cmonfils | May 9, 2012
www.myhealthguide.com
MyHealthGuide Source: Fred Hunt, Active Past President, and Anne Lennan, Society of Professional Benefit Administrators (SPBA), 5/2/2012,www.SPBATPA.org
Recently, SPBA responded to a Stop-Loss Request for Information (RFI) requested by the IRS, Department of Labor EBSA, HHS CMS. The response was designed as a layman background, context and explanation to provide the “big picture” and assist the government in understanding what may be more technical responses from others. Below is an excerpt from the response and key points. (more…)
Category: CMS, HHS, IRS, Stop Loss |
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cmonfils | April 10, 2012
KENNEBUNK, Maine–(BUSINESS WIRE)–Mark Farrah Associates, in its latest Healthcare Business Strategy Report, noted roughly 36.4 million people were covered by Medicaid managed care programs in 2010, up 8% over 2009. Working with data reported by state regulators to the Centers for Medicare & Medicaid Services (CMS) and by insurers through the National Association of Insurance Commissioners (NAIC), Mark Farrah Associates (MFA) confirmed U.S. enrollment in managed Medicaid plans continues to escalate. Total membership grew by 8% from June 2009 to June 2010, reaching roughly 36.4 million. Furthermore, current estimates for 2011 show enrollment up an additional 4% to 37.8 million.
http://www.businesswire.com/news/home/20120404005669/en/Mark-Farrah-Associates-Finds-Managed-Medicaid-Enrollment
Category: CMS, Medicaid |
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cmonfils | April 6, 2012
The Centers for Medicare & Medicaid Services (CMS) today announced payment and policy guidance for Medicare Advantage (Part C) and Medicare prescription drug (Part D) plans for Calendar Year (CY) 2013 that will continue the trend of lower premiums and stable or improved benefits that beneficiaries in these programs have experienced over the last two years. This guidance describes payment changes that reflect an estimated annual average growth rate of 3.07 percent, which will sustain a stable Medicare Advantage landscape next year.
Category: CMS, Medicare |
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cmonfils | April 6, 2012
The Centers for Medicare & Medicaid Services today issued a final rule with comment period for the Medicare Advantage (MA) and prescription drug (Part D) benefits programs for Calendar Year 2013. These regulations, posted today at the Federal Register, implement MA and Part D technical and program changes that were determined based on public comments to a proposed rule that was published on October 11, 2011, and by applying insight obtained through CMS and stakeholder operating experiences. CMS believes these provisions strengthen beneficiary protections, encourage high plan performance, improve program efficiencies, and clarify program requirements.
Category: CMS, Medicare |
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cmonfils | March 26, 2012
States to receive federal funding to provide high-quality, affordable coverage
Health and Human Services Secretary Kathleen Sebelius today announced final policies that will ensure that millions of uninsured Americans will have a simple, seamless path to affordable health insurance coverage.
Category: CMS, Health Insurance, HHS, Medicaid |
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cmonfils | March 14, 2012
Health reform has been strongly urging plans to cover the essential health benefits (EHB) package, and that means there will have to be coverage in 10 categories of health benefits.
Category: CMS, Health Care Legislation, Health Insurance |
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cmonfils | February 29, 2012
Self-Insurer January 2012 Issue, Volume 39
By Jason Kimpel, Baker & Daniels LLP and Nick Manetto, B&D Consulting
When it comes to reviving patients from near-death experiences, the Medicare Shared Savings Program (MSSP), or Accountable Care Organization (ACO) initiative, may rival even the most herotic examples of medicine. (more…)
Category: Accountable Care Organizations, CMS |
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cmonfils | February 26, 2012
Over 13.3 million people were enrolled in Medicare Advantage (MA) plans as of February 2012, 27% of the 49.3 million people eligible for Medicare, according to data from The Centers for Medicare and Medicaid Services (CMS). Aggregated enrollment in MA plans increased by 1.151 million members between February 2011 and February 2012. Roughly 18% of MA enrollment is from employer group health plans (EGHPs). This brief, using enrollment data through February 1, 2012, takes a look at how companies have performed in the Medicare Advantage Market.
Category: CMS, Medicare |
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cmonfils | February 19, 2012
Coordination Of Benefits January 2012 Vol. 20 No. 1
Medicare Advantage (MA) and Prescription Drug Plan (PDP) sponsors should have the same leverage as Medicare’s own carriers and fiscal intermediaries when collecting for Medicare Secondary Payer (MSP) overpayments, the Centers for Medicare & Medicaid Services (CMS) said in a recent memo. CMS’ clarification comes soon after two federal courts said MA plans weren’t allowed to recover proceeds under the MSP Act, which authorizes double damages (see the October 2011 newsletter). Without authority under the MSP Act, some private-payer entities that administer MA and PDP benefits would have to seek collections in state courts. (more…)
Category: CMS, Medicaid, Medicare |
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cmonfils | February 17, 2012
CMS’ Office of E-Health Standards and Services (OESS) has announced a 90-day period of “enforcement discretion” for compliance with the new 5010 HIPAA transaction standards, but leading professional organizations say that is not enough.
Category: CMS, HIPAA |
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cmonfils | February 5, 2012
Health care spending in 2009 and 2010 grew at the slowest rates in 50 years. This startling news, published in an article by staff of the Centers for Medicare and Medicaid Services (CMS) in Health Affairs, was largely attributed to the shrinking economy.1 Loss of jobs and insurance, slow growth in wages and family incomes, and greater out-of-pocket health care costs have undoubtedly caused uninsured, underinsured, and low-wage workers and their families to forgo care, contributing to the slowdown in health spending. An estimated 9 million people became uninsured when they lost a job with benefits over 2008–10, and they were much more likely than those who did not lose coverage to report delaying needed care.2
Category: CMS, Health Care Legislation |
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cmonfils | February 3, 2012
Just-released estimates of national health spending in 2010 by the Centers for Medicare and Medicaid Services (CMS) show that 45% of our health care spending is financed by the federal and state governments, primarily through the Medicare and Medicaid programs. This share has grown temporarily in recent years because of the economic downturn, as private insurance has declined and Medicaid has grown. It has also increased due to our demographic destiny: the growing cohort of baby boomers who are retiring and shifting from employer-sponsored health insurance to Medicare.
Category: CMS, Health Insurance, Medicaid, Medicare |
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cmonfils | January 30, 2012
Many in healthcare, including leaders at the CMS Innovation Center, are betting on experiments with more coordinated services and value-based payments to show it’s possible to spend less for better outcomes. For two decades, the Medicare program has tried some of these ideas—and now a new federal report has some bad news about the results
http://www.modernhealthcare.com/article/20120121/MAGAZINE/301219973/
Category: CMS, Health Care Legislation, Medicare |
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cmonfils | January 20, 2012
The nation’s economy is improving, but it’s doing so weakly, and that continues to curb the growth in healthcare costs.
That was the message last week when CMS analysts released the agency’s annual National Health Expenditure Accounts, which showed U.S. healthcare spending totaled $2.6 trillion, or about $8,402 a person, in 2010. Spending that year grew at a rate of 3.9%, just a tenth of a point higher than the rate of 3.8% in 2009. Together, the two years represent rates that grew more slowly than any other years in the 51-year history of the National Health Expenditure Accounts. Meanwhile, healthcare spending as a share of gross domestic product held steady at about 17.9%.
Category: CMS, Health Insurance |
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cmonfils | January 20, 2012
The CMS issued a proposed rule that would redefine which hospital patients are uninsured for the purpose of calculating Medicaid disproportionate-share payments.
The CMS would determine whether the patients were covered for the specific services provided by a hospital rather than, as now, deeming a patient as insured if they have any active insurance coverage. The proposed change also would add to the DSH calculation any service provided that is not covered by an insurance policy because it exceeds a policy’s annual or lifetime limits. The existing eligibility definitions drew objections from hospitals and state officials when they were finalized in 2008, the CMS noted in the rule, because in practical application, so much uncompensated care was excluded.
Category: CMS |
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