Tag Archives: CBO

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

Issues and challenges in measuring and improving the quality of healthcare
The Congressional Budget Office (CBO) released a new paper providing an overview of the current state of measuring healthcare quality. The agency uses the Medicare program to illustrate the key issues and challenges that arise in doing so.

To download the paper, click here.

Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) enforcement report published
The Centers for Medicare and Medicaid Services (CMS) has published a new report to increase transparency with respect to enforcement of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Although CMS has taken action to ensure compliance with MHPAEA since its enactment in 2008, this report only includes MHPAEA investigations completed in 2016 and beyond.

To download the report, click here.

 

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

Employer shared responsibility appeal form released
The U.S. Department of Health and Human Services (HHS) issued a health insurance marketplace appeal request form for employers.

To download a copy of the form, click here.

Spending for Social Security and major healthcare programs
The Congressional Budget Office (CBO) published the report “The 2016 Long-Term Budget Outlook,” which describes the agency’s projections of federal spending, revenues, deficits, and debt over the next 30 years.

The CBO projects that spending for Social Security would increase noticeably as a share of the economy—from 4.9% of gross domestic product (GDP) in 2016 to 6.3% in 2046—if current laws generally remained unchanged. Spending for the major healthcare programs is projected to grow even faster—net outlays for those programs would increase from 5.5% of GDP now to 8.9% in 2046. The major healthcare programs include Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), as well as spending on subsidies for health insurance purchased through the marketplaces established by the Patient Protection and Affordable Care Act (ACA) and related spending. About three-quarters of the increase in spending for the major healthcare programs would be for Medicare.

To download the report, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

DOL releases annual report to Congress on self-insured group health plans
The Department of Labor (DOL) has released “Annual report to Congress on self-insured group health plans,” which provides detailed statistics currently available on self-insured group health plans filing a Form 5500 and on the sponsors of such plans that issue publicly traded equity or debt.

To download the entire report, click here.

CMS releases discussion paper for HHS-operated risk adjustment methodology meeting
The Center for Consumer Information and Insurance Oversight (CCIIO) of the Centers for Medicare and Medicaid Services (CMS) has released a discussion paper for a meeting to be held on March 31, 2016. The paper, “HHS-operated risk adjustment methodology,” discusses possible changes to the Patient Protection and Affordable Care Act (ACA) program for protecting insurers that cover sicker populations. Possible ideas covered by the discussion paper are how to include high-risk patients in risk adjustment payments made by plans that have healthier enrollees and including prescription drug information in the formula used to calculate payments.

To read the entire paper, click here.

Federal subsidies for health insurance coverage for people under age 65
The Congressional Budget Office (CBO) has released a report, “Federal subsidies for health insurance coverage for people under age 65: 2016 to 2026,” in conjunction with the Joint Committee on Taxation. The two agencies project that the federal subsidies, taxes, and penalties associated with health insurance coverage for people under age 65 will result in a net subsidy from the federal government of $660 billion in 2016.

To read the entire report, click here.

Excise tax on high-cost employer-sponsored health coverage
The Congressional Research Service has released the report “Excise tax on high-cost employer-sponsored health coverage: In brief.” The report provides an overview of how the excise tax, or the “Cadillac tax,” is to be implemented. The information in the report is based on statute and guidance issued by the Department of the Treasury and the Internal Revenue Service.

To read the entire report, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

Report on private health insurance market reform in the ACA
The Congressional Research Service (CRS) has published a report entitled “Private health insurance market reforms in the Patient Protection and Affordable Care Act (ACA)” (R42069), which provides background information about the private health insurance market, including market segments and regulation. The report also describes each ACA market reform. The reforms are grouped under the following categories: obtaining coverage, keeping coverage, cost of purchasing coverage, covered services, cost-sharing limits, consumer assistance and other healthcare protections, and plan requirements related to healthcare providers. An appendix provides details about the types of plans that are required to comply with the different reforms.

To download the entire report, click here.

Report on private health insurance premiums and federal policy
The Congressional Budget Office (CBO) released a report entitled “Private health insurance premiums and federal policy.” According to the report, “CBO and the staff of the Joint Committee on Taxation (JCT) project that in 2016, the average premium for an employment-based insurance plan will be about $6,400 for single coverage and about $15,500 for family coverage… Although premiums for private insurance have grown relatively slowly in recent years, they have usually grown faster than the economy as a whole and thus faster than average income. Over the period from 2005 to 2014, premiums for employment-based insurance grew by 48 percent for single coverage and by 55 percent for family coverage. CBO and JCT expect them to grow at similar rates over the next decade—by about 5 percent per year, on average, or about 2 percentage points faster than income per capita.”

To download the entire report, click here.

Improving health coverage for mental health and substance use disorder patients
The U.S. Department of Labor (DOL) has released the report “Improving health coverage for mental health and substance use disorder patients” to Congress. This report summarizes the DOL’s active role in issuing regulations and sub-regulatory guidance and interpreting the Mental Health Parity and Addiction Equity Act (MHPAEA) and other federal laws, as appropriate, to maximize access to quality mental health and substance use disorder benefits; enforcing the law; and assisting plans, issuers, medical providers, plan participants and beneficiaries, and states in understanding their rights and responsibilities.

To download the entire report, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

Medicare Parts A and B COLAs for 2015
The Centers for Medicare and Medicaid Services (CMS) has issued the cost-of-living adjustments (COLAs) applicable to components in the Medicare program. For 2015, the rates will be as follows:

• Medicare Part A (hospital insurance) payroll tax remains at 1.45% (paid by employers and employees) on all wages, plus an additional 0.9% (for a total of 2.35%) for high-income individuals (earnings over $200,000 for an individual or $250,000 for joint filers), to be assessed only on the employees.

• Medicare Part A inpatient hospital deductible increases to $1,260 (up from $1,216 in 2014).

• Medicare Part A daily coinsurance amounts: $315 for the 61st through 90th days of hospitalization in a benefit period (up from $304), $630 for lifetime reserve days (up from $608), and $157.50 for the 21st through 100th day of extended care services in a skilled nursing facility in a benefit period (up from $152).

• Medicare Part A premium to purchase coverage: $407 (down from $426 in 2014), and for those entitled to a reduced monthly premium, $224 (down from $234 in 2014).

• Medicare Part B deductible: $147.00 (unchanged from 2014).

• Medicare Part B standard monthly premium: $104.90 (unchanged from 2014).

The following chart shows the 2015 Medicare Part B monthly premiums based on income tax filing (unchanged from 2014):

Individual Income Joint Income  Part B Premium
$85,000 or less $170,000 or less $104.90
$85,001 – $107,000 $170,001 – $214,000 $146.90
$107,001 – $160,000 $214,001 – $320,000 $209.80
$160,001 – $214,000 $320,001 – $428,000 $272.70
Above $214,000 Above $428,000 $335.70

The figures above are from notices that have been published in the Federal Register of October 10, 2014.

Medicare Part A

Medicare Part A (hospital deductible)

Medicare Part B

CMS issues guidance for small employers to enroll in SHOP coverage
The CMS has issued an announcement with helpful links for employers to enroll online in the Small Business Health Options Program (SHOP). The announcement reminds small employers that starting November 15, 2014, they will be able to begin enrolling their small businesses. To enroll in SHOP coverage, employers must have less than 50 full-time employees and meet certain other requirements.

For more information, click here.

ACA’s FAQs on reference pricing and maximum out-of-pocket limitations
The U.S. Departments of Treasury, Labor, and Health and Human Services, and the CMS have issued Patient Protection and Affordable Care Act (ACA) frequently asked questions (FAQs) regarding pricing and the maximum out-of-pocket requirements.

To read the FAQs about ACA implementation (Part XXI), click here and here.

CBO working paper: Assessing the design of the low-income subsidy program in Medicare Part D
The Congressional Budget Office (CBO) released a new working paper, “Assessing the design of the low-income subsidy program in Medicare Part D.” The study finds that the rules of the low-income program in Part D create incentives for low-income subsidy plans to be less responsive to the number of plan sponsors, to raise their bids toward the benchmark, and to strategically bid in ways that raise the low-income benchmark and the government’s cost.

To read the entire working paper, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

GAO report: The range of average annual premiums in the small group market by state in early 2013
The U.S. Government Accountability Office (GAO) released a new report entitled “Private health insurance: The range of average annual premiums in the small group market by state in early 2013.” The report shows the range of average premiums for health insurance products sold to small employers in the small group market of each of the 50 states and the District of Columbia during the first quarter of 2013.

The average premiums reflected information from data submitted by insurers to the Center for Consumer Information and Insurance Oversight (CCIIO) within the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS). They represented an annual average of the premiums paid per covered life by all small employers that purchased a particular product.

To read the entire report, click here.

HHS annual report to Congress on breaches of unsecured protected health information
The U.S. Department of Health and Human Services (HHS) issued an Annual Report to Congress on Breaches and Unsecured Protected Health Information for Calendar Year 2011 and 2012, describing the types and numbers of breaches reported to the Office for Civil Rights (OCR) (the office within HHS that is responsible for administering and enforcing the HIPAA Privacy, Security, and Breach Notification Rules) that occurred between January 1, 2011, and December 31, 2012. It also provides some cumulative data on breaches reported since the September 23, 2009, effective date of the breach notification requirements.

The report also describes actions that have been taken by covered entities and business associates in response to the reported breaches.

To read the entire report, click here.

Presentation: Coverage effects of limiting the tax exclusion of employment-based health insurance
The U.S. Congressional Budget Office (CBO) has published a 22-slide presentation given by Allison Percy from the Health, Retirement, and Long-Term Analysis Division, at the Fifth Biennial Conference of the American Society of Health Economists. Topics include:

• Effects of the tax exclusion.
• How big is the tax subsidy and how does it vary by income?
• Why would the effect be different today?
• How CBO and and the Joint Committee on Taxation (JCT) model health insurance coverage.
• How CBO and JCT model firms’ offers of employment-based coverage.
• Three approaches to limiting the tax exclusion.

To view the entire presentation, click here.