HHS finalizes ACA insurance market, rate review rule   02/22/2013
The Department of Health and Human Services today issued a final rule implementing insurance market reforms that prohibit health plans from denying coverage due to pre-existing medical conditions or charging individuals and small employers higher premiums based on health status or gender. The rule generally allows individual and small group premiums to vary based on family size, geography, age and tobacco use only; and directs individual and small group plans to accept everyone who applies for coverage. The rule also requires insurers to maintain a single risk pool for the individual market and a single risk pool for the small group market; and outlines standards for enrollment in catastrophic plans for young adults and people who cannot otherwise afford health insurance. In addition, the rule revises the timeline for states to propose thresholds for rate review, requires health plans to submit data on all proposed rate increases in a standardized format and modifies the criteria for an effective state rate review program. Most of the rule's provisions take effect 60 days after publication in the Feb. 27 Federal Register and apply to health plan or policy years beginning in 2014.
OIG reports on state efforts to streamline Medicaid/CHIP enrollment   02/22/2013
At least 35 states anticipate meeting federal requirements to streamline eligibility and enrollment procedures for Medicaid, the Children's Health Insurance Program and health insurance exchanges by 2014, according to a new report by the Department of Health and Human Services' Office of Inspector General. Based on an OIG survey of 45 states last April, at least 40 states anticipate having streamlined application forms, 38 streamlined eligibility and enrollment systems, and 37 data sharing and matching by Jan. 1, as required by the Patient Protection and Affordable Care Act. However, many respondents reported challenges implementing the requirements, including the need for more guidance and information on the HHS application form, federal data services hub and modified adjusted gross income requirements. OIG recommends that the Centers for Medicare & Medicaid Services continue to provide guidance to states. In the report, CMS describes its ongoing work with states since the survey was conducted.
AHA to host special members-only Advocacy Day webcast   02/22/2013
AHA's hospital and health system members are invited to join AHA President and CEO Rich Umbdenstock, Executive Vice President Rick Pollack and Senior Vice President of Federal Relations Tom Nickels for a live webcast Tuesday in conjunction with AHA's Advocacy Day. The webcast, at 9:30 a.m. ET, will allow hospital leaders who could not travel to Washington, D.C., for Advocacy Day to participate virtually. To access the special webcast, participants must be registered for AHA's 2013 Town Hall Interactive webcasts (even if they have registered in past years). To register, click here.
CORE updates operating rules for use with remittance advice standard   02/22/2013
The Committee on Operating Rules for Information Exchange has published updated operating rules for code combinations used with the Health Insurance Portability and Accountability Act's remittance advice standard. The remittance advice standard uses Claim Adjustment Reason Codes and Remittance Advice Remark Codes to explain how a health plan adjudicated an electronic health care claim. The updated operating rules promote consistency in the use of these codes to comply with new operating rules for remittance advice and electronic funds transfer under the Patient Protection and Affordable Care Act.
Webinars highlight strategies to eliminate disparities, promote diversity   02/22/2013
Two new webinars from the AHA's Center for Healthcare Governance review strategies to eliminate health care disparities and promote leadership diversity at hospitals and health systems. Available free to all AHA members at www.americangovernance.com/policy, the webinars include key strategic planning questions for trustees to consider, board action checklists, and sources for additional information on health care disparities and diversity at the leadership and board level. The webinar is part of the Center's Health Care in Transition education series, which brings the AHA's policy expertise and center's educational expertise to bear on critical policy and regulatory issues for trustees.