Verification of PPACA Individual Subsidies

HHS issued a bulletin serving notice that the Center for Consumer Information and Insurance Oversight intends to develop a standardized method for individuals and employers to determine eligibility for PPACA health insurance exchange subsidies for 2014 and 2015.  Comments were requested on the proposal as well as on the development of a long-term verification strategy in the Verification of Access to Employer-Sponsored Coverage initiative.

Stop-Loss for Small Self-Insured Plans Targeted

The Internal Revenue Service, Department of Labor, and Department of Health and Human Services issued a request for information on the use of stop-loss coverage by small self-insured plans focusing on “the prevalence and consequences of stop loss insurance at low attachment points.”  The NAIC also is considering possible changes to its model state law on the use of stop-loss coverage for small group health plans.

Consumer Education Grants

HHS announced that about $2.5 million in federal grants will be made available under a limited competition process to educate consumers about health insurance coverage enrollment, appeals and other provisions.

PPACA Minimum Value Determinations

The IRS issued notice requesting comments on three options that health insurers and group health plans can use to determine “minimum value” of employer sponsored or other health insurance coverage in which individuals are enrolled and which would prelude subsidies for their duplicate coverage under an exchange.  HHS is scheduled to provide an actuarial value calculator for use by qualified health plans and plans in the small group market.  However, HHS and the IRS will jointly develop a minimum value calculator for employer-sponsored self-insured plans and large insured group plans.  The IRS also asked for comments on PPACA reporting requirements under IRC Section 6055 and 6056 that apply to coverage provided in 2014 and later.  In addition, the IRS asked for comments on proposed rules that will allow for the disclosure to HHS of return information under IRC Section 6103(1)(21) to carry out eligibility requirements under the PPACA.

Medicare Trustees Report

The trustees of the Medicare Part A Hospital Trust Fund and Part B Supplemental Medical Insurance Trust Fund issued their annual report which stated that the hospital fund will remain solvent until 2024, the same year as projected last year, although expenses continue to exceed revenues.  Part A growth is expected to be about 5.3% annually and Part B costs are projected to grow by 7.6% if Congress mitigates scheduled physician payment cuts.  Of note, the trustee report contained another “Medicare funding warning” that general revenues will exceed 45% of Medicare funding for any of the first seven fiscal years of the projection period.  Treasury Secretary Timothy Geithner said that “the financial projections in this report indicate a need for additional steps to address Medicare’s remaining financial challenges….at the same time, adjustments to Social Security and Medicare must be balanced and evenhanded….We will not support proposals that sow the seeds of their destruction in the name of reform, or that shift the cost of health care to seniors in order to sustain tax cuts for the most fortunate Americans….”  House Budget Committee Chairman Paul Ryan responded that the Administration was choosing “to play politics with seniors’ care rather than advance a Medicare reform proposal.”  In another report issued by CMS, the Office of the Actuary projected that the PPACA will save Medicare more than $200 billion through 2016.

PPACA Home Care Rules

CMS issued a final rule under the PPACA that establishes a new Medicaid option, Community First Choice, for states to provide home and community-based services.  The rule becomes effective in July.  CMS also asked for comments on a proposed rule that would revise Medicaid regulations to allow states to design home and community-based services to better meet the needs of Medicaid enrollees, particularly the elderly and disabled.  In a related announcement, CMS said it has selected the first sixteen participating organizations for a demonstration project allowing up to 10,000 Medicare patients with chronic conditions to receive care at home.

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