Accountable Care Organizations under the Medicare Shared Savings Program
On March 31, 2011, the Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), proposed new rules under the Affordable Care Act to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program will reward ACOs that lower growth in health care costs while meeting performance standards on quality of care and putting patients first. Patient and provider participation in an ACO is purely voluntary.
Rate Review
The Department of Health and Human Services (HHS) is finalizing its proposed rate review regulation released last December. The proposed rule, which would be effective July 1, 2011, sets a national threshold to trigger review – either by the state if HHS determines it has an “effective” review process, or by HHS. For 2011, the proposed trigger for review is if an insurers’ “weighted average increase” is 10 percent or more for the rate filing.
New Guidance on Appeals
The Affordable Care Act created a new section of the Public Health Service Act requiring insurers and group health plans to have internal appeals and external review mechanisms. Last September, the Department of Labor (DOL) provided a grace period until July 1, 2011 for plans to have this done, and stated that they would take no enforcement action against an insurer or group health plan working in good faith to implement these standards.
House Votes to Repeal Health Care Law
The below is a synopsis of articles posted by the Associated Press and other media resources.
On Wednesday, Jan. 19, 2011, Republicans pushed legislation to repeal the Democrats’ health care overhaul with a 245 to 189 vote. However, the repeal faced opposition in the Democrat-controlled Senate, and did not pass that vote on February 2, 2011, as well as a veto threat from the President.
Reform’s Six-Month Anniversary Means Change for Consumers
Congress passed the health care reform bill in March 2010, and a wave of changes take effect on the six month anniversary of this bill, Thursday, Sept. 23. These changes will take place at the time when companies renew their employee coverage. A detailed summary of changes are available via the links at the end of this article. Here are some of the more significant changes taking place.
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Health Care Reform Legislation – Get the Facts!
Read the detail behind the health care reform legislation passed in March 2010. Click below for detailed Fact Sheets on the key elements of reform.
Blue KC Hosts Broker Reform Meetings
Blue Cross and Blue Shield of Kansas City hosted meetings with its broker distribution network recently to update and inform them about evolving elements of health care reform. Senior management at Blue Cross and Blue Shield of Kansas City and Deloitte Consultants provided an overview of reform, where it stands now, and its anticipated impact to key stakeholders. To see a copy of Deloitte’s presentation and handouts, click on the links below.
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BCBSKC Broker Reform Presentation |
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Broker Brochure |
To view Blue KC’s broker handouts, click below:
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Early Retiree Reinsurance Program – What You Need to Know…
Blue Cross and Blue Shield of Kansas City (Blue KC) would like to update you on the Early Retiree Reinsurance Program that is part of the health reform bill that was passed in March. This write-up includes information on how we plan to support our clients who wish to apply for funds under this program. This program encourages employers to maintain insurance benefits for early retirees by reimbursing the employer for some of the increased costs of providing insurance for them.
Early Retiree Reinsurance Program Established
An interim final regulation on early retiree reinsurance was issued last week. This program encourages employers to maintain insurance benefits for early retirees (ages 55-64) by reimbursing the employer for some of the increased costs of providing insurance for them. The program will reimburse claims for early retirees, their spouses, surviving spouses and dependents (if currently on the employer’s plan) at 80 percent of claims between $15,000 and $90,000 per plan year. The reimbursement must be used to offset plan costs, or to reduce premiums, copayments, deductibles or other out-of-pocket member expenses.
Temporary High Risk Pools to Help the Uninsured
Thirty states have agreed to take part in a new program to offer insurance to people with pre-existing health conditions. Missouri and Kansas have both agreed to participate. Both states will use the current administrators of their high risk pools to administer this program as well. Blue Cross and Blue Shield of Kansas City administers the Missouri High Risk Pool today in our service area.