Massachusetts: New $254 Million Health Exchange Website is working

November 18, 2014 at 2:30 pm | Posted in Affordable Care Act, Health and Human Services, Health Care, Health Insurance Marketplace, HHS, Medical, Wellness | Leave a comment
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by Steve LeBlanc, Associated Press

BOSTON (AP) — Massachusetts officials are reporting a successful weekend launch of the state’s revamped health insurance website, but cautioned of possible “hiccups” in the system with expected heavier traffic during the week.

Officials said Monday that in the first two days of the new federal open enrollment period, nearly 5,000 eligible people were immediately registered for state Medicaid coverage.

Nearly 7,000 others were able to complete the process of determining eligibility for plans that comply with the federal Affordable Care Act. They still need to review those insurance plans, choose one, and make their first month’s premium payment.

The successful rollout was in sharp contrast to a year ago, when a failed health exchange forced the state to place hundreds of thousands of residents into temporary Medicaid coverage and led to a costly overhaul of the website. The website woes were also an embarrassment for the state that provided a blueprint for the federal health care law.

Maydad Cohen, a special assistant to Gov. Deval Patrick, said Monday that the new website has proven stable and reliable — handling more than 57,000 visitors over the first two days of open enrollment.

“During the weekend we saw excellent performance of the website,” Cohen told reporters Monday. “We had a very successful, very exciting weekend.”

Of the nearly 7,000 people deemed eligible to obtain insurance through the state’s health insurance exchange during the weekend, about 3,600 individuals and families already have selected a plan and 137 already have paid their first month’s premium, state Health Connector officials said.

Those numbers will continue to climb as more people sign up for insurance.
Hundreds of call representatives also are assisting those looking to sign up for coverage, having trouble with the website or are unsure how to use it.

Cohen said one of the main reasons for high call wait times is that many of those seeking one-on-one help want to go through the entire application on the phone, something that can take 45 minutes or more per application.

Cohen urged those seeking to sign up for coverage to try the website first.

As a result of the previous website troubles, the state ended up putting more than 400,000 individuals into temporary subsidized insurance programs, including MassHealth, the state’s Medicaid program.

Secretary of Health and Human Services, John Polanowicz said between 175,000 and 225,000 of those were expected to enroll in new coverage, including through MassHealth.

Polanowizc said the number is lower than the 400,000 because of what he called the natural “churn” of subsidized care, with individuals losing their eligibility because they’ve found a job that offers insurance, or have obtained health care through a spouse, or have moved out of state.

Dec. 23 is the deadline to ensure coverage that starts on Jan. 1. Fixing the website hasn’t been cheap. The original cost of Massachusetts’ website was estimated at $174 million. That has jumped to $254 million.

HHS Claims that Quality Improvements and the Affordable Care Act Saved 15,000 Lives and $4 Billion in Health Spending During 2011 and 2012

May 7, 2014 at 10:43 am | Posted in Affordable Care Act, Health and Human Services, Health Care, Medical, PPACA, Regulations | Leave a comment
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HHS announced today that new preliminary data show an overall 9% decrease in hospital acquired conditions nationally during 2011 and 2012. National reductions in adverse drug events, falls, infections, and other forms of hospital-induced harm are estimated to have prevented nearly 15,000 deaths in hospitals, avoided 560,000 patient injuries, and approximately $4 billion in health spending over the same period.

HHS claims that the Affordable Care Act is also helping reduce hospital readmissions. After holding constant at 19% from 2007 to 2011 and decreasing to 18.5% in 2012, the Medicare all-cause 30-day readmission rate has further decreased to approximately 17.5% in 2013. This translates into an 8% reduction in the rate and an estimated 150,000 fewer hospital readmissions among Medicare beneficiaries between January 2012 and December 2013.

A complete copy of the HHS announcement can be found here: http://www.hhs.gov/news/press/2014pres/05/20140507a.html

HPID Requirements Apply to Self Insured “Stand Alone” Dental Plans

April 14, 2014 at 3:12 pm | Posted in ERISA, Federal Laws, Medical | Leave a comment
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Self Insured Dental Plans
Protector Group recently issued an email ALERT advising clients on whether or not they had a responsibility to obtain a Health Plan Identification (HPID) number from the federal government. The HPID requirement is not specific to medical plans alone. A self insured “stand alone” dental plan would also have to obtain a HPID since it satisfies the applicable definitions of health plan and medical care under ERISA and the Internal Revenue Code. On the other hand, if a self insured dental plan is part and parcel of a self insured health plan, only one HPID is necessary.  

Timing of Compliance
A self insured dental plan will need to obtain a HPID no later than November 5, 2014 if it has $5 million or more in “annual receipts.” If the self insured stand alone dental plan has less than $5 million in receipts, you are allowed another year (November 5, 2015) to obtain the HPID. The phrase “annual receipts” is understood to mean receipts of paid claims before the payment of stop-loss premiums exclusive of administrative costs.  

FSAs and HRAs
We are waiting for further government guidance re: the possible application of the HPID requirements to FSAs and HRAs.

HHS Announces New Round of 2014 HIPAA Compliance Audits: Are You Ready?

March 25, 2014 at 9:18 am | Posted in Compliance, Federal Laws, Health and Human Services, Health Care, HIPAA, Medical, Regulations | Leave a comment
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Last month, the HHS Office of Civil Rights (OCR) announced that there will be a more vigorous HIPAA audit effort in 2014 of HIPAA covered entities, including health plans, and their business associates. Speaking at a February 24th health care technology conference, Susan McAndrew, OCR deputy director for health information privacy said: “Hopefully in coming months you’ll see actual activity that will start up on the audit process.” OCR soon will launch a survey of 1,200 organizations as a first step toward selecting those to be audited. McAndrew also stated that the organizations to be surveyed were selected from “a large database,” and the survey seeks to verify if the entity is a suitable candidate for a HIPAA audit.

In a February 24th notice published in the Federal Register, OCR announced that it will survey “up to 1,200 HIPAA covered entities, including health plans, healthcare clearinghouses and certain healthcare providers, and business associates, to determine suitability for the OCR HIPAA audit program.” According to the notice, the survey “will gather information about respondents to enable OCR to assess the size, complexity and fitness of a respondent for an audit.” An OCR spokesperson says the survey will target approximately 800 covered entities and 400 business associates.

If you have not done so already, at a minimum, a plan sponsor should start to self assess: (1) whether it is a HIPAA covered entity; (2) whether it receives protected health information (PHI); and (3) assuming it receives PHI, has it taken timely and reasonable steps to secure the PHI in a manner consistent with HIPAA’s regulations?

ACA Exchange Enrollment Hits 4 Million

February 26, 2014 at 2:09 pm | Posted in Affordable Care Act, Compliance, Health and Human Services, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Medical, PPACA, Regulations | Leave a comment
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HHS announced Tuesday that approximately 4 million Americans have enrolled through the end of January for coverage through the Affordable Care Act Exchanges. A full enrollment report for February will be released in mid-March.

“With individuals and families enrolling in coverage every day, we continue to see strong demand nationwide from consumers who want access to quality, affordable coverage,” Centers for Medicare & Medicaid Services administrator Marilyn Tavenner wrote in a blog post Tuesday. “Our outreach efforts are in full force with community partners and local officials participating in hundreds of events each week and enrollment assistors are helping more and more people enroll in coverage,” she continued.

Only five weeks remain in the open enrollment period.

HHS Announces 53% Increase in Federal Exchange/Marketplace Enrollment

February 14, 2014 at 9:21 am | Posted in Affordable Care Act, Compliance, Health and Human Services, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Medical, PPACA | Leave a comment
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HHS Secretary Kathleen Sebelius announced on February 12 that enrollment in the Health Insurance Marketplace continued to rise in January, with a 53 percent increase in overall enrollment over the prior three-month reporting period, with young adult enrollment outpacing all other age groups combined.

Nearly 3.3 million people enrolled in the Health Insurance Marketplace plans by February 1, 2014 (the end of the fourth reporting period for open enrollment), with January alone accounting for 1.1 million plan selections in state and federal marketplaces. In January, 27 percent of those who selected plans in the Federally-facilitated Marketplace are between the ages of 18 and 34, a three percentage point increase over the figure reported for the previous three-month period. Young adult enrollment grew by 65 percent in January, from 489,460 at the end of December to 807,515 as of February 1, while all other age groups combined grew by 55 percent.

A copy of the HHS press release is here: http://www.hhs.gov/news/press/2014pres/02/20140212a.html

 

The Massachusetts Affordable Care Act (ACA) Website Is Woefully Underperforming: Outside Review Ordered

January 10, 2014 at 11:52 am | Posted in Affordable Care Act, Compliance, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Massachusetts Health Connector, Medical | Leave a comment
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While much has been reported in the media about the problematic rollout of the federal government’s ACA website, Healthcare.Gov, Massachusetts officials have now acknowledged that the state’s website is beset by a blizzard of problems as well. The Boston Globe has reported that thousands of Massachusetts residents have been unable to enroll, and the website’s troubles also include poor communication and inconsistent enrollment data.

There are widespread reports of substandard customer service as well when individuals try to call the Massachusetts Health Connector in an effort to find an alternative means of enrolling. The state is exploring litigation against the website’s vendor, CGI, which is the same vendor who designed the federal government’s ACA website. Progress on the Massachusetts website has stalled and the state late last year stopped paying CGI’s $69 million contract because the firm failed to deliver pieces of the website and necessary fixes on time.

The Board for the Massachusetts Healthcare Connector announced yesterday that MITRE, an independent technology firm, will review the state’s failed health insurance website and make recommendations about how to move forward in rebuilding a system that allows people to easily shop for and buy coverage online.

DOL Sues Employer/Plan Sponsor for Approximately $500,000 and Removal of Health Plan Fiduciaries for Failure to Fund Health and COBRA Coverage and Pay Incurred Claims

December 26, 2013 at 11:51 am | Posted in COBRA, Compliance, Department of Labor, Employment Law, Flexible Spending Accounts, Health Care, Medical | Leave a comment
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On December 18th, in Perez v. Home Valu, et al., the DOL sued a self insured health benefit plan, self insured dental plan, flexible benefit plan, COBRA plan, and the individuals responsible for its administration seeking recoupment of approximately $500,000.

On December 24, 2009 the self insured plans stopped paying benefit claims. On January 10, 2010 Home Valu stopped doing business because of financial pressures. All Home Valu benefit plans were formally terminated on January 22, 2010 although they were practically terminated on December 24 when the self insured plans stopped paying claims. Nevertheless, HomeValu continued to deduct approximately $12,000 in insurance premiums from employee paychecks in January 2010 and failed to apply those premiums towards health insurance. The Home Valu benefit plans did not pay approximately $490,000 in claims incurred in November and December 2009 and January 2010.

A copy of the DOL complaint can be found here:
http://www.dol.gov/ebsa/pdf/0-13-cv-03572.pdf

HHS Announces Increase in Healthcare.Gov November Enrollment Figures: Significant Number Going to Medicaid Expansion

December 11, 2013 at 1:02 pm | Posted in Affordable Care Act, Compliance, Essential Health Benefits, Health and Human Services, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Medical, PPACA | Leave a comment
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This morning HHS reported that nearly 365,000 individuals have selected plans from the state and federal Marketplaces by the end of November. HHS reported, among other things, that:

  • November’s federal enrollment number outpaced the October number by more than four times.
  • Nearly 1.2 million Americans, based only on the first two months of open enrollment, have selected a plan or had a Medicaid or CHIP eligibility determination.
    • Of those, 364,682 Americans selected plans from the state and federal Marketplaces; and
    • 803,077 Americans were determined or assessed eligible for Medicaid or CHIP by the Health Insurance Marketplace.
  • 39.1 million visitors have visited the state and federal sites to date.
  • There were an estimated 5.2 million calls to the state and federal call centers.

What “may” be a troubling sign is that, to date, the majority of enrollees have been directed into Medicaid or CHIP coverage and are not paying premiums for their coverage. HHS is hopeful that the premium-paying, working “young invincibles” (ages 19-35), who are a key actuarial pillar to the Affordable Care Act, will enroll closer to the end of the enrollment period in March 2014.

A copy of the HHS Release and accompanying report is here: http://www.hhs.gov/news/press/2013pres/12/20131211a.html

U.S. Supreme Court to Address Constitutionality of Affordable Care Act’s Contraception Mandate On Private Employers

November 26, 2013 at 1:04 pm | Posted in Affordable Care Act, Compliance, Creditable Coverage, Essential Health Benefits, Federal Laws, Health Care, Medical, PPACA, Regulations, Wellness | Leave a comment
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The Supreme Court announced today that it will accept for hearing and decision the constitutional challenge to the Affordable Care Act’s (ACA) contraception mandate as it applies to private employers who have a religious objection to the mandate. The contraception mandate is part of one of the ten required health essential benefits (women’s preventive health services) required of health plans under ACA.

There is currently a disagreement among the federal Circuit Courts of Appeals as to its constitutionality. It is reported that the hearing will be this spring.

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