Weekly Health Care Wrap-Up.
HHS Announces Exchange Funding…
This week, the Department of Health and Human Services (HHS) awarded $229 million in Level One Exchange Establishment grants to 10 states. For four states — Arkansas, Colorado, New Jersey and Pennsylvania — it was their first Level One award. Several states received their second round of Level One funding (states are permitted to reapply for a second year of funding under the Level One grants if necessary to meet the criteria to apply for Level Two awards). States receiving a second round of Level One funding, include: Kentucky, Minnesota, New York, Nevada and Tennessee. In addition, Massachusetts received a little over $11 million to conduct analysis on coverage transitions and operational interfaces between the Connector and the Massachusetts Medicaid program in preparation for 2014.
…Indicates Delay in Exchange Grant Funding Timeline…
The Center for Consumer Information and Insurance Oversight (CCIIO) indicated this week that it will extend the availability of Exchange Establishment grants (both Level One and Level Two) through the end of 2014. Previously, Level One funding was expected to close by the end of June. While CCIIO has yet to formally announce the policy change (a formal announcement is expected soon), the timeline shift is likely to figure into state exchange planning processes across the country, particularly as some states choose to “wait and see” how the Supreme Court rules on the ACA.
…And Provides More Detail on Processes for Medicaid, ACA Waivers
Also this week, HHS offered revised rules for the increased transparency requirements for Medicaid 1115 waivers as well as state “innovation waivers” included as part of the Affordable Care Act (ACA). Neither rule offered significant revisions. On the Medicaid front, states and the federal government will be required to adhere to new transparency and public input standards for the 1115 waiver negotiation process beginning April 22 of this year. More broadly, states beginning in 2017 will have the opportunity to pursue a state “innovation waiver” under the ACA if they can demonstrate that their plans will provide coverage that is at least as comprehensive and affordable as the coverage that would have been provided under the ACA; cover at least as many residents as would have otherwise been covered; and will not increase the federal deficit. Senators Wyden (D-OR) and Brown (R-MA) have supported legislation to move the timeline for the innovation waivers up to 2014. While the Obama administration has backed this approach publicly, Congress has yet to vote on the measure.
Eight Co-Ops Receive Start-Up Funding
Earlier this week, the Center for Consumer Information and Insurance Oversight (CCIIO) announced $639 million in funding to help start co-ops in eight states. The winners of the awards were: Freelancers CO-OP of Oregon, New Mexico Health Connections, Montana Health Cooperative, Midwest Members Health, Common Ground Healthcare Cooperative, Freelancers CO-OP of New Jersey and Freelancers Health Service Corporation. CCIIO officials indicated that several applicants are “retooling” their proposals in advance of the next round of funding. There is $3.4 billion in seed funding available for co-ops under the Affordable Care Act.
State 2 Meaningful Use Proposed Rules Released…
The Centers for Medicare and Medicaid Services (CMS) this week released the long-awaited Stage 2 proposed rule for meaningful use. After a comment period, the proposed rules are expected to be finalized sometime this summer, perhaps June or July. The new rules are slated to take effect in 2014, a year later than originally intended. Beginning in 2015, Medicare will start to reduce hospital and physician payments by one percent for providers not achieving meaningful use.
…While Use Of HIT Increasing
Also this week, HHS Secretary Sebelius reported that the number of hospitals using health information technology has more than doubled in the past two years. In addition, almost 2,000 hospitals and upwards of 41,000 doctors have received $3.1 billion in meaningful use incentive payments.
From the States
For full coverage of state exchange activities, check out this week’s State of the States: Health Insurance Exchange Developments here.
Alabama. Republican Representative Greg Wren, Vice Chair of the House Insurance Committee, introduced legislation authorizing the establishment of the Alabama Health Insurance Exchange (AHIE), as a non-profit independent state entity and requiring the AHIE to set up a separate Small Employer Insurance Exchange. Currently the legislation has no cosponsors and has been referred to the House committee on Health.
North Carolina. Early data for a Medicaid pregnancy medical home initiative in the state suggests the new approach has led to fewer emergency room visits by pregnant women and less use of neonatal intensive care units. Implemented less than a year ago, the North Carolina program incentivizes physicians to identify pregnant women at risk and refer them to case managers to coordinate health care as well as social services throughout their pregnancy. To encourage physician participation, doctors receive an additional $200 per patient from Medicaid.