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November/December 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

Stabilizing Premiums Under the Affordable Care Act: State Efforts to Reduce Adverse Selection
Urban Institute and Robert Wood Johnson Foundation

This paper explores several strategies states could implement beyond federal requirements, using policy decisions in 11 states—Alabama, Colorado, Illinois, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island, and Virginia—to illustrate the choices being made to protect against and mitigate the effects of both “rate shock” and adverse selection in the individual market. The findings indicate that study states had mixed approaches to mitigating rate shock and adverse selection, with some taking steps beyond the required federal measures but with other policy options left unexplored. Minimizing the impact of adverse selection—both against the overall insurance market and the exchanges—will require strong monitoring and oversight.

Final Rule: Health Insurance Providers Fee
Internal Revenue Service

This final rule establishes the annual fee that will be imposed on health insurers, HMOs, self-insured Multiple Employment Welfare Arrangements (MEWAs), and entities that provide coverage under Medicare Parts C and D, and Medicaid beginning in 2014. This health insurance tax is intended to help fund the insurance coverage expansion under the Affordable Care Act (ACA).

Proposed Rule: HHS Notice of Benefit and Payment Parameters for 2015
Centers for Medicare and Medicaid Services

This proposed rule sets forth payment parameters and oversight provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also proposes additional standards with respect to composite rating, privacy and security of personally identifiable information, the annual open enrollment period for 2015, the actuarial value calculator, the annual limitation in cost sharing for stand-alone dental plans, the meaningful difference standard for qualified health plans offered through a Federally-Facilitated Marketplace, patient safety standards for issuers of qualified health plans, and the Small Business Health Options Program.

Insurance Exchanges

Navigator Resource Guide on Private Health Insurance Coverage and the Health Insurance Marketplace
Robert Wood Johnson Foundation
Prepared by Georgetown University's Center on Health Insurance Reforms, this guide is intended to supplement the Navigator training available from HHS and help answer questions people may have about the private insurance reforms in the ACA. This comprehensive resource addresses more than 230 enrollment questions about everything from tax credits and cost standards to enrollment periods, and more.

Proposed Quality Rating System Framework for Qualified Health Plans
Centers for Medicare and Medicaid Services
This notice with comment describes the overall Quality Rating System (QRS) framework for rating Qualified Health Plans (QHPs) offered through an Exchange. The purpose of this notice is to solicit comments on the list of proposed QRS quality measures that QHP issuers would be required to collect and report, the hierarchical structure of the measure sets and the elements of the QRS rating methodology. In addition, this notice solicits comments on ways to ensure the integrity of QRS ratings, and on priority areas for future QRS measure enhancement and development.


Lessons from Early Medicaid Expansions Under Health Reform: Interviews with Medicaid Officials
Centers for Medicare and Medicaid Services
The ACA dramatically expands Medicaid in 2014 in participating states. Meanwhile, six states have already expanded Medicaid since 2010 to some or all of the low-income adults targeted under health reform. The brief took an in-depth look at these six “early-expander” states — California, Connecticut, the District of Columbia, Minnesota, New Jersey, and Washington — through interviews with high-ranking Medicaid officials. While the context of each state’s expansion is unique, early Medicaid expansions under the ACA offer important lessons to federal and state policymakers as the 2014 expansions approach.

State Medicaid and CHIP Eligibility Verification Plans
State Refor(u)m
Due to the ACA’s new eligibility verification rules, states have developed plans outlining Medicaid and CHIP eligibility verification procedures. This chart highlights key elements from states’ verification plans, such as which eligibility factors are verified through electronic data and the specific data sources states are using, as well as whether self-attestation is accepted for some eligibility factors. The chart also contains information about how states will determine reasonable compatibility, which is how they will resolve issues if there are discrepancies between electronic data sources and information provided by applicants.

Coordinating Medicaid Eligibility and Enrollment with a Federally Facilitated Marketplace: Assessment vs. Determination Model
National Academy for State Health Policy
States with Partnership or the Federally Facilitated Marketplace (FFM) are coordinating closely with the federal government on Medicaid eligibility and enrollment. Each state Medicaid agency has chosen whether the Marketplace will only assess, or whether it will also determine, Medicaid eligibility for individuals who apply through the Marketplace. This brief outlines the responsibilities of the FFM in assessing or determining Medicaid eligibility, explains the differences between these two models, and examines the rationales behind two choices.

Strategic Planning

Trends in Health Care Cost Growth and the Role of the Affordable Care Act
White House Council of Economic Advisors
The ACA was passed against a backdrop of decades of rapid growth in health care spending in the United States. While much of this historical increase reflects the development of new treatments that have greatly improved health and well-being, there is widespread agreement that the system suffered from serious inefficiencies that increased costs and reduced the quality of care that patients receive.
A key goal of the ACA was to begin wringing these inefficiencies out of the health care system, simultaneously reducing the growth of health care spending – and its burden on families, employers, and state and federal budgets – while increasing the quality of the care delivered. This report analyzes recent trends in health care costs, the forces driving those trends, and their likely economic benefits.

Delivery System Redesign

Better Care at Lower Cost: Is It Possible?
The Commonwealth Fund
This brief examines the sources of high costs in the United States, the obstacles to getting them under control, and the promising public and private efforts under way to uncover the secret to high-value health care.