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July/August 2013 St@teside

Health Reform Resources

SCI keeps its Federal Reform Resources Web page up-to-date with the most recent information from the states, the federal government, and health policy organizations in an effort to guide our readers through the health reform implementation process. We know there are several places to go for the latest health reform resources, and we thank you for using SCI as one of your trusted sources. Here are some of the most recent resources that can be found on our Federal Reform page:
Insurance Market Reforms
HealthReform GPS
On July 1, 2013, HHS issued final implementing regulations that specify which individuals may be eligible for exemptions from the Shared Responsibility penalty payment, a special tax established under the Affordable Care Act (ACA) that applies to non-exempt individuals who have access to affordable insurance but fail to purchase it. The final rule also explains the role of Exchanges in granting “certificates of exemption” from the penalty payments, and identifies the range of health benefits that the government will consider as satisfying the Act’s “minimum essential coverage” rule. The final rule shows some, but not a lot, of changes from its original proposed form.  This update summarizes the highlights of the final rule.
Office of the Assistant Secretary for Planning and Evaluation
A goal of the ACA is to increase competition and transparency in the markets for individual and small group insurance, leading to higher quality, more affordable products. To date, this proposition has largely been based on theory. However, information on proposed premiums in the individual and small group markets has recently been made available by selected states, and it is now possible to move from theoretical arguments to data-driven analysis. This research brief analyzes proposed rates in the individual market for 2014 in the eleven states that have made information available, and compares these rates to those estimated by the Congressional Budget Office. 
Insurance Exchanges
Urban Institute
This analysis compares the population most likely to enroll in the ACA's nongroup exchanges to those who now have employer coverage, focusing on characteristics related to health risks. If the populations are comparable, unsubsidized premiums in the reformed nongroup market should be set at reasonable levels once reform is fully phased-in. While individuals with higher-than-average health care needs may be somewhat more likely to enroll in the nongroup market in the first year, once past the transition period, the health characteristics of nongroup enrollees can be expected to be quite similar to those with employer-based insurance.
Centers for Medicare and Medicaid
This set of instruments released by the Centers for Medicare and Medicaid provides guidance on the methodology and surveys that CMS will use to assess enrollee satisfaction with the Marketplace and QHPs.
Kaiser Family Foundation
Arkansas and Iowa recently released for public comment draft demonstration waiver applications proposing to implement the ACA’s Medicaid expansion by using Medicaid funds as premium assistance to purchase coverage for some or all newly eligible Medicaid beneficiaries in Marketplace (formerly called Exchange) Qualified Health Plans (QHPs). Arkansas and Iowa seek demonstration waiver authority primarily because they propose to make premium assistance enrollment mandatory for affected beneficiaries. Iowa also proposes to waive its obligation to provide wrap-around benefits. This fact sheet compares the two proposals. 
Center for Health Care Strategies, Inc.
The success of integrated care initiatives for Medicare-Medicaid enrollees will depend in large part on the skills and knowledge of state Medicaid staff. Knowledge of Medicare policy, managed care oversight, data analysis and reporting, and communication strategies will be critical to program implementation. This technical assistance brief examines key areas where states will need to build their internal capacity as they pursue integrated care programs for Medicare-Medicaid enrollees. Focus areas include: basic organizational capacity; contract development; data analysis and information systems; stakeholder communication; rate setting; and quality measurement.
State Health Reform Assistance Network
A number of provisions in the ACA, from changes to income eligibility (section 2002) to coverage for freestanding birth center services (section 2301), require states to alter Medicaid eligibility guidelines, service benefits, or payment criteria. To assist in determining which provisions require states to submit amendments to their Medicaid state plan, the Center for Health Care Strategies, with support from the State Network, has developed a resource which catalogues required and optional provisions that may require amendments, including links to the applicable ACA text, deadlines for approval, and available guidance. States may use this document to plan sufficient time for development, stakeholder engagement, submission and approval of the applicable amendments to CMS. This document has been updated as of July 2013 to reflect the latest guidance.
Strategic Planning
Kaiser Family Foundation
This brief provides highlights from new state and sub-state estimates of how the number and composition of individuals enrolled in Medicaid/CHIP would change with full implementation of the ACA, including the Medicaid expansion. These estimates provide more detail on the projected coverage changes under the ACA at the state level than in prior research. They also provide new information on the expected coverage changes resulting from the ACA at the local level in all states. This analysis demonstrates that there is substantial variation across and within states in the magnitude and composition of the population that is projected to gain Medicaid coverage under the ACA. These estimates also provide guidance on the areas that are likely to experience the largest declines in the uninsured and where the residual uninsured are likely to be concentrated.
Delivery System Redesign
The Commonwealth Fund
The need to readmit a patient to the hospital soon after discharge can be an indicator of poor care coordination. Hospital readmissions are also extremely costly to the health system overall. Commonwealth Fund–supported researchers identified several strategies that hospitals could use to lower their 30-day readmission rates, among them: partnering with community physicians or physician groups, making nurses responsible for medication reconciliation, and arranging follow-up appointments before leaving the hospital.