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New Hampshire is Next!

“The CMS on Monday, May 7th, gave New Hampshire the green light to impose work rules for some adult Medicaid recipients. It’s the fourth state to win approval for that requirement.

“The state’s Medicaid 1115 waiver will require adult beneficiaries between the ages of 19 and 64 to participate in 100 hours of “community engagement activities” a month to maintain eligibility for coverage. Community engagement is defined as having a job, being enrolled in school, participating in job skills training, or performing some sort of community service.

“‘Today’s announcement by the CMS … is a transformative step towards a more thriving workforce,’ Gov. Chris Sununu said in a written statement. ‘Work requirements help lift able-bodied individuals out of poverty by empowering them with the dignity of work and self-reliability while also allowing states to control the costs of their Medicaid programs—we are committed to helping more people get into the workforce, as it is critical not only for individuals but also for our economy as a whole.'”
Source: Steven Ross Johnson, Modern Healthcare.

CMS Encourages Innovation!

On Monday April 9, 2018 the Centers for Medicare and Medicaid finalized the rule that “eliminates (Affordable Care Act) standardized options starting in 2019 to encourage innovative plan designs among insurers.”

This is a good move for the coming years in the, non-Medicare, individual/family health insurance markets of America!  This change indicates that our current government recognizes that health insurance plans are not a one-size-fits-all financial product.  We have been saying this all along and CMS Director Verma has now been quoted saying as much- and we are thankful.

At this time it is unclear if ACA-compliant plans this fall, for the 2019 calendar year, will reflect this change in standardization requirements, and make health insurance plans more reflective of the coverage needs of the people in each state.  However, since the standardization requirements are eliminated in 2019- we do expect the individual/family plans, for the 2020 calendar year, to be more fitted to each state.

As everyone anticipates smart changes coming in the years ahead to the individual/family health insurance market we should be aware that according to Director Verma, the states are still subject to the ACA requirement that insurers offer 10 essential health benefits.  Although the standardization requirements are eliminated, this doesn’t mean states can allow ACA-compliant plans to exclude maternity care or mental health benefits.

We do expect to have more appropriate premiums and coverage choices for individuals and families in the coming years.  All in all, a good day.

Reference: Shelby Livingston and Susannah Luthi, Modern Healthcare.

Changes in Cardiac Device Coverage

CMS, the Centers for Medicare and Medicaid, has finalized its changes to its Medicare coverage of implantable cardiac devices, which should reduce the wait-times required to get the implantation procedure done and cut the regulatory burden for providers that use the devices for their patients.

This “is the first major change to Medicare’s implantable cardioverter defibrillator, or ICD, coverage in more than a decade. The CMS wants to reduce some of the barriers to care outlined in its most recent coverage determination, issued in 2005.

“The CMS is eliminating waiting periods for device implantation and dropping a policy that requires patients to be tracked in a registry.”

“It is also requiring shared decision-making, which the agency said would empower patients…

“The agency is also looking to hasten access to ICDs by allowing patients with an existing ICD who suffer a heart attack or undergo a coronary revascularization procedure to obtain a replacement device without waiting. Previously, the devices could not be implanted within 40 days of a heart attack or 90 days of bypass surgery or angioplasty…

“ICDs have been used since the 1980s, and the CMS began covering them in 1986. Initially, they were mostly used in patients with recurrent cardiac arrest who were not responsive to drug treatments. In 2005, the agency finalized coverage for primary prevention of arrhythmia.

“The devices are wired to the heart and deliver an electric shock if they detect an abnormal rhythm. They are a significant revenue driver for hospitals. It’s estimated that 10,000 ICDs are implanted every month, and the average hospital stay after placement is eight days. That generates an average of $12,423 in hospitalization costs per patient.”
Source: Virgil Dickson, Modern Healthcare.

Kentucky Leads the Way!

“Kentucky has become the first state in the nation to receive federal approval to impose work requirements as a condition of Medicaid coverage.

“Nine other states—Arizona, Arkansas, Indiana, Kansas, Maine, New Hampshire, North Carolina, Utah and Wisconsin—have also applied for the Section 1115 waivers.

“In the coming weeks, adult beneficiaries in Kentucky between 19 to 64 will be required to complete 80 hours per month of community engagement activities, such as employment, education, job skills training, and community service to maintain their Medicaid eligibility.

“Former foster-care youth, pregnant women, primary caregivers of a dependent, beneficiaries considered medically frail and full-time students are exempt from the new requirements.

“Kentucky will lock beneficiaries out of coverage for noncompliance. A person’s coverage can only be reactivated on the first day of the month after they complete 80 hours of community engagement in a 30-day period.

“If a suspended beneficiary hasn’t met the work or volunteering requirement by their redetermination date, their Medicaid enrollment will be terminated and they will have to submit a new application to rejoin Medicaid.

“The CMS also approved Kentucky’s request to impose premiums on expansion beneficiaries and parents and other family caretakers in the state.

“Non-payment over a 60-day period will result in a six-month lockout from coverage.

“Enrollees will also lose coverage if they don’t report income changes quickly.

“The approval also allows Kentucky to end retroactive coverage for Medicaid beneficiaries.

“The new waiver nixes providers’ ability to bill for services provided in the three months before the application, assuming the patient was eligible during that time.

“Finally, Kentucky has gained permission to continue not covering non-emergency transportation services.

“As of October 2017, Kentucky has more than 1.2 million people in Medicaid and the Children’s Health Insurance Program, a net increase of 108% since Medicaid expansion under the ACA, according to the CMS.”
Source: Virgil Dickson, Modern Healthcare.

CMS: “Patients Over Paperwork”

CMS Administrator, Seema Verma,  has announced the initiative to ease the burden of records and reporting management in medical pracctices.  Nationally, medical providers and staff typically spend a disproportionate amount of time on maintaining medical records in comparison to actual patient care.

“On a typical day, primary care doctors spent about 27% of their time on “meaningful patient care” and about 49% on administrative activities, he said, according to a 2016 study published in Annals of Internal Medicine.”

The new initiative, “Patients Over Paperwork,”  seems to be set to review current regulations and eliminate those that may not be adding to quality of care, or possibly unnecessary altogether.  The coming steps to be taken have the potential, in the long run, to lower today’s healthcare costs, increase efficiency and benefit both the healthcare industry and the people in America directly.  Source:  Medpage.

CMS Asking for Ideas

SUMMARY:

The Department of Health and Human Services (HHS) is actively working to reduce regulatory burdens and improve health insurance options under Title I of the Patient Protection and Affordable Care Act. Executive Order 13765, “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal,” directs the Secretary of Health and Human Services to achieve these aims. HHS seeks comment from interested parties to inform its ongoing efforts to create a more patient-centered health care system that adheres to the key principles of affordability, accessibility, quality, innovation, and empowerment.

DATES:

Comments must be submitted on or before July 12, 2017.

For more information click here.

 

White House: More ACA Changes

The Trump administration has announced new Affordable Care Act (ACA) rules for individuals and employers for this fall open enrollment and for the health insurance plans next year.

1.  As of now, the ACA open enrollment period will start on November 1st and end on December 15th.  This is substantially shorter than the most recent open enrollment period.  The intention seems to be to provide a standard 12- month policy period for everyone, and shore up complexities in processing insurance plans that could have a  1/1,  2/1,  or a 3/1 effective date.

2.  Anyone who signs up for health insurance outside of the open enrollment period, will have to provide specific and verifiable proof of eligibility to enroll based on a qualifying life event.  In the years before the ACA this was always the case, and is a reasonable requirement.  The intention to return to this protocol is to eliminate the opportunity to “game the system”  and for people to obtain coverage when they were not actually eligible to do so.  In many cases, over the years, expensive medical procedures and treatments were covered for some of these people, but then they stopped paying premiums and cancelled their plans as soon as the coverage was not needed for those procedures and treatments.  This ultimately affects everybody’s premiums.

3.  The administration’s new ACA rule allows insurers to refuse to cover a person who hasn’t paid their premiums.  The insurance companies will have to apply this to all employers or individuals.  Supposedly some state laws will have to change regarding this rule.   Also, this rule will apparently not be applied to employer plans sold on the federal small business SHOP marketplace due to “operational constraints,” according to the information available.

Regardless, Evansville Insurance Center deems this to be creating an uneven playing field.  The problems with SHOP enforcement of this rule should be resolved before it is a rule levied on all other insurance plans.

4.  Health plans will also get more flexibility in creating products to sell in their market- and not be restricted to the bronze, silver, gold, and platinum Qualified Health Plan benefit designs that were required by ACA rules.   This is the great news!  Insurance companies should now be able to design health insurance plans that are more suited to the particular people they are intended to cover.  Hopefully this new rule will be the mark that we are on the way to good changes.

Source:  Virgil Dickson, Modern Healthcare.

Judge Decides No Merger

The Anthem and Cigna merger is not allowed, according to a federal judge deciding the merger case because of a complaint filed by the Obama DOJ.  Anthem’s response is below:

“Anthem is significantly disappointed by the decision as combining Anthem and Cigna would positively impact the health and well-being of millions of Americans – saving them more than $2 billion in medical costs annually,” said Joseph R. Swedish, Chairman, President and Chief Executive Officer, Anthem. “Anthem has been a leader in providing individuals with access to high quality, affordable healthcare. Our decision to acquire Cigna is grounded in our commitment to this goal and to leading our industry during this period of dynamic change. If not overturned, the consequences of the decision are far-reaching and will hurt American consumers by limiting their access to high quality affordable care, slowing the industry’s shift to value based care and improved outcomes for patients, and restricting innovation which is critical to meeting the evolving needs of healthcare consumers. Moving forward, Anthem will continue to work aggressively to complete the transaction while remaining focused on serving as America’s valued health partner, delivering superior health care services to our approximately 40 million members with greater value at less cost.”

Source: Anthem Investor Relations as reported by BusinessWire.

Georgia is Making a Move

Go Georgia!!

“State Rep. Brad Raffensperger has introduced a resolution that would urge Republican Gov. Nathan Deal to submit a request for a 1115 waiver to transition the state’s Medicaid program into a per-capita capped system…Under that model, the CMS would distribute a limit of federal dollars per person in the state. Spending would grow as the number of enrollees did, and the state could set eligibility, benefits and delivery system approaches however it chooses.

“Raffensperger said that change could expand Medicaid to people living below the poverty line, which would reduce uncompensated care costs for hospitals. The Georgia Hospital Association’s most recently estimated that its members faced $1.02 billion in uncompensated care costs for indigent Georgia citizens in 2014. That same year, 66% of rural hospitals had negative margins. In all, 41% of Georgia’s hospitals ended 2014 with negative margins, according to the Georgia Hospital Association. Currently, there are about 565,000 uninsured low-income Georgians below the poverty line in a recent Deloitte study.

“‘Working together for both the nation’s and Georgia’s best interest, I believe [(Governor) Deal and (HHS nominee) TomPrice] can craft the block grant funding solution that reflects the desire of Congress, President Trump and our conservative, fiscally responsible values,’ Raffensperger said.”  Source: Modern Healthcare.

Perspectives on New Order

Regarding President Trump’s Executive Order that for every new regulation passed, two regulations have to be eliminated:

“Rick Pollack, CEO of the American Hospital Association, released a statement Monday heralding the order, saying it reduces bureaucracy. He noted that last year alone, the federal government added 23,531 pages to existing regulations affecting hospitals and health systems. Pollack said reduced regulations will lead to lower costs and less paperwork for healthcare professionals.
“‘The regulatory burden that is imposed on hospitals and health systems is substantial and unsustainable, and has grown in recent years,’ Pollack said. ‘We are encouraged by the executive order signed by President Trump today that will help reduce red tape.’…

“Scott Whitaker, CEO of the Advanced Medical Technology Association, said his organization is still reviewing the executive order. The group lobbies on behalf of device makers.

“‘We look forward to working with the administration on developing regulatory policy that promotes medical innovation, patient access and maintains robust safety and effectiveness standards while minimizing unnecessary burdens on medical technology innovators,’ Whitaker said. ‘We have long maintained that any regulation needs to benefit patients and foster innovation, and the medical technology industry has developed a strong working relationship with key agencies such as the FDA and the CMS in support of those principles.’…

“‘(President) Trump says that the order is aimed at ”cutting regulations massively for small business.’ He added that it was the ‘biggest such act that our country has ever seen.'”  Source:  Modern Healthcare.