HHS Tweaks Several ACA Provisions.
Released Friday, CMS posted a notice on its website explaining several new changes to various provisions of the Affordable Care Act. First, the New York Times (3/15, Pear, Subscription Publication) reported that the Obama Administration on Friday opted to change requirements for health insurance plans offered under the Affordable Care Act “to address a flood of complaints from consumers who said that costs were too high and that the choice of doctors, hospitals and prescription drugs was too limited.” Officials said they plan to “scrutinize health plans more closely and rely less on evaluations by state insurance regulators and private groups that accredit health plans.”
The Washington Post (3/15, Millman) “Wonkblog” reported that the Obama Administration will require “health plans in Obamacare insurance marketplaces to include a more robust offering of care providers in 2015,” in a move to mitigate “early backlash over limited networks in the health care law’s first year.”
Second, the Washington Post (3/15, Carey) reported that a website notice posted on Friday said that people enrolled in the Pre-Existing Condition Insurance Plan would have another month to purchase new insurance, although they need to enroll by April 15 to avoid a coverage gap. The current program will continue in force until April 30 and insures some 20,000 people. The Post notes that this is the third time the plan has been extended. States that run their own high-risk plans also can extend them until that date. HHS said the extension was meant “to help smooth consumers’ transition.”
The Wall Street Journal (3/15, Radnofsky, Subscription Publication) also reported, noting that the issue of people who could be in treatment had been a sensitive one for the Administration. The American Cancer Society Action Network welcomed the extension.
Third, The Hill (3/15, Viebeck) reported that HHS on Friday detailed how it plans to handle adjustments to “risk corridors” for health insurers, issuing a 279-page document that spells out “the formula that determines how much money insurers pay and receive” to “‘suitably offset’ any unexpected spending.” The Hill notes that “the change will mean that some companies see higher payments, or higher charges than under previous rules.” The administrative cost ceiling will be raised to 22 percent from 20 percent, and the profit margin floor for the risk corridors will go up to 5 percent from 3 percent.
Other reports of ACA tweaks were offered by FOX News (3/15), the Wall Street Journal (3/15, Weaver, Ante, Radnofsky, Subscription Publication), the National Journal (3/14, Ritger, Subscription Publication), Modern Healthcare (3/14, Demko, Subscription Publication), The Hill (3/15, Viebeck) “Healthwatch” blog, the Washington Post (3/15, Millman) “Wonkblog,” CQ (3/14, Adams, Subscription Publication), a second piece in CQ (3/14, Reichard, Subscription Publication), a third piece in CQ (3/14, Reichard, Subscription Publication), Modern Healthcare (3/15, Subscription Publication), another piece from Modern Healthcare (3/14, Dickson, Subscription Publication), and the Helena (MT) Independent Record (3/15, Dennison).
HHS Offers More Insurance Guarantees To Same-Sex Couples, HIV/AIDS Patients. The AP (3/15, Alonso-Zaldivar) reported that HHS said Friday that insurers that offer insurance to spouses must cover same-sex couples married in a state where their marriage was legal and that insurers can’t turn away HIV/AIDS patients whose premiums are paid by the Federal Ryan White program. Same-sex couples had “complained about confusing rules on spousal coverage in the new health insurance exchanges,” while the issue of third-party premiums for HIV/AIDS patients was “seen as a national test of whether insurance companies will be able to continue avoiding costly patients.”
Reuters (3/15, Morgan) reported that insurers must insure same-sex couples by 2015, although they were encouraged to do so now.
The Washington Post (3/15, Andrews) reported the instruction to insure same-sex couples applies to any “married in any of the 17 states and the District of Columbia that authorize same-sex marriage…no matter where they currently live or where the policy is offered.” Katie Keith, head of research for the Trimpa Group consultancy, which advocates on the issue, called the change “a big deal. … If you identify as married, it’s hard to stomach that you can’t get family coverage.”
Bloomberg News (3/15, Chen) reported the rule on the Ryan White premiums “was announced after three Louisiana insurers and one North Dakota insurer said they would stop taking funds from the taxpayer-supported program.”
Also reporting on one or both of the developments were the Kaiser Health News (3/15, Andrews) “Capsules” blog, the National Journal (3/15, Baker, Subscription Publication), The Hill (3/15, Trujillo) “Healthwatch” blog, CQ (3/14, Staff, Subscription Publication), Reuters (3/14, Begley), Modern Healthcare (3/14, Carlson, Subscription Publication), the Washington Examiner (3/17, Gehrke), the Cleveland Plain Dealer (3/14, Koff), and Bloomberg News (3/14, Wayne).