Tag Archives: Health Insurance

As ACA Repeal/Replace Debate Drags On, Trump Seeks Advice on How to Make Improvements to Health Care Markets

In a tacit acknowledgement of the hurdles ahead for enactment of Affordable Care Act (ACA) repeal/replace legislation, the Trump Administration is soliciting suggestion for changes that could be made within the current legal framework to improve health insurance markets and meet Administration reform goals. In particular, the Department of Health and Human Services (HHS) is … Continue Reading

House Judiciary Committee Advances Medical Liability, Insurance Antitrust Reform Bills

The House Judiciary Committee has approved HR 1215, the “Protecting Access to Care Act of 2017.” The bill includes a variety of medical liability reforms, including a $250,000 cap on noneconomic damages, limits on contingency fees, and allocation of damages in direct proportion to fault. The provisions would apply only to claims concerning the provision … Continue Reading

Conflict of Interest Concerns Prompt New CMS Restrictions on Dialysis Facility Payment of Beneficiary Health Plan Premiums; Allows Plans to Reject Third-Party Payments

Citing “differences between providers’ and suppliers’ financial interests and patients’ interests” that “may result in providers and suppliers taking actions that put patients’ lives and wellbeing at risk,” CMS is imposing stringent new requirements on Medicare-certified dialysis facilities that seek to make payments of premiums for individual market health plans. By way of background, earlier … Continue Reading

Recent Congressional Health Policy Hearings and Markups

A number of Congressional committees have recently considered legislation and/or held hearings on various health policy proposals.  The Ways and Means Committee approved seven bills related to health care coverage and tax policy, including various bills to: expand access to health reimbursement arrangements and health savings accounts; ease employer insurance coverage mandates for students and … Continue Reading

HHS Finalizes ACA Nondiscrimination Protections for HHS Programs

The Department of Health and Human Services (HHS) has published a final rule implementing Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in any health program or activity that receives financial assistance from or is administered by HHS or any … Continue Reading

Senate Votes for Budget Reconciliation Bill Repealing Key ACA Provisions

The Senate has approved an amended version of a budget reconciliation bill (H.R. 3762) that would repeal key provisions of the ACA.  As approved by the Senate on December 3, 2015, the legislation would repeal ACA insurance subsidy and mandate provision, the transitional reinsurance program, and various tax provisions and make a variety of other … Continue Reading

Obama Administration Proposes 2017 ACA Marketplace Plan Benefit and Payment Parameters

On December 2, 2015, CMS is publishing its annual proposed Notice of Benefit and Payment Parameters, which would govern participation in the Affordable Care Act (ACA) Health Insurance Marketplaces for 2017. The wide-ranging rule includes a number of provisions intended to protect consumers enrolled in Marketplace plans, enhance transparency, improve marketplace premium stabilization programs, and … Continue Reading

Obama Administration Updates Rules for ACA Grandfathered Health Plans

On November 18, 2015, the Obama Administration published final regulations to update requirements for group health plans and health insurance issuers under the ACA, particularly with regard to the changes they can make to the terms of their plan/coverage while retaining their “grandfathered” status. The regulations also address preexisting condition exclusions, lifetime and annual dollar … Continue Reading

House Passes Budget Reconciliation Bill with ACA Mandate, Tax Repeal Provisions

Today the House of Representatives approved H.R. 3762, budget “reconciliation” legislation that would repeal four provisions of the Affordable Care Act (ACA).  Specifically, the legislation would repeal the ACA employer and individual insurance mandates, the medical device excise tax, and the so-called “Cadillac tax” on high-cost health plans (an earlier House Ways and Means Committee provision that would … Continue Reading

Congress Clears Bill to Block ACA Change to Definition of Small Employer; House Votes to Broaden ACA Religious Exemption

The House and Senate have approved a bill (H.R. 1624) that would amend the Affordable Care Act’s definition of “small employer” to reduce the number of employers covered by new health insurance coverage requirements set to go into effect in 2016. The legislation would define small employers as those with 50 or fewer employees (rather … Continue Reading

Congressional Panels to Review Small Business Health Care, Medicaid Program Status

Two Congressional hearings are scheduled this week on health policy issues: On July 7, 2015, the Senate Health, Education, Labor and Pensions Committee has scheduled a hearing on “Small Business Health Care Challenges and Opportunities”; and On July 8, the House Energy & Commerce Health Subcommittee will focus on “Medicaid at 50: Strengthening and Sustaining the … Continue Reading

Administration Releases Final ACA Summary of Benefits and Coverage and Uniform Glossary Rule

On June 12, 2015, the Internal Revenue Service, Employee Benefits Security Administration, and Centers for Medicare & Medicaid Services released final regulations regarding the summary of benefits and coverage (SBC) and the uniform glossary requirements for group health plans and health insurance coverage in the group and individual markets under the Affordable Care Act. The regulations … Continue Reading

House Approves Bills to Modify ACA Rules for Employers Related to Part-Time Workers, Veterans

On January 8, 2015, the House of Representatives approved H.R. 30, the “Save American Workers Act.”  The legislation would amend the ACA’s definition of “full-time employee” for purposes of the requirement that certain employers provide health care coverage for their full-time employees. Specifically, the bill, which was approved on a 252 to 172 vote, would … Continue Reading

Congressional Hearings Examine Medicare Fraud, ACA, Digital Health, MedPAC Report, Brain Injuries

Recent Congressional hearings on health policy issues include the following: A House Energy and Commerce Health Subcommittee “21st Century Cures Roundtable” discussed steps Congress can take to bridge the gap between medical advances and the regulatory policies that govern them, and ultimately advance digital and personalized health care. The panel also released a related white … Continue Reading

HHS Provides Update on ACA Insurance Costs and Choices, Announces Management Changes

HHS has released a report on premiums, tax credits, and health plan choices on the ACA federal Marketplace for plans operating in 2014.  In addition, CMS has launched an initiative, dubbed “From Coverage to Care,” designed to answer questions consumers may have about their new health coverage under the ACA and to help individuals make … Continue Reading

Congressional Committees to Consider HHS Secretary Nomination, HHS Budget, ACA Implementation, Cancer Research

The Senate Appropriations Committee has scheduled a May 7, 2014 hearing to review the Administration’s FY 2015 budget request for the Department of Health and Human Services (HHS). Also on May 7, the House Energy and Commerce Oversight Subcommittee will examine the status of health insurance enrollment under the ACA, and the Senate Aging Committee will … Continue Reading

Congressional Health Policy Hearings

 A number of Congressional committees have held hearings recently to address various health policy issues, including the following: The House Energy and Commerce Committee conducted hearings on Medicare Part D drug policy, the role CMS contractors play in management of the Medicare program, and the public health threat of counterfeit drugs; The House Education and the … Continue Reading

GAO Report Confirms Insurance Coverage Prior to Medicare Linked to Better Health, Lower Program Spending

This post was written by Nancy Sheliga. The Government Accountability Office (GAO) has released a report examining the effect of prior health insurance coverage on Medicare beneficiaries. The report specifically focuses on the health status, program spending, and use of services by Medicare beneficiaries with and without continuous health insurance coverage before Medicare enrollment. According to … Continue Reading

Congressional Hearings Examine ACA Insurance Developments and Other Health Policies

Recent Congressional hearings on health policy issues have included the following, among others: A House Small Business Committee hearing focused on the ACA’s Small Business Health Options Program. A House Ways and Means Health Subcommittee hearing reviewed “the Challenges of the Affordable Care Act,” focusing on “immediate and long-term challenges Americans face in finding affordable, quality health coverage … Continue Reading

House Approves Legislation to Amend ACA to Delay Insurance Mandates

In response to the Obama Administration’s announcement that it is delaying the ACA’s requirement that certain large employers with more than 50 employees pay an excise tax if they do not offer qualified insurance to their employees, the House of Representatives approved legislation on July 17, 2013 (H.R. 2667, the Authority for Mandate Delay Act) to … Continue Reading

HHS Proposes Standards for Essential Health Benefits, Actuarial Value, and Accreditation under the ACA

The Department of Health and Human Services (HHS) has published a major proposed rule that would, among other things, implement key provisions of the Affordable Care Act (ACA) related to essential health benefits (EHBs), calculation of actuarial value (AV), and accreditation standards. By way of background, the ACA requires health plans offered in the individual … Continue Reading

CMS Proposes ACA Health Insurance Market Reform Rules

On November 26, 2012, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would implement ACA provisions related to fair health insurance premiums, guaranteed insurance availability and renewability, statewide insurance risk pools, enrollment in catastrophic plans, and insurance rate reviews. Among other things, the proposed rule would prohibit health insurance companies … Continue Reading

Obama Administration Proposes Rules on Incentives for Nondiscriminatory Wellness Programs in Group Health Plans

The Obama administration published a proposed rule on November 26, 2012 that addresses nondiscriminatory wellness programs in group health plan coverage, consistent with ACA requirements, effective for plan years starting on or after January 1, 2014. Among other things, the proposed rule, which was promulgated by the Internal Revenue Service, the Employee Benefits Security Administration, … Continue Reading
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