Nov. 25, 2013
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(1) The Obama administration is moving closer to letting consumers bypass HealthCare.gov and purchase coverage, as well as apply for subsidies, directly from insurers and online brokers, according to a Nov. 19 article in the Huffington Post. CMS is working to give carriers the technical capability to take subsidy applications and sell plans directly to customers, CMS spokesperson Julie Bataille said on Nov. 19, according to the Post. “We've put in place a number of the most important fixes. This is something that issuers are going to look at within the context of their own systems, and I believe that, in the coming days, as they make their own assessments, they will make determinations about what may be appropriate,” she said. Currently, shopping through an insurance exchange is the only way for a consumer to obtain a tax subsidy for purchasing a plan. Online brokers such as eHealth and Go Health as well as about 30 others will soon have this capability, Bataille said. (Reprinted from AIS’s Health Reform Week's e-News Alert)
(2) HHS is planning to delay the start of the second year of public exchange enrollment by a month in order to give health insurers some extra time to set rates based on their 2014 experiences .... (more)
(3) Michigan on Nov. 5 recommended that eight managed care plans be awarded contracts for its proposed Medicare-Medicaid dual eligibles initiative under CMS’s Financial Alignment Demonstration .... (more)
(4) Henry Schein, Inc., the world’s largest purveyor of health care products and supplies to medical, dental and veterinary practices, agreed to pay $1.14 million to settle allegations that it violated the civil monetary penalty law applicable to kickbacks .... (more)
(5) A top CMS technology official said that up to 40% of the HealthCare.gov website is still being built, particularly the “back-office systems,” The New York Times reported Nov. 19 .... (more)
(6) Health Net, Inc., Blue Shield of California and WellPoint, Inc. unit Anthem Blue Cross were ordered to “cease and desist” by the California Department of Managed Health Care .... (more)
(7) High-risk insurance pools, which were supposed to be phased out by the end of the year under the Affordable Care Act (ACA), will have a second life in some states due to problems with the federal exchange, according to a Nov. 17 Wall Street Journal article. Roughly 35 states operate high-risk pools that insure approximately 200,000 people. About half of these states had planned to close these pools near the end of this year, because the ACA requires insurers to accept all customers regardless of their health history, the Journal said. Some of these states now are considering extending their pools' lives, including Wisconsin, which has one of the biggest high-risk pools at about 22,000 members. That state said on Nov. 14 that it would hold a special legislative session with the aim of extending the program by three months. Other states considering the same option include Texas and Indiana. Another 17 states already had decided to keep the pools open beyond the end of 2013. This includes Maryland, which is moving 20,000 people in its pool gradually to the state-run exchange over the next few years. (Reprinted from AIS’s Health Reform Week's e-News Alert)
(8) President Obama told a group of health insurance CEOs that his decision to let carriers extend their current policies for another year may result in additional costs, including by encouraging healthier people to remain on their policies and driving sicker people to the exchanges, according to a Nov. 18 article in Politico. To address insurers’ concerns about these costs, the White House said it would tweak the “risk corridor” program in the ACA to give them more help. But Obama made clear that the financial support has a limit, Politico said, citing CEOs who attended the meeting. “As the president emphasized, there is not an unlimited amount of money out there for the government to do that [i.e., make up for extra costs],” Tufts Health Plan CEO Jim Roosevelt said, according to the article. Mario Molina, M.D., CEO of Molina Healthcare, said, “I think the best thing we can do to mitigate risk is getting…as many people enrolled as possible. There is no substitute.” (Reprinted from AIS’s Health Reform Week's e-News Alert)
(9) The Ensign Group, which operates skilled nursing facilities in the western United States, has agreed to pay the U.S. government $48 million to settle allegations that it submitted false claims to Medicare for medically unnecessary therapy services .... (more)
(10) A carve-out from an exclusive contract between a hospital and an anesthesiology group could pose significant risk of illegal remuneration .... (more)
(11) Alaska Sen. Mark Begich (D) on Nov. 19 introduced legislation calling for the creation of “copper plans” within the Affordable Care Act as a way to attract younger consumers who are willing to pay more in out-of-pocket medical costs in exchange for lower premiums .... (more)
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