HHS Delays Basic Health Program
In the February Q & A released by the Centers for Medicare and Medicaid Services (CMS), the HHS announced that implementation of the Basic Health Program would be delayed until 2015. According to CMS, “Given the scope of the coverage changes that states and the federal government will be implementing on Jan. 1, 2014, and the value of building on the experience that will be gained from those changes, HHS expects to issue proposed rules regarding the Basic Health Program for comment in 2013 and final guidance in 2014, so that the program will be operational beginning in 2015 for states interested in pursuing this option.” The Basic Health Program is an option for states under the Patient Protection and Affordable Care Act (PPACA) that allows the use of federal tax subsidy dollars that would otherwise be used for subsidies in the exchange, to be used for coverage for people with incomes between 139 percent and 200 percent of the federal poverty guidelines. Read this Kaiser Family Foundation report for more information on the Basic Health Program.
Upcoming Webinars: March 6 and March 8
Improving Medicaid Program Integrity: State Strategies to Combat Fraud and Abuse
Every year states and the federal government lose billions of dollars to fraud, waste and abuse in Medicaid. States are taking a variety of approaches to combat this problem. This webinar will highlight promising state practices to improve Medicaid program integrity, with an emphasis on providers, where the vast majority of states’ actions are focused. From focusing on “high risk” providers and refining how states review claims, to exploring the potential of new technology, states are working to implement strategies that save taxpayer dollars—and appeal to policymakers on both sides of the aisle.
Wednesday, March 6, 2013
2 p.m. ET/ 1 p.m. CT/ Noon MT/ 11 a.m. PT
Click here to register
Community Health Centers’ Role in the Health System, Now and In the Future
This webinar will explain how health centers operate and how their patient mix presents funding challenges. Health centers must rely heavily on third-party payer reimbursement (such as Medicaid, CHIP, and Medicare) because of their mission to serve the uninsured. The uninsured are the largest group served by health centers but they account for less than
6 percent of their total revenue. The webinar will also discuss the impact of Medicaid eligibility or benefit changes on health centers as well as other issues facing health centers in the coming years.
Registration is free and details are included below:
Friday, March 8, 2013
2 p.m. ET/ 1 p.m. CT/ Noon MT/ 11 a.m. PT
Click here to register
A State, Federal or Partner Exchange? That is No Longer the Question
States have made their decisions about who will run the health insurance exchanges, choosing whether to run their own, allow the federal government to run it for them, or partner with the federal government and run certain parts of the exchange. In December 2012, 18 states and the District of Columbia declared that their state would run all functions of the exchanges. The remaining states were given extra time— until Feb. 15— to consider a partnership with the federal government to run certain functions of the exchange. Despite the extension of deadlines, states decisions did not change dramatically.
The following list shows state decisions to date:
Will have a State-Run Health Insurance Exchange
Will Partner with the Federal Government
Will have a Federally Facilitated Exchange
California, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, Oregon, Rhode Island, Utah, Vermont and Washington
Arkansas, Delaware, Illinois, Iowa, Michigan, New Hampshire and West Virginia
Alabama, Alaska, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Virginia, Wisconsin and Wyoming
States pursuing the state-run or partnership option were required to submit plans to HHS demonstrating that they are heading in the direction to have a fully functioning exchange by Jan. 1, 2014, with enrollment beginning Oct. 1, 2013. Of the 18 states that submitted state-run exchange “blueprints,” 17 were conditionally approved by HHS. Mississippi’s blueprint, submitted by the commissioner of insurance but not supported by the governor, was not approved by HHS.
Seven states submitted plans to partner with the federal government to run the exchange. So far, three of the seven states have received HHS’s conditional approval: Arkansas, Delaware and Illinois. Last week, North Carolina backed out of pursuing this option, while New Hampshire submitted its blueprint for a partnership.
Twenty-six states will have a federally facilitated exchange.
State legislatures created the state-run exchanges in 11 states and the District of Columbia: California, Colorado, Connecticut, the District of Columbia, Hawaii, Maryland, Massachusetts, Nevada, Oregon, Utah, Vermont and Washington. Utah’s legislation, which was enacted prior to ACA, created a small business health insurance exchange that is similar to the federal law’s SHOP exchange. The governors and the executive branches in Kentucky, Idaho, Minnesota, New Mexico, New York and Rhode Island created their state-run exchange. Idaho awaits the legislature’s seal of approval with SB142 and HB179.
All exchanges—state, federal and partnership—will need to be ready to open their doors by Oct. 1, 2013. The states that opted to run their exchange will need to continue their implementation plans while meeting federal rules and guidance that will set standards along the way. The latest final rule, released Feb. 20, for example, offers guidance on health insurance issuer standards for essential health benefits. Last week, Covered California, California’s health insurance exchange, released standards for benefit plans that will be made available in the individual and small employer group markets later this year.
So far, in 2013, 13 states have introduced bills to establish state-run exchanges and 10 states have introduced legislation prohibiting the establishment of or participation in an exchange. New Hampshire is considering HB544 to repeal the 2012 state law that prohibits the establishment of a health insurance exchange. The state’s political climate has shifted since the election from a Republican majority to a Democratic majority.
States have the option to change course regarding the exchange plan at any time. In other words, a state working with the federal government on the implementation of a partnership exchange, may intend to have a fully functional state-run exchange, such as Illinois’s plan to have a state exchange by January 2015. In the meantime, the federal government is moving full speed ahead with developing the federally facilitated exchanges that will offer coverage options to millions of Americans in 26 states.
Tennessee and Hawaii Opt-Out of Program for Dually-Eligible People
Since December, two states have announced their withdrawal from the CMS Medicare-Medicaid Coordination Office’s Financial Alignment Initiative designed to improve care and better align financing of services for seniors enrolled in both Medicare and Medicaid—more commonly known as the dually-eligible population or “duals.”
Just before the new year, Tennessee withdrew its proposal for a financial alignment demonstration program citing concerns about continuity of care and reimbursement rates, among others. Hawaii also recently announced that it was withdrawing its proposal under the initiative, opting instead to seek a five-year renewal of its Section 1115 demonstration project from the CMS.
The financial alignment initiative was announced by CMS in July 2011 to test new payment and financing models to promote better care and align the incentives for improving care and lowering costs between Medicare and Medicaid. Under this initiative, states can choose to test one of two models in their state: a capitated model where the state, CMS and a health plan enter into a three-way contract; or, a managed fee-for-service model under which the state and CMS enter into an agreement by which the state creates initiatives to coordinate care and is then eligible to benefit from savings generated.
Tennessee and Hawaii are not the first states to change their minds about the demonstration. New Mexico formally withdrew its proposal last August and Oregon did the same in October. Minnesota also withdrew its proposal last year, but is now pursuing an alternative demonstration program.
A CMS official was recently quoted as saying that 23 states are still moving forward with plans to participate in the Financial Alignment Demonstration.
“Sunshine Rule” Brings Disclosure by Drug and Device Manufactures
The ACA includes a less-known provision (Section 6002), called the “National Physician Payment Transparency Program,” or “OPENPAYMENTS.” The CMS published the final rule on Feb. 8, which requires that manufacturers of drugs, biologicals, medical devices and supplies covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) report payments or other transfers of value to physicians and teaching hospitals. The final rule also requires manufacturers and group purchasing organizations (GPOs) to disclose physician ownership or investment interests. They must also disclose what they pay to doctors for purposes such as consulting or speaking on behalf of the manufacturer or a specific drug.
According to the National Legislative Association on Prescription Drug Prices, several state legislatures, including Vermont, Maine, Massachusetts, Minnesota, West Virginia and D.C, enacted similarly intended laws prior to the ACA.
Data collection will begin on Aug. 1, 2013. CMS will release the data on a public website by September 30, 2014.
New Publication on Medicaid Fraud & Abuse
Fraud, waste and abuse in Medicaid costs states and the federal government billions of dollars each year. In a new LegisBrief, Medicaid Program Integrity: Fighting Fraud, Waste and Abuse, NCSL highlights recent state action to prevent, detect and pursue fraudulent activity among Medicaid providers.