The Affordable Care Act, One Year Series: The Losers Part I

It’s been one year since the Affordable Care Act became law. In our last posts, we explored the positive impacts of the health law. In this post, we will take a look at those who didn’t fare nearly as well.

  1. Insurance companies. Insurance companies have been particularly affected by the ACA. Due to competition in the marketplace, the companies with the lowest monthly premiums appeal the most to those shopping for healthcare. According to a recent Huffington Post report, policyholders value lower premiums more than access to a wider network of doctors. Additionally, insurers that did not comply with ACA standards, sent out cancellation notices to thousands of customers.
  2. Employers. Starting in 2015, employers with over 100 employees will be required to provide health insurance to their employees. If they do not, they will be fined a penalty.
  3. Employees with modified benefits. Some employers are changing benefits to pass on more costs to employees in the form of higher premiums and higher deductibles and some are even cutting schedules to avoid providing health insurance under the employer mandate. Furthermore, many employees who work two part-time jobs are losing out since they may not receive insurance from either employer, but make too much to qualify for subsidized insurance on the exchanges.
  4. Insurance brokers. The health law has initiated numerous new changes in regards to health insurance, making education and compliance especially important during this time. Brokers will need to keep clients abreast of specific plan changes, new fees and taxes, reporting requirements, new rules regarding enrollments, non-discrimination and other changes. Being able to assist clients through this process and ensure that they understand the law and comply with it, will be particularly challenging during this transitional period.

Basic Health Program Funding Methodology Proposed Notice

CMS has issued a proposed notice establishing the methodology for determining federal funding for the Basic Health Program in program year 2016. The Basic Health Program gives states the option to establish a health benefits coverage program for lower-income individuals as an alternative to Health Insurance Marketplace coverage under the ACA. This voluntary program enables states to create health benefits program for residents with incomes that are too high to qualify for Medicaid through Medicaid expansion in the ACA.

CMS proposes to use the same payment methodology for program year 2016 as it established for 2015, with updated values for several factors. The proposed notice will be posted in the Federal Register tomorrow.

Click here to see the proposed notice.


CDC Issues Stronger Safety Standards For Healthcare Workers Dealing With Ebola

The CDC has issued more robust standards to better protect healthcare workers who come into contact with Ebola and other deadly infectious diseases. The previous recommendations, which were first issued in 2008 and last updated this past August, did not work in the case of Texas Health Presbyterian Hospital Dallas, where two nurses were infected while treating an infected patient. The updated protocols recommend workers to wear personal protective equipment that covers the entire body and leaves no skin exposed. Other recommendations include wearing two sets of gloves and wearing boot covers that are waterproof and go to at least mid-calf or cover the legs.

Click here to read more.

Click here to see the updated CDC guidelines.

Tiptastic Tuesday: State Attorney General Issues Guidance Regarding Reporting Of Certain Physician Transactions

October 1 was the effective date for new legislation requiring physician groups (two or more physicians) and other healthcare organizations to report certain physician group-related transactions to the State Attorney General. Public Act 14-168 requires parties to notify the Attorney General thirty days in advance of the effective date of mergers, purchase and sale transactions and employment-related arrangements between physician groups that result in groups of eight or more physicians, and mergers, purchase and sale transactions and employment-related arrangements between a physician group and a hospital, medical foundation or other hospital-related entity, regardless of the number of physicians in the resulting entity.

Click here for more information.

Status of Jurisdiction K Provider Appeal Requests Submitted to NGS

National Government Services (NGS) has recently experienced an increase in the number of claims submitted to Medicare Part B Appeals for review. NGS advises anyone who may have submitted an appeal within the last 60 days to be patient and not resubmit claims as this may cause further delays in processing your appeal request.  Once an initial claim determination is made, providers have the right to appeal the decision of that determination.

If you are a current NGSConnex user, you can check the status of your appeal. However, please do not resubmit the appeal when using NGSConnex.

Click here for more information from NGS.

Monday Morning Recap

The HMS Healthcare Management Solutions Monday Morning Recap reviews some of the top stories and healthcare highlights you may have missed last week.

Providers, Insurers Partnering To Launch Narrow-Network Plans

Across the country, providers and insurers are partnering to launch narrow-network plans. In some cases, these healthcare systems and insurers will offer the narrow-network plans on state exchanges with monthly premiums in line with other exchange options. According to experts, the ACA is driving the shift toward these narrow-network products. Because the health law standardizes health plan benefits and sets caps on out-of-pocket costs, providers and insurers use the networks as a “differentiator.” Experts say it will take “unique and appealing plan benefits and participating providers to attract consumers who are accustomed to broader choices of hospitals and doctors.”

Click here to read more.