Health policy news waits for no one. For scheduling reasons
I've recently been publishing the weekly blog on Thursday night. This week, CMS decided they would have some
fun with me and released a slew of announcements on Friday. I'll cover all of
these issues in more detail with next week’s blog, but in the meantime, here is
some information to tide you over.
The announcements included:
- Special enrollment period for tax filers subject to penalty
- 800,000 Incorrect Tax forms mailed
- New rules for 2016 open enrollment and plans
- Medicare announcements
Special enrollment period for tax filers subject to penalty
In perhaps the least surprising announcement ever, CMS
announced there will be a special enrollment period from March 15 to April 30
for those who find out they have to pay a penalty (shared responsibility payment)
for not being covered in 2014 and are not enrolled in a plan for 2015.
More details are in the press release: Press
release: CMS Announces Special Enrollment Period for Tax Season
And the NY Times reviews the situation: A
Second Chance to Avoid a Second Tax Penalty Over Obamacare “The
department’s decision reflects two realities: 1) Confusion about how Obamacare
works remains very high. Several surveys have shown that many of the uninsured
don’t understand that there are deadlines for coverage, penalties for failing
to get insurance, or financial assistance that might make insurance affordable.
2) There’s a basic mismatch between enrollment season and tax season that
interferes with the incentive structure of the law. The punishment for not
being insured last year comes too late to sign up for this year. That means
that without the special period, many people would have been doomed to pay two
years’ worth of penalties.”
800,000 Incorrect Tax forms mailed
In a goof that does not help us make the argument that
government programs can run efficiently, HHS announced they sent out 800,000 incorrect
forms. These were forms 1095-A which are
needed to allow individuals to calculate the actual APTCs (advanced premium tax
credits) they are entitled to as opposed to the amount estimated during
enrollment. Some of these forms contain the
wrong benchmark premium, an amount needed to correctly calculate the
appropriate APTC.
You can read details here: The
government sent 800,000 Obamacare enrollees inaccurate tax forms “Approximately
800,000 people who bought coverage through Healthcare.gov received inaccurate
tax filing documents, federal officials said Friday. These forms had the wrong
price for the local "benchmark plan:" an important number that the
government uses to calculate every Obamacare enrollee's subsidy.”
And the NY Times provides this helpful FAQ: What
to Do if You Got the Wrong Tax Forms
New rules for 2016 open enrollment and plans
While 2015 open enrollment completed, it’s not too soon to
be thinking about 2016. In a series of
announcements, CMS released final details on many provisions: Press
release: CMS issues the final HHS Notice of Benefit and Payment Parameters for
2016 and Final
HHS Notice of Benefit and Payment Parameters for 2016 (CMS Fact Sheet)
As of this writing, Tim Jost has released two pieces on the
rules – he is planning on releasing two more in the coming days which I will
cover next week.
Here are some of what I consider the most significant
announcements:
- The rule finalizes the annual open enrollment period for 2016 to begin on November 1, 2015 and run through January 31, 2016. Note this is a change from what was previously planned.
- Network directories must be up-to-date, accurate, plan specific and complete (including if the provider is accepting new patients). Issuers also must make this information available in standard, machine-readable formats accessible without creating an account.
- Formularies most also be posted and accessible without an account, also machine readable.
- Machine readable means that third party vendors will be able to produce decision support tools to assist with the process.
- Auto reenrollment stays the same as this year – they will not change as originally proposed to account for lower cost plans. Individuals will be reenrolled in their same plan regardless of changes in premium.
- CMS intends to continue to use the state EHB benchmark approach through at least plan year 2017 rather than define EHB itself.
- Plans are warned against back-door discrimination such as what happened in FL where certain plans put all HIV drugs in a specialty tier thereby discouraging enrollment of those who needed the drugs.
- Changes to the definition of essential community providers (those interested in details should read the second Tim Jost link above).
- Some changes to special enrollment rules, including allowing special enrollment period if income increases over 100% FPL threshold making them eligible for APTCs.
Medicare announcements
CMS announced proposed payment factors for 2016 Medicare
Advantage and Part D plans: Press
release: CMS proposes 2016 payment and policy updates for Medicare Health and
Drug Plans
Most significantly is the proposed Medicare Advantage rate
increase. However, what was released is
far from final: “The CMS has proposed increasing health insurers' Medicare
Advantage payment rates by 1.05% for 2016, a move that kicks off a 45-day
dogfight in Washington before the rates are cemented. The base rate was an
0.95% average decrease, but "when combined with expected growth in plan
risk scores due to coding," Advantage plans will actually receive the
1.05% hike in revenue next year, according to a release from the CMS posted
late Friday afternoon.” (CMS
pitches 1.1% boost to Medicare Advantage payments)
A significant element in how Medicare Advantage plan rates
are set is the risk score assigned to the plan. We covered last week how
suspect these scores are. Here is a
piece published before the new rates were announced reviewing the topic: Reducing
Medicare Advantage Overpayments “Upcoding is a long-standing problem in
Medicare Advantage, as CBO and the Government Accountability Office (GAO) have
documented. According to MedPAC, risk
scores were 8 percent higher in Medicare Advantage, on average, than in
traditional Medicare for comparable beneficiaries. And MedPAC analysts noted that the amount of
upcoding seems to be getting larger.”
And finally, on Friday CMS also announced a change in the
way Nursing Home ratings are assigned: Press
release: CMS Strengthens Five Star Quality Rating System for Nursing Homes.
“The star ratings of nearly a third of the nation’s nursing
homes were lowered on Friday, as federal officials readjusted quality standards
in the face of criticism that the ratings were inaccurate and artificially
inflated.” (Medicare
Toughens Standards on Nursing Homes)
Thanks for reading.
