a State-based Health Insurance Marketplace (SBM) to preserve an accurate accounting of all activities, receipts, and expenditures, and to submit a report annually to the HHS Secretary concerning such accounting. HHS will use the information collected from states to determine if a state is maintaining a compliant and operational Exchange and provide HHS with any information regarding known or potential changes in an SBM's priorities and approaches for the upcoming year.

The ACA established Affordable Insurance Exchanges (§1311(b)) to provide individuals and small business employees with access to health insurance coverage beginning January 1, 2014, where low and moderate income Americans will be eligible for premium tax credits (§1401, §1411) to make purchasing a health plan more affordable by reducing out-of-pocket premium costs.If states choose not to run either a State-Based Exchange or a State-Federal Partnership Exchange, HHS will operate a Federally-facilitated Exchange (§1321).

Comments are due January 14, 2014.

Read the notice at: http://www.gpo.gov/fdsys/pkg/FR-2013-11-15/pdf/2013-27305.pdf (see item #2)

11/14/13 The Obama Administration announced a transitional policy that may allow individuals with non-ACA compliant insurance policies to remain on their current health insurance plans through 2014. The policy would give insurers the option (if approved by the state's Insurance Commissioner) to renew their current policies for current enrollees without adopting the ACA-required insurance market protections scheduled in begin 2014. The proposed change would affect individuals and families who buy plans directly from insurers as well as small-employer plans that didn't meet ACA requirements. The rule applies only to individuals and small businesses with coverage that was in effect on October 1, 2013 (it does not apply to individuals and small businesses that obtain new coverage after October 1, 2013).

In Massachusetts, where state reforms virtually eliminated policies that didn't already conform to ACA standards, officials decided not to take up the administration's option and will not allow health insurance issuers that do not conform to the requirements of the ACA and the Massachusetts insurance law and regulations to renew or otherwise continue existing policies.

The Obama administration's proposal requires insurers offering such renewals to ensure consumers are informed about their other options under the ACA. Insurers offering these renewals must inform policyholders about the protections their renewed plan will not include and what benefits they would be foregoing by not signing up with health plans that meet the ACA's essential benefits standard (EHB) standards. Health plans would also have to tell consumers about the new options on the Exchanges that offer more comprehensive coverage and about that they might qualify for financial assistance on the Exchange, such as tax credits or be eligible for Medicaid.

Beginning October 1, 2013, qualified individuals and qualified employees could purchase private health insurance coverage through Exchanges (Marketplaces) for January 1, 2014 effective dates. The ACA established Affordable Insurance Exchanges (§1311(b)) to provide individuals and small business employees with access to health insurance coverage beginning January 1, 2014, where low and moderate income Americans will be eligible for premium tax credits (§1401, §1411) to make purchasing a health plan more affordable by reducing out-of-pocket premium costs.

As required under ACA §1302(b), EHBs are a package of medical services and treatments which includes ambulatory and emergency care, maternity care, prescription drugs and other comprehensive health care services in 10 statutory benefit categories, and are equal in scope to a typical employer health plan. Absent the transitional policy, effective January 1, 2014, all plans sold in the exchanges and through the small group and individual markets must be equal in scope to the benefits covered by a typical employer plan and offer an EHB package of medical services and treatments in the ten prescribed categories.

Read the Massachusetts' Division of Insurance Commissioner's letter to CCIO at:

http://www.mass.gov/ocabr/docs/doi/letter-to-cciio-gary-cohen-11-18-13.pdf

Read CCIIO's letter to Insurance Commissioners at: http://www.cms.gov/CCIIO/Resources/Letters/Downloads/commissioner-letter-11-14-2013.PDF

11/14/13 HHS/CMS released a notice called "Patient Protection and Affordable Care Act; Exchanges and Qualified Health Plans, Quality Rating System (QRS), Framework Measures and Methodology." In order to support the delivery of quality health care coverage offered in the Exchanges, §1311(c)(3) and (c)(4) direct the HHS Secretary to develop a system that rates qualified health plans (QHPs) based on their relative quality and price.

The notice describes the overall Quality Rating System (QRS) framework for rating Qualified Health Plans (QHPs) offered through an Exchange (Marketplace). The notice solicits comments on the list of proposed QRS quality measures that QHP issuers would be required to collect and report, the hierarchical structure of the measure sets, the elements of the QRS rating methodology and on ways to ensure the integrity of QRS ratings.

The ACA established Affordable Insurance Exchanges (§1311(b)) to provide individuals and small business employees with access to health insurance coverage beginning January 1, 2014, where low and moderate income Americans will be eligible for premium tax credits (§1401, §1411) to make purchasing a health plan more affordable by reducing out-of-pocket premium costs. QHPs are health plans that have been certified by an Exchange, provide essential health benefits (§1301) and follow established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts).

Comments are due January 21, 2014.

Read the notice (which was published in the Federal Register on November 19, 2013) at: http://www.gpo.gov/fdsys/pkg/FR-2013-11-19/pdf/2013-27649.pdf

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