Weekly Health Care Wrap-Up.
CCIIO Holds 3-Day Exchange Meeting, Releases FAQs
Exchange watchers this week focused on stories emerging from the three-day implementation forum hosted by the Center for Consumer Information and Insurance Oversight (CCIIO) in Washington, DC. With plenty to discuss after a myriad of exchange announcements last week, including guidance on the federally facilitated exchange (FFE), state partnership models and tax credits, states and stakeholders gathered to sort through a host of issues. CCIIO has a series of implementation forums scheduled throughout the summer. The complete schedule can be found here.
Additional information about the CCIIO implementation forum can be found in this week’s State of the States: Health Insurance Exchanges. Also this week, CCIIO moved forward by adding a FAQ section to its website focused on the blueprint process. The new FAQs are available here.
PDUFA Clears Senate…
Prescription drug user fee legislation cleared the Senate easily on Thursday evening by a 96-1 vote. Senator Bernie Sanders (I-VT) was the lone senator to oppose the legislation. The full House is expected to turn to its version of the bill on Wednesday. Congressional leaders indicate they hope to wrap up consideration of the issue by the beginning of July.
…While Prevention and Public Health Offset Fails
The Senate also on Thursday voted down legislation that would offset upcoming increases in student loan interest rates with funds from the Prevention and Public Health Fund. Ten Republicans joined Democrats in opposing the legislation. A nearly identical plan was approved by the House in April.
HHS Announces Funding for Family-to-Family Information Centers
The Department of Health and Human Services (HHS) this week announced $4.9 million in funding for Family-to-Family information centers. Created in 2005, the centers are state-wide, family-led organizations that provide information, education, training, outreach and peer support to families of children with special health care needs. The centers are staffed by trained family leaders who have children with special health care needs, and expertise in navigating federal, state and local public and private health care systems. The Health Resources and Services Administration (HRSA) oversees the centers. More information can be found here.
PCORI Releases Funding Opportunities
The Patient Centered Outcomes Research Institute (PCORI) announced the availability of $96 million in grant funding for research in four out of its five research agenda areas. Specifically, the funding opportunities are focused in the following areas:
- Assessment of Prevention, Diagnosis, and Treatment Options
- Improving Healthcare Systems
- Communication and Dissemination
- Addressing Disparities
Additional information on the funding opportunities can be found here.
More Co-Op Loans Announced
Late last week, more than $135 million in co-op loans were announced, funding co-ops in Nevada and Michigan. The Hospitality Health Co-op, located in Nevada, received $65.6 million, with Michigan Consumer’s Healthcare Co-op receiving $71.5 million. More information can be found here.
From the States
California. The Bay Area Council’s Economic Institute is out with a new report estimating that the ACA will generate nearly 100,000 jobs in the state when it is fully implemented. The report also finds that full implementation of the ACA would add $4.4 billion to the state’s economic activity. The report can be found here.
Missouri. Late last week, the Missouri House passed House Bill 464, which prevents Governor Jay Nixon (D) from using an Executive Order to create an exchange and puts the question of whether Missouri should establish an exchange on the November ballot. Similar legislation had already been passed by the Missouri Senate earlier this year. To give the law added teeth, any Missouri general assembly member or Missouri taxpayer may file suit against the state if it cooperates with the federal government to set up an exchange.
Texas. The state’s Medicaid director since 2010, Billy Millwee, announced this week that he will retire in August. Millwee has spent 18 years with Texas’ Medicaid program, one of the largest in the country.
Health Insurance Exchanges: State of the States update.
Similar to last week, exchange watchers witnessed a number of developments at the federal level this week. Let’s review before diving into what’s happening in the states.
Late last Friday, the Internal Revenue Service issued a final rule on the ACA’s insurance premium tax credits. An important change was the elimination of the so-called “marriage penalty” that impacted couples who qualified individually for insurance premium tax credits, but did not qualify as a couple. Under the old rule, newlyweds that saw their income increase as a result of being married would have to repay the federal government for any subsidy overpayments. Under the new rule, couples will now make separate income calculations on their pre- and post-marriage income, which should help them avoid penalties.
Also, the IRS continues to weigh how it will determine if employer-sponsored insurance is “affordable.” As it currently stands, “affordable” employer insurance is calculated against the employee’s share of the premium for the lowest-cost, self-only coverage option proposed by the employer. Many argue this calculation should be based on family, not individual, coverage. The regulation indicates this issue will be addressed in future regulations concerning employer-sponsored insurance.
Meanwhile, at this week’s three-day exchange implementation meeting sponsored by the Center for Consumer Information and Insurance Oversight (CCIIO), participants received additional details on federally-facilitated exchanges and the state-federal partnership model. At the meeting, CCIIO encouraged states, even those pursuing a state-based exchange, to consider applying for the federal-state partnership model as a backup, in case states had unexpected problems setting up their exchanges.
After the meeting, CCIIO added a FAQ section to its website to answer previously asked questions about the blueprint process. The FAQ describes how to submit a Blueprint Application, the information required in a Blueprint Application, and lays out what reference documentation HHS will seek from states. States that receive conditional approval of their exchange from HHS will be subject to monitoring reviews by HHS to make sure the exchange is operational by the 2014 deadline. To further help address any exchange-related questions by either the states or other stakeholders, CCIIO is gearing up for a series of regional implementation forums, with the first one kicking off in Washington, DC on July 18. After DC, the forum heads to Chicago, Denver and Atlanta.
Also, we learned this week that Virginia is taking some additional steps to plan for an exchange. The chairman of the Senate Commerce and Labor Committee, Sen. John Watkins (R), announced that he is going to re-establish a subcommittee to review potential exchange-enabling legislation. Currently, the state has the legal authority to plan for an exchange, but not the authority to create one without either legislation or an Executive Order from Governor Bob McDonnell (R). Additionally, Virginia expects to release an RFP shortly to procure a Medicaid eligibility system. The RFP is expected to include an option that will allow Virginia to procure the IT backbone for the state’s Individual and SHOP exchanges. There are also reports that Virginia is preparing a Level One grant to submit to HHS this summer.
Virginia is not the only state busy preparing grant applications for HHS. California is preparing to apply for another Level One grant in the next few months. Also, expect to see Connecticut apply for Level Two funding sometime later this year, along with Arizona, which is targeting its Level Two application for the November 1 deadline.
Finally, earlier this month, the California Health Benefit Exchange announced a preliminary decision to award First Data Corp a $9.3 million contract to manage the development of the exchange’s enrollment system. The California Health Benefit Exchange is still mulling which vendor it will choose to actually develop and implement its IT exchange backbone.