MLA Weekly Health Care Wrap-Up: 6.4.10
Federal Health Care Update
With Congress on its Memorial Day recess, action on issues such as the Medicare “doc fix” and an extension of the federal Medicaid assistance percentage (FMAP) has stalled. Congress will return to Washington next week when it will be faced once again with these issues.
NAIC Fails to Meet MLR Deadline
In a letter earlier this week, the National Association of Insurance Commissioners (NAIC) informed Health and Human Services (HHS) Secretary Kathleen Sebelius that they would be unable to come up with a definition and standardized methodologies for calculating a medical loss ratio by the June 1 deadline. Citing the need to “do this right,” NAIC officials framed the struggle as trying to make the MLR requirements useful without destabilizing choice in the marketplace. The NAIC letter to Secretary Sebelius is available here.
HHS Announces $60 Million in Grants
HHS announced this week the availability of $60 million in grants to help seniors and their caregivers seek health care and long term care. Funds will be available to states, area agencies on aging (aaa’s), State Health Insurance Assistance Programs (SHIPs) and Aging and Disability Resource Centers (ADRCs) to:
- Provide outreach and assistance to Medicare beneficiaries on their Medicare benefits including prevention;
- Use additional funds through a competitive process to provide Options Counseling on health and long-term care through ADRCs;
- Use additional funds through a competitive process to strengthen the ADRCs role in Money follows the Person program and support state Medicaid agencies as they transition individuals from nursing homes to community-based care; and
- Coordinate and continue to embed tested Care Transition models that integrate the medical and social service systems to help older individuals and those with disabilities remain in their own homes and communities after a hospital, rehabilitation or skilled nursing facility visit.
More information is available here.
CMS Announces Multi-Payer Medical Home Demo
Earlier this week, the Centers for Medicare and Medicaid Services (CMS) invited states to apply to participate in the Multi-payer Advanced Primary Care Practice Demonstration. Under this program, Medicare, Medicaid and private payers will work together to develop and test medical home models. To qualify, states will have to meet specific requirements, including: identifying a state agency to implement the program, making payments to participating providers within six months after being selected and offering a pathway to connect patients to community resources. CMS is expected to choose 6 states to participate. More information is available here.
From the States
California. With the deadline for moving bills out of the houses in which they originated looming, both arms of the state legislature took up initiatives to implement the provisions of The Patient Protection and Affordable Care Act (PPACA). Among the various measures were new insurance market mandates called for in the federal reform--including an extension of benefits to dependents through age 26, a prohibition on lifetime benefit caps and the requirement that preventive services be provided with no cost-sharing. Also receiving initial approval was legislation requiring state approval for any rate increases by insurers. In addition, the Assembly and Senate each passed separate legislation calling for the establishment of a California Health Benefits Exchange with the authorities provided for in PPACA. How and when action on the bills will unfold remains to be seen.
Georgia. Republican Governor Sonny Perdue signed the “Healthy Georgians Act of 2010” into law this week. Originally focused on authorizing insurers to offer health and wellness incentives as part of their plans, the bill was amended to include the provision that, “No law or rule or regulation shall compel, directly or indirectly, any person, employer, or health care provider to participate in any health care system.” The language is aimed at the individual mandate to purchase insurance contained in PPACA. Perdue has also signed onto a federal lawsuit challenging the constitutionality of the federal reform.
Medicaid. States are growing increasingly concerned that a six-month extension of the temporary increase in Federal Medical Assistance Percentage (FMAP) rates for the Medicaid program will not make it out of Congress this year. The extension has been added and dropped from a number of bills that have seen action in the past few months, but never made it into the final versions. Most recently, the provision was dropped from a jobs bill sent to the President last week. Without successful action, FMAP rates will revert to their previous levels at the end of the calendar year.
MLA Health Care News
Health Care Advisory: Modification to Medicare Timely Filing Requirements
The Patient Protection and Affordable Care Act (PPACA) includes a large number of health care related provisions that will take effect over a period of many years. Yet, one provision involving the time limit for submission of fee for service (“FFS”) Medicare claims will immediately impact health care providers and suppliers by reducing the period for filing such claims. PPACA reduces the maximum time period for submission of Medicare fee-for-service (FFS) claims to 12 months. Before this amendment, some claims had a filing period of almost 27 months. The complete advisory is available here.
Calendar: Looking Ahead
- Monday, June 7: Congress returns from Memorial Day recess.
- Tuesday, June 8: NAIC Actuarial Subgroup Conference Call at 3 pm ET.
- Looking Ahead: CMS Reg Watch (1) ESRD Final Dialysis Bundle -- Friday, June 11 target date. (2) Proposed 2011 Physician Fee, Hospital Outpatient & Ambulatory Surgical Center Rule -- Friday, June 25 target date. HHS Reg Watch: Interim final rule on grandfathered health plans will likely be this summer.
Webinar: Health Care Reform --
What Does it Mean for Employers and Plan Sponsors
Wednesday, June 16, 2010
2-3:30pm EST
Learn more about what employers and plan sponsors need to do immediately and before the end of the year to ensure your plan complies with changes made under health care reform.
The webinar is complimentary. Please contact Kathryn Price at kprice@mckennalong.com or 404.527.8337 by Friday, June 11th.
Quotes of the Week...
“The MLR regulations must clearly define which activities do and do not improve health care quality.”
--AHA President Rick Pollack on medical loss ratios.
"This is just too important to rush through it.”
-- Kansas Insurance Commissioner Sandy Praeger on NAIC's medical loss ratio delay.