4/18/14 CMS/HHS issued a notice under the Paperwork Reduction Act of 1995 (PRA) seeking comments on information collection activities related to the prospective evaluation of evidence-based community wellness and prevention programs. ACA §4202(b) requires that CMS/HHS conduct an evidence review and independent evaluation of wellness programs focusing on six intervention areas. The subject matters include such interventions as chronic disease self- management, increased physical activity, improved diet and nutrition, and mental health management.

 

HHS/CMS implemented a three-phase approach to evaluate the impact of wellness programs on Medicare beneficiary health, utilization, and costs to determine whether broader Medicare beneficiary participation in wellness programs could lower future growth in Medicare spending. Phase 1 and Phase 2 have been completed. The outcomes of Phase 3 will demonstrate how wellness programs impact Medicare beneficiaries and if cost-saving opportunities exist for the Medicare program. HHS/CMS will conduct a national survey of Medicare beneficiaries in order to evaluate their willingness to participate in community-based wellness programs. Based on feedback received on the survey, the agency is altering and clarifying several components of the survey in order to achieve a higher response rate.

 

Comments are due May 19, 2014.

 

Read the notice at: http://www.gpo.gov/fdsys/pkg/FR-2014-04-18/pdf/2014-08897.pdf

 

4/18/14 CMS/HHS issued a notice under the Paperwork Reduction Act of 1995 (PRA) seeking comments on the extension of information collection activities related to the "Basic Health Program (BHP) Report for Health Insurance Exchange Premiums."

 

The BHP program, as authorized by §1331 and subsequent guidance, provides states the option to establish a health benefits coverage program for low-income individuals who would otherwise be eligible to purchase coverage through the Health Insurance Exchange. Under the BHP rules, citizens or lawfully present non-citizens who do not qualify for Medicaid, the Children's Health Insurance Program (CHIP) or other minimum essential coverage and have incomes between 133% FPL and 200% FPL are eligible for the BHP.

 

The BHP is federally funded by determining the amount of payments that the federal government would have made through the premium tax credit and cost sharing reductions (CSR) for individuals enrolled in BHP had they instead been enrolled in an Exchange. To calculate the amounts for each state, HHS/CMS is asking states for "reference premiums" for the second lowest cost silver plans in each geographic area in a state, as those amounts are a basic unit in the calculation of tax credits and CSRs under the Exchanges. Furthermore, reference premiums are critical components of the BHP payment methodology. According to HHS/CMS, the agency has the required data to establish reference premiums for states whose Exchanges are operated by the Federally Facilitated Exchange (FFE) or are operated in partnership with the FFE, although the agency is seeking such information from the 17 states that are operating State Based Exchanges.

 

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 individuals would be eligible for premium tax credits (§1401, §1411) to make purchasing a qualified health plan (QHP) 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).

 

Beginning January 1, 2015, states will have an option to establish a BHP for certain individuals who meet the income criteria and would otherwise be eligible to obtain coverage through the Exchange. BHP benefits are required to include at least the ten essential health benefits specified in §1301. BHP monthly premiums and cost sharing cannot exceed what an eligible individual would have paid if the eligible individual were to receive coverage from a QHP through the Exchange. A state that operates a BHP will receive federal funding equal to 95% of the amount of the premium tax credits and the cost sharing reductions that would have otherwise been provided to (or on behalf of) eligible individuals if these individuals enrolled in QHPs through the Exchange.

 

Comments are due June 17, 2014.

 

Read the notice at: http://www.gpo.gov/fdsys/pkg/FR-2014-04-18/pdf/2014-08898.pdf (see item #1)