May 20, 2013

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(1) Utah and CMS have agreed to split responsibilities for the state’s health insurance exchange next year. CMS on May 10 approved Utah’s first-in-the-country “bifurcated” exchange model in which the state will run the small-business market and the feds will run the individual market .... (more)

(2) Michigan insurance regulators on May 13 approved the state’s first statewide Consumer Operated and Oriented Plan (CO-OP) that will cover individuals and small groups starting Jan. 1, 2014, under the Affordable Care Act (ACA). Consumers Mutual Insurance of Michigan will be run similar to a credit union, with customers representing a majority of its governance through a board, according to a May 13 article in The Detroit Free Press. The nonprofit will offer plans geared toward low-income and lower-middle-income residents, as well as small groups and businesses. But it will have to compete against established insurers such as Blue Cross Blue Shield of Michigan, whose size gives it leverage in negotiating costs with hospitals and providers, the article says. Consumers Mutual is one of two dozen CO-OPs across the country that will launch next year with the full rollout of the ACA. The concept was devised to give consumers an alternative to commercial insurance plans. For start-up funding, Consumers Mutual received a $72 million federal loan through the ACA that it must pay back by 2027, the Free Press said. CEO Dennis Litos said Consumers Mutual hopes to enroll 37,000 to 38,000 customers by the end of next year. The company has yet to set prices. (Reprinted from AIS’s Health Reform Week's e-News Alert)

(3) The Center for Consumer Information and Insurance Oversight on May 1 offered guidance on the broker role in public exchanges operated by, or in partnership with, the federal government .... (more)

(4) The Medicare Fraud Strike Force unveiled a takedown involving eight cities, 89 individuals and allegations of $223 million of fraudulent Medicare billings, the Departments of Justice and HHS announced at a May 14 press conference .... (more)

(5) HHS Sec. Kathleen Sebelius reportedly has asked health industry officials to make large financial donations to help implement the ACA. Over the past three months, Sebelius has made multiple phone calls to health industry executives, community organizations and church groups asking them to contribute whatever they can to nonprofit groups that are working to enroll uninsured Americans and increase awareness of the law, according to a May 10 article in The Washington Post. Republicans charged that Sebelius’s outreach was improper because it pressured private companies and other groups to support the ACA. An HHS spokesperson told the Post that Sebelius was within the bounds of her authority in asking for help. HHS spokesperson Jason Young added that a special section in the Public Health Service Act allows the secretary to support and encourage others to support nonprofit groups working to provide health information and conduct other public-health activities. (Reprinted from AIS’s Health Reform Week's e-News Alert)

(6) In a new report (A-01-12-00522), the HHS Office of Inspector General (OIG) has estimated that Medicare and beneficiaries could have saved a bundle in 2011 on anemia management drugs provided to end-stage renal disease patients if the agency had updated its ESRD base rate — $510 million for Epogen and Aranesp and $19 million for the iron supplements Venofer and Ferrlecit .... (more)

(7) The HHS OIG has found that state agencies and accredited organizations are conducting recertification surveys within 36 months as required by the regulations .... (more)

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