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

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.

Affordable Care Act Update: Final Regulations for 90-Day Waiting Period Released

February 21, 2014 at 11:19 am | Posted in Affordable Care Act, Compliance, Creditable Coverage, Department of Labor, Employment Law, Federal Taxes, Health and Human Services, Health Care, PPACA, Regulations | Leave a comment
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On February 20th, The U.S. Departments of Labor, Treasury, and Health and Human Services published final regulations (85 pages) implementing a 90-day limit on waiting periods for health coverage. The final regulations require that no group health plan or group health insurance issuer impose a waiting period that exceeds 90 days after an employee is otherwise eligible for coverage. The rules do not require coverage be offered to any particular individual or class of individuals.

To ensure that eligibility conditions based solely on the passage of time are not used to evade the waiting period limit, the rules state that such conditions cannot exceed 90 days. Other conditions for eligibility are generally permissible, such as meeting certain sales goals, earning a certain level of commission, or successfully completing an orientation period.

Additionally, requiring employees to complete a certain number of hours before becoming eligible for coverage is generally allowed as long as the requirement is capped at 1,200 hours. The rules also address situations in which it cannot be determined that a new employee will be working full-time.

The departments are issuing a companion proposed rule that would limit the maximum duration of an otherwise permissible orientation period to one month. This proposal will be open for public comment.

A link to the final rule is here: http://www.dol.gov/opa/media/press/ebsa/20140220-redfeg1.pdf.

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


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.

DOL Affordable Care Act Compliance Assistance Webcasts Available to Public

November 22, 2013 at 10:50 am | Posted in Affordable Care Act, Compliance, Department of Labor, Federal Laws, Health and Human Services, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Medical, PPACA, Regulations | Leave a comment
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On November 20, DOL Assistant Secretary for Employee Benefits Security (EBSA) Phyllis C. Borzi testified on the Affordable Care Act implementation before the Senate Entrepreneurship and Small Business Committee. Borzi joined fellow officials from the Department of Health and Human Services and Small Business Administration in updating the Committee on efforts being made to reach employers with information about the law. She said that the current focus of the DOL was to assist with compliance as opposed to penalize for non compliance.

Among other things, Borzi also advised the Committee that (1) the EBSA Compliance Assistance toll free phone line (1-866-444-EBSA) was heavily utilized (47,000 inquiries) and EBSA staff was responding to calls from brokers, consumers, and business owners; (2) The EBSA Compliance Assistance webpage, which catalogs and updates all of the new compliance requirements, had registered over 1.5 million visitors in the past year; and (3) the EBSA had made its webcast titled “Complying With the Affordable Care Act” available to the public.

A link to the archived webcast is here:

Regulatory Green Light, Red Light! President Obama “Allows” Health Insurers Discretion to Reinstate, Upon Request, Individual Coverage Not Compliant with ACA Essential Benefits Requirements

November 18, 2013 at 9:15 am | Posted in Affordable Care Act, Compliance, Essential Health Benefits, Health and Human Services, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Medical, PPACA, Regulations | Leave a comment
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President Obama held a brief news conference Thursday, November 14, where he announced that his administration would “allow” health insurance companies, without any legislative amendment to the Affordable Care Act (ACA) to reinstate, at a consumer’s request, individual health insurance earlier cancelled this year. However, insurers will be required to educate individual policyholders that they should first explore whether they could get a better plan from healthcare.gov before asking for their cancelled coverage to be reinstated. As of November 14, there were no regulations or legislative amendments that allow for the remedy. However, HHS and CMS sent out a letter to health insurers telling they “may” do so. Apparently what the President is doing is putting the onus on the health insurance industry to make the change voluntarily so the legislative process can be avoided.

The Hill publication reports that Karen Ignagni, president of America’s Health Insurance Plans (AHIP), said the administration’s move could damage the insurance market.

“The only reason consumers are getting notices about their current coverage changing is because [ObamaCare] requires all policies to cover a broad range of benefits that go beyond what many people choose to purchase today,” Ignagni said in a statement.

“Changing the rules after health plans have already met the requirements of the law could destabilize the market and result in higher premiums for consumers.”

Only time will tell what actually happens.

A link to the letter from HHS/CMS is at

IRS Liberalizes Section 125 Election Change Menu for Non-Calendar Year Plans to Allow “Transition Relief” for Participants to Drop Coverage and Elect Coverage Through an Exchange

November 1, 2013 at 11:28 am | Posted in Affordable Care Act, Cafeteria Plans, Compliance, Federal Laws, Flexible Spending Accounts, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, IRS, Medical, PPACA, Regulations | Leave a comment
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The IRS has announced that it will allow, subject to an employer’s amendment of its non-calendar year cafeteria plan, the decision of an employee to change his/her Section 125 Cafeteria Plan health care election to drop coverage from his/her employer and obtain coverage through a health insurance exchange created under the Affordable Care Act.

According to the IRS: “An employer may amend its § 125 cafeteria plan to allow an employee who elected to salary reduce through the § 125 cafeteria plan to pay for accident and health plan coverage under the § 125 cafeteria plan with a non-calendar plan year beginning in 2013 to prospectively revoke or change his or her election with respect to the accident and health plan once, during a limited period (for example, the first month of 2014 only rather than the entire plan year) without regard to whether the employee experienced a change in status event described in Treas. Reg. § 1.125–4.”

Bipartisan Effort Forming in Seeking a Delay of the Individual Mandate… CNN Televises the Inability to Utilize HealthCare.gov Website.

October 25, 2013 at 9:52 am | Posted in Affordable Care Act, Compliance, Health Insurance Exchanges, Health Insurance Marketplace, PPACA, Regulations | Leave a comment
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The Hill publication reported Thursday that Sen. Kay Hagan (D-N.C.) and Georgia Senate Democratic candidate Michelle Nunn added their names to a growing list of Democrats calling on the administration to delay enrollment in Affordable Care. Hagan recommended the Obama administration delay the penalty for the individual mandate and extend open enrollment for two months to make up for the time lost from people who have been unable to enroll in health insurance through the HealthCare.gov website. Hagan and Nunn join Sens. Mark Pryor (D-Ark.), Mark Begich (D-Alaska), Jeanne Shaheen (D-N.H.), and Joe Manchin (D-W.Va.) in calling for some form of a delay. The longer the website and enrollment process is dysfunctional, the greater the pressure there will be to delay the 2014 individual mandate.

In the 6:00 p.m. news hour last night, CNN asked three interns to spend an hour each trying to log on and submit an application for health insurance on HealthCare.gov. Of the three interns, one was never able to log onto the website, another could not complete the on-line application and could not even download a paper application, and the last was “frozen” in the selections menu which precluded her from submitting an application.

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