Resources from the Federal Government

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Health Plan Choice and Premiums in the 2015 Health Insurance Marketplace

Jan 2015

Research indicates that the Affordable Care Act (ACA) is working to enhance competition, expand choice and promote affordability among Marketplace health insurance plans in 2015. This brief presents analysis of qualified health plan data in the Marketplace for 35 states, providing a look at the plan choice and premium landscape that new and returning consumers will see for 2015. It also examines plan affordability in 2015 after taking into account premium tax credits. The findings presented here include states for which sufficient plan data were available for both 2014 and 2015.


An Overview of Delivery System Reform Incentive Payment (DSRIP) Waivers

Dec 2014

Delivery System Reform Incentive Payment (DSRIP) initiatives are part of broader Section 1115 Waiver programs and provide states with significant funding that can be used to support hospitals and other providers in changing how they provide care to Medicaid beneficiaries.  While they originally were more narrowly focused on funding for safety net hospitals and often grew out of negotiations between states and HHS over the appropriate way to finance hospital care, they increasingly are being used to promote a far more sweeping set of payment and delivery system reforms. This brief examines similarities and difference across key elements of DSRIP waivers in six states – California, Texas, Kansas, New Jersey, Massachusetts, and New York.


Minimum Essential Coverage Guidance

Dec 2014

This letter provides guidance on the types of Medicaid coverage that qualify as minimum essential coverage (MEC), which includes certain coverage for low-income pregnant women, coverage for medically needy individuals, and coverage under an 1115 waiver program. This letter also clarifies how other Medicaid and CHIP coverage is regarded as MEC, and discusses related federal guidance issued by the Internal Revenue Service (IRS) to ensure pregnant women are not adversely impacted by a decision either to recognize or to not recognize certain coverage as MEC. Finally, this letter discusses hardship exemptions and the availability of special enrollment periods for individuals enrolled in Medicaid coverage that is not MEC.


Establishment of the Multi-State Plan Program for the Affordable Insurance Exchanges

Dec 2014

The U.S. Office of Personnel Management (OPM) issued a proposed rule to implement modifications to the Multi-State Plan (MSP) Program based on the experience of the program to date. This proposed rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers that contract with OPM to offer MSP options. This proposed rule amends MSP standards related to coverage area, benefits, and certain contracting provisions under section 1334 of the Affordable Care Act. This document also makes non-substantive technical changes.


2016 Benefit and Payment Parameters Proposed Rule

Dec 2014

This proposed rule provides payment parameters and 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 provides additional standards for the annual open enrollment period for the individual market for benefit years beginning on or after January 1, 2016, essential health benefits, qualified health plans, network adequacy, quality improvement strategies, the Small Business Health Options Program, guaranteed availability, guaranteed renewability, minimum essential coverage, the rate review program, the medical loss ratio program, and other related topics. Comments on the proposed rule are due by December 22, 2014.


Designing Care Management Entities for Youth with Complex Behavioral Health Needs

Oct 2014

Youth with complex behavioral health needs face a range of challenges and often receive services from multiple agencies that do not always coordinate services and care plans. Care Management Entities (CMEs) are designed to coordinate services provided by state agencies, and ensure services are comprehensive and not duplicative. This new Implementation Guide provides information about the CME design process for states interested in implementing or improving CMEs for youth with complex behavioral health needs. The guide focuses on experiences of the three CHIPRA quality demonstration states, Maryland, Georgia, and Wyoming, who are using funds to implement or expand CMEs.


Proposed Notice: Basic Health Program: Federal Funding Methodology for 2016

Oct 2014

This document provides the methodology and data sources necessary to determine federal payment amounts made in program year 2016 to states that elect to establish a Basic Health Program under the Affordable Care Act in order to offer health benefits coverage to low-income individuals otherwise eligible to purchase coverage through affordable insurance exchanges.


How are CHIPRA quality demonstration States testing the Children's Electronic Health Record Format?

Sep 2014

This new Evaluation Highlight focuses on how North Carolina and Pennsylvania are testing the success of the Children’s Electronic Health Record Format’s requirements, such as usability and interoperability. The highlight also focuses onhow well these requirements support the provision of primary care to children and how readily they can be incorporated into existing EHRs.


Hospital Guide to Reducing Medicaid Readmissions

Sep 2014

Reducing readmissions is a national priority for payers, providers, and policymakers seeking to improve health care and lower costs, and readmissions are a significant issue among patients with Medicaid. This guide from AHRQ is designed to help acute care facilities adapt or expand existing Medicaid readmission reduction efforts; develop Medicaid readmission reduction strategies using the guide’s roadmap featuring 13 customizable online tools; comply with the Centers for Medicare and Medicaid Services’ Conditions of Participation requirements for standard, improved and transitional care for all patients; and develop partnerships across other settings. The guide is the only federal tool available that is tailored to the adult Medicaid population.


Increased Coverage of Preventive Services With Zero Cost Sharing Under the Affordable Care Act

Jul 2014

The Affordable Care Act (ACA) ensures that most insurance plans (so-called ‘non-grandfathered’ plans) provide coverage for certain preventive health services without cost sharing for plan or policy years beginning on or after September 23, 2010. This includes screening for colon cancer for adults over 50, Pap smears and mammograms for women, well-child visits, flu shots for all children and adults, and many more services. This report examines the impact of ACA’s expanded preventive services coverage to date.

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