NACCHO Update – Health Care Reform

In its “News from Washington” weekly update, the National Association of County and City Health Officials (NACCHO) provides a series of updates on health care reform.  The information below is from the weekly newsletter.

CMS Letter to States on Opportunities through Medicaid to Address Behavioral Health Disorders
On December 3, the Centers for Medicare and Medicaid Services (CMS) issued an informational bulletin on Coverage and Service Design Opportunities for Individuals with Mental Illness and Substance Use Disorders.
CMS Issues Fact Sheet on the Federally Facilitated Exchange
On November 30,CMS issued a status update on the Federally Facilitated Exchange (FFE).  At a minimum, 20 states will be participating in the FFE rather than operating their own. CMS issued guidance in May but has yet to issue implementing regulations.
CMS Issues FAQ on Medicaid and CHIP ACA Implementation
On November 19, CMS issued Frequently Asked Questions regarding Medicaid/Children’s Health Insurance Program (CHIP) ACA implementation. Medicaid programs in states that are not expanding Medicaid or building their own exchanges must still coordinate with the federally facilitated exchanges. Beginning in 2014, states are required to convert to an electronic eligibility and enrollment system for Medicaid and CHIP. The new electronic system will also determine eligibility for federal subsidies on the exchange.
Office of Personnel Management Releases Multistate Rule
On November 30, the Office of Personnel Management (OPM) released a proposed rule providing guidance to insurers that want to offer a national multistate plan allowing them to phase in their participation in all 50 states over four years. In the first year, the plans would only have to operate in 31 states. Section 1334 of the ACA requires at least two insurers or more to operate in each state’s exchange as a multistate plan to ensure that every state has robust insurance options. The rule seeks to create a level playing field between large national carriers and smaller local health plans competing in exchanges. Multistate plans would benefit people who live in more than one state or small businesses that operate in several states but want to offer their employees uniform benefits. A factsheet on the rule is available here.
CMS Requests Input on Quality Measurements for Health Plans in Health Exchanges
On November 23, CMS issued a request for comments about current quality rating systems, quality improvement, and purchasing strategies that promote care redesign and patient safety, as well as effective methodologies to measure health plan value. It also requested feedback about how to align current quality improvement requirements (i.e., the National Strategy) with future quality reporting and display requirements for Quality Health Plans (QHPs) effective in 2016.
Section 1311 of the ACA requires QHP issuers to focus on quality improvement and patient safety through contracting requirements and data reporting, and Section 10329 of the ACA required the HHS Secretary to develop a method for determining the value of a health plan. In May 2012, HHS released guidance on FFE that includes a phased approach to quality reporting and display standards for all health insurance exchanges and QHP issuers. New quality reporting standards are effective in 2016. Per Section 3011 of the ACA, the National Quality Strategy was implemented last year to promote health care quality improvement at the local, state, and national levels.
Medicaid Expansion Costs to States
On November 26, the Kaiser Commission on Medicaid and the Uninsured released the Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis about costs associated with the expansion of Medicaid to 133 percent of the federal poverty level (FPL) if all states expand Medicaid:

  • Between 2013 and 2022, state Medicaid spending will increase 3 percent; federal spending will increase 26 percent.
  • 41 percent more individuals will be Medicaid eligible.
  • In total, states would spend $8 billion between 2013 and 2022 on Medicaid expansion; a 0.3 percent increase from what states will spend to implement other aspects of the ACA.
  • State and local spending on uncompensated care will decline $18 billion.
  • In total, states will see a $10 billion decrease in Medicaid spending between 2013 and 2022.
  • Half of the states will see costs increase by less than 5 percent between 2013 and 2022; other states will see increase by 5 to 11 percent.

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