Happy Labor Day Weekend!

In observance of Labor Day, Monday, September 1, HMS Healthcare Management Solutions will be closed. We will re-open during normal operating hours Tuesday, September 2.



CBO Forecasts Lower Medicare & Medicaid Costs

Earlier this week, the Congressional Budget Office (CBO) stated reduced costs for medical services and labor have reduced the 10-year projected cost of Medicare and Medicaid by $89 billion. Medicare spending is projected to decrease by $49 billion from 2015 and 2024, while Medicaid spending is expected to drop by $40 billion. Despite the long-term projected drop, federal spending for major health programs will increase this year by $67 billion or approximately 9 percent. Medicaid is projected to grow by $40 billion, or 15 percent. The short-term increase is due to the ACA, including its Medicaid expansion and the financial assistance to help people purchase health insurance. CBO has also stated that it expects Medicare outlays to increase by about $12 billion this year.

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Wadleigh Named Interim CEO Of Access Health CT

Access Health CT, Connecticut’s online insurance exchange, has named James R. Wadleigh Jr. as interim CEO. Wadleigh is currently Access Health CT’s chief information officer; he begins his new role tomorrow. Earlier this week, Access Health’s current CEO Kevin Counihan announced he was resigning to lead the federal government’s insurance exchange, HealthCare.gov. Wadleigh has served as chief information officer since 2012 and has spent 25 years in information technology across multiple insurance industries, including healthcare, property casualty, life insurance and annuities.

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Report: Health Law Increases Taxes On Insurers With Big Pay Packages

A new report says a little-noticed provision in the federal health law could drastically reduce insurers’ ability to shield much of that pay from corporate taxes. Last year, insurers owed at least $72 million more to the U.S. treasury as a result. Researchers analyzed the compensation of 57 executives at the 10 largest publicly traded health plans and found that they earned a combined total of $300 million in 2013. Insurers were able to deduct 27 percent of that from their taxes as opposed to before the health law when 96 percent would have been deductible. The 2010 law states that insurers can deduct only the first $500,000 of annual compensation per employee from corporate taxes; the law also requires insurers to include “performance pay,” including stock options which often represent a large portion of an executive’s pay.The report found that on average, insurers owed $1.3 million more in taxes per executive and that the “performance pay” accounted for more than $204 million of the compensation awarded. In 2013 executive pay also rose an average of $5.4 million per person.

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Access Health CEO To Run Federal Exchange

Kevin Counihan, CEO of Connecticut’s health insurance exchange, Access Health, is resigning to lead the once-troubled federal exchange, HealthCare.gov. Since 2012, Counihan has led Connecticut’s exchange which sells private insurance plans and enrolls people in Medicaid. The board overseeing the Connecticut exchange will appoint an interim CEO in the meantime and conduct a national search for Counihan’s replacement. Access Health has been one of the nation’s better-performing exchanges. In recent months, Access Health has been marketing its system to other exchanges as an alternative to building their own marketplaces from scratch. Currently, thirty-four states use the federal government to full or partially run their exchanges.

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Federal Officials: Medicaid Must Cover Autism Services

Last month, CMS announced that comprehensive autism services must be covered for children under all state Medicaid and Children’s Health Insurance Program plans. Advocates believe coverage of applied behavioral analysis (ABA), which uses positive reinforcement and other techniques to encourage behavior change, should be covered. According to experts, ABA is the most accepted and effective treatment for autism that isn’t experimental or investigational. Although some states provide limited coverage to certain age groups, the new policy will require mandatory coverage for everybody under 21. CMS has stated that Medicaid programs must cover a full range of autism services under the “early and periodic screening, diagnostic and treatment services” provision of the law. However, some states are concerned about the requirement saying that it doesn’t cover people with Asperger’s syndrome or other forms of autism spectrum disorder.

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New York Times: Nursing Homes Boost Ratings Using Self-Reported Data

According to a recently published article in the New York Times, nursing homes are using self-reported data to boost their ratings on CMS’ Nursing Home Compare system. Although annual health inspections are performed by independent reviewers, other factors that contribute to ratings, such as measures of staff levels and quality statistics, are reported by operators themselves. Additionally, even though more than 50 nursing homes are on the Special Focus Facilities’ federal watch list, approximately two-thirds have four or five star ratings on staff and quality. However, most of the homes on the watch list received one or two stars under health inspections.

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Click here for the original New York Times article.