MLA Weekly Health Care Wrap-Up: 10.1.10

October 1, 2010

Federal Health Care Update

HHS Announces Exchange Planning Grants

The U.S. Department of Health and Human Services' (HHS) Office of Consumer Information and Insurance Oversight (OCIIO) announced Thursday that 48 states and the District of Columbia were approved for up to $1 million per state to cover the cost of planning for establishment of a health insurance exchange, as required under the Patient Protection and Affordable Care Act (PPACA).  Minnesota and Alaska were the two states not to apply for funding.  OCIIO indicated that a second round of grants focused on implementation would be available to states in the first half of next year.

Gilfillan Named Acting Director of Innovation Center

Dr. Richard Gilfillan was named Acting Director of the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services (CMS) this week.  Dr. Gilfillan currently leads the performance-based policy staff at CMS, a position he accepted in August.  Previously, he was president and CEO of Geisenger Health Plan and executive vice president of insurance operations for Geisinger Health System.  No timetable was provided regarding filling the position on a permanent basis.  The Center will officially begin operations on January 1.

From the States

Medicaid Costs Soar

Enrollment in Medicaid grew by 8.5 percent in the 2010 fiscal year, according to a new study released by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.  Medicaid spending grew 8.8 percent -- well above state projections of 6.3 percent. This represents the largest increase in eight years. The complete Kaiser report is available here.

Exchange Legislation Signed Into Law in California

California Governor Arnold Schwarzenegger signed into law two pieces of legislation that authorize the establishment of a state health insurance exchange in California. AB 1602 details the functions and responsibilities of the exchange, while SB 900 defines the composition of the executive board that will oversee operations.   

Florida Could Seek MLR Waiver

After a unanimous vote by its insurance advisory board, Florida seems poised to join Maine and Iowa in seeking a waiver from the medical loss ratio (MLR) requirements in PPACA.  Several states have expressed a desire to see the new MLR standards phased-in over a period of time to grant the market more stability.

Health Insurance Report

NAIC Releases Exchange Model Act

Earlier this week, the National Association of Insurance Commissioners (NAIC) released an American Health Benefit Exchange Model Act that could possibly serve as a basis for Exchange-enabling legislation in some states.  The NAIC guidance sticks closely to PPACA, but addresses several key decisions states must make when establishing an Exchange. Comments on this guidance are due to NAIC by October 6.  In addition, NAIC is planning to develop issue papers regarding governance options for state Exchanges and regional or interstate Exchanges.  Further guidance regarding Exchanges could come from HHS as soon as the end of 2010.

MLA Health Care News

CMS Publishes Self-Referral Disclosure Protocol

The Centers for Medicare & Medicaid Services (“CMS”) recently published the Medicare self-referral disclosure protocol (“SRDP”) as required by the Patient Protection and Affordable Care Act enacted on March 23, 2010; thus, restoring self-disclosures under the physician self-referral statute (“Stark Law”) after alternating decisions regarding the matter have been issued.  The SRDP sets forth a process to allow healthcare providers and suppliers, including individuals and entities, to self-disclose violations arising under the Stark Law.  Pursuing the SRDP process may be beneficial to providers and suppliers who have identified actual or potential violations of the Stark Law.  A complete client alert is available here.

Event Reminder: Space is Still Available!

What's Ahead in Health Policy: Reform and Beyond

Monday, October 4, 2010

8:00 am - 1:30 pm ET
1900 K Street, NW
Washington, DC 20006

Discussions will provide an overview from the perspective of the administration, Capitol Hill and the states on a range of issues, including: Medicare payment policy, Medicaid, drug and device user fee reauthorizations and health care tax issues. Featured speakers will include:

For questions or to RSVP please contact Elizabeth Carpenter at

Quotes of the Week...

“ We aren't going to do that.”

-- Brian Webb, manager of health policy and legislation at the NAIC on the Secretary's request that the draft "blank" language be submitted ahead of schedule.

“The NAIC's proposed regulation recognizes and balances the claims of the various stakeholders that have fully participated in its drafting."

-- Professor Timothy Jost, on the NAIC MLR draft.

Calendar: Looking Ahead

Monday Oct. 4: Congressional Quality Care Caucus will hold a conference on health care quality and value, 9 a.m. CVC Auditorium, Capitol building.

Wednesday Oct. 6: Interagency Autism Coordinating Committee will hold an Advisory Committee meeting, 9 a.m. National Institute of Mental Health.

Thursday Oct. 7: Health Information Standards Committee will hold a web event, 2 p.m.