Category: Implementation

“Vermont Gov. Peter Shumlin (D) said Tuesday (Sept. 16) that the state has shut down its exchange website as it scrambles to finish operational and other improvements by Nov. 15, but the state expects the site to be “restored to full, improved operation before the start of open enrollment.”
The state made the decision to shut down the site after consulting with CMS, Shumlin said in a statement. The state also announced a number of management changes that will remove oversight of the exchange from the Department of Vermont Health Access and install Lawrence Miller, a senior advisor to the governor, as the person responsible for operational leadership of Vermont Health Connect. The Department of Vermont Health Access oversees the state’s Medicaid program.
“As all Vermonters know, we’ve had disappointment after disappointment with the Vermont Health Connect website,” Shumlin said. “I have been very frustrated that the website remains incomplete. Bringing down the site now to make improvements with our new partner Optum is the best choice to deliver a well-functioning, secure website for customers by the open enrollment period that begins Nov. 15.””

“Morning Consult’s healthcare poll finds that while a majority of voters (54%) are concerned about security breaches in the health exchange websites, 52% currently believe that the information on the exchange websites is secure. Further, a plurality of voters would choose to sign up for health insurance online over a paper application or over the phone.
This poll was conducted from September 12-13, 2014, among a national sample of 2,188 registered voters. The margin of error is plus or minus 2.1 percentage points. You can see the full results here (http://bit.ly/1BMkPRm).
A majority of voters (54%) are concerned about security breaches in the health exchange websites— Interestingly, a majority of both voters who approve of President Obama and those who disapprove of the President indicate they are concerned about security breaches in the exchange websites.”

“Federal health officials said Monday that more than 100,000 immigrants who bought health-care plans through the federal insurance exchange will have their coverage cut off at the end of the month, because they failed to provide proof by the Sept. 5 deadline that their citizenship or immigration status makes them eligible for insurance on the marketplace.
Those individuals can still send in the needed information to the federal exchange and if they are found eligible, they will be able to regain coverage, officials said. They will be considered under a special category reserved for people who have experienced a major life change, such as having a baby or getting divorced or losing a job with health insurance.”

“The Obama administration bragged about its enrollment numbers in the compulsory ObamaCare system, but the lack of eligibility-confirmation systems in the exchanges may take a big bite out of those numbers shortly. Just how big a bite is anyone’s guess, however, with warnings to multiple groups that either their coverage or their subsidies may stop at any time. Last night, HHS warned that 115,000 people currently covered by ObamaCare might lose their insurance thanks to immigration issues:”

“This week exchangers could get data on enrollment in the small business exchanges operated by the federal government as Mayra Alvarez, director of CCIIO’s State Exchange Group, will testify at a House Small Business Committee hearing Thursday on SHOP exchange implementation. CMS Administrator Marilyn Tavenner will also return to the House to face the Oversight Committee on Thursday on healthcare.gov security concerns, one day after the Government Accountability Office’s planned Sept. 17 release of a report on that controversial subject.
Academics and researchers are also diving into new data out Tuesday (Sept. 16) from the Centers for Disease Control and Prevention and the U.S. Census Bureau on the number of uninsured. The CDC’s early release of data from the National Health Interview Survey found that the uninsured rate for adults ages 18 to 64 had dipped from 20.4 percent in 2013 to 18.4 percent in the first three months of 2014. The survey does not account for the late surge of enrollments toward the end of the first exchanges open enrollment period, however it is the first official government report to document the reduction in uninsured following the ACA’s coverage expansions.”

“House Ways & Means health subcommittee chair Kevin Brady (R-TX) questions HHS’ authority to settle hospitals’ appeals of denied inpatient claims and is urging HHS Secretary Sylvia Burwell to retract what he views as an “ill thought” settlement process. Brady wants Burwell to work with lawmakers to come up with a different “fair, transparent and conclusive settlement process.”
Brady wrote to Burwell Tuesday (Sept. 16) that he is dismayed by HHS’ reluctance to work with the committee on an equitable settlement process that is fully legal, adding that the “lack of engagement makes it challenging for the Congress to solve the current appeals problems and prevent similar problems in the future.”
CMS announced late last month (Aug. 29) that it will pay hospitals 68 percent of denied inpatient status claims in the appeals queue if hospitals take them out of the backlogged appeals process. The agency has been encouraging hospitals to take advantage of the settlement to “alleviate the burden of Medicare appeals on both the hospital and Medicare systems,” according to the CMS website.
Hospitals should decide whether to participate by the end of October, and CMS in a Frequently Asked Questions document released Sept. 9 says that four hospitals have already stepped forward to take the settlement offer. The document also states that this is a one-time offer from CMS.”

“Last year I wrote that Obamacare could leave doctors holding the bag for claims for patients who don’t pay their insurance premiums. That’s because the law includes a three-month grace period during which health insurers must continue to cover patients who sign up, but don’t pay the price of their insurance. If the patients eventually make good, there’s no problem. But if patients don’t pay the owed premiums, the insurance company has to cover the cost of claims filed during the first month. Providers are stuck with the tab for any claims filed during months two and three.
The piece I wrote last July was theoretical. The notification letter I’m holding in my hand, addressed to my wife’s pediatric practice, is reality. And reality costs, in this case, over $600. That’s the outstanding balance owed the practice by a patient insured by BlueCross BlueShield of Arizona. It’s a balance that my wife might have to eat, or else try to collect herself.”

“There are widespread instances of Obamacare insurance plans violating the rigid rules surrounding whether customers can use federal health care subsidies on insurance policies that cover abortion procedures, according to a Government Accountability Office investigation.
The report, commissioned by House Republican leadership and obtained by POLITICO on Monday night, found that 15 insurers in a sample of 18 are selling Obamacare plans that do not segregate funds to cover abortion (except in cases of rape, incest or the mother’s life) from their Obamacare subsidies.

“During the 2014 open enrollment for Obamacare coverage, Mary Denson, 21, a student at Columbia (Mo.) College, qualified for a federal premium subsidy that reduced her premium contribution for buying health insurance to less than $20 a month.
But she fears that when she renews her coverage for 2015, she won’t have enough income from her nanny job to reach the subsidy income threshold of 100% of the federal poverty level and continue qualifying for premium tax credits. She isn’t eligible for Medicaid because Missouri hasn’t expanded that program for low-income adults. Denson says she’s considering looking for another job to reach the $11,670 income threshold but worries she may have to drop classes. Without the subsidy, her coverage would cost nearly $400 a month, far more than she can afford.
“I’m just going to have to re-apply and pretty much hope that I make the cut again,” Denson said.”

“States have developed various ways to avoid paying their fair share of Medicaid expenses over the years, in some cases costing the federal government hundreds of millions of dollars in extra funding for the program.
The Department of Health and Human Services, which runs Medicaid through its Centers for Medicare and Medicaid Services (CMS), has known about the issue for more than a decade, but states still find ways to game the system. The agency’s inspector general this year listed the issue among 25 key problems the agency needs to address.”