Tag Archives: CMS

Regulatory roundup

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

Cost-sharing reduction subsidies to seize
The Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma issued a memorandum stating cost-sharing reduction (CSR) payments made to issuers of qualified health plans will stop. The decision is based on a legal opinion provided by the Office of the Attorney General.

Executive order on healthcare allows the purchase of insurance across state lines
President Donald Trump signed an executive order on healthcare directing the Department of Labor (DOL) to updated rules allowing small employers to create association health plans. Small businesses will be able to band together if they are within the same state, in the same line of business, or are in the same trade association.

For more information, click here.

Proposed extension of information collection request submitted for public comment
The DOL released a notice providing the general public and federal agencies the opportunity to comment on a revision of the “Coverage of certain preventive services under the Affordable Care Act—private sector” information collection request (ICR). The notice was issued to align the ICR with the executive order signed on May 4, 2017, “Executive order promoting free speech and religious liberty.”

For more information, click here.

Regulatory roundup

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

Medicare offers more health coverage choices and decreased premiums in 2018
The Centers for Medicare & Medicaid Services (CMS) announced that people with Medicare will have more choices and options for their Medicare coverage in 2018. CMS estimates that the Medicare Advantage average monthly premium will decrease by $1.91 (about 6 percent) in 2018. More than three-fourths (77 percent) of Medicare Advantage enrollees remaining in their current plan will have the same or lower premium for 2018.

For more information, click here.

Fee funding the Patient-Centered Outcomes Research Trust Fund issued
The IRS released Notice 2017-61 which provides the adjusted applicable dollar amount to be multiplied by the average number of covered lives for purposes of the fee imposed by §§ 4375 and 4376 of the Internal Revenue Code for policy years and plan years that end on or after October 1, 2017, and before October 1, 2018.

The fee imposed by §§ 4375 and 4376 helps to fund the Patient-Centered Outcomes Research Trust Fund (PCORTF) and is calculated using the average number of lives covered under the policy or plan and the applicable dollar amount for that policy year or plan year.

The applicable dollar amount that must be used to calculate the fee imposed by §§ 4375 and 4376 for policy years and plan years that end on or after October 1, 2017, and before October 1, 2018, is $2.39. The increase from the prior amount is calculated by multiplying the adjusted applicable dollar amount for policy years and plan years ending in the previous Federal fiscal year, $2.26, by the percentage increase of the projected per capita amount of National Health Expenditures published by HHS on February 14, 2017.

For more information, click here.

Regulatory roundup

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

CMS announces special enrollment periods for Americans impacted by recent hurricanes
As a result of Hurricanes Harvey, Irma, and Maria, the Centers for Medicare and Medicaid Services (CMS) will make available special enrollment periods for all Medicare beneficiaries and certain individuals seeking health plans offered through the Federal Health Insurance Exchange. This important step gives these individuals and families who have been impacted by the hurricanes the opportunity to change their Medicare health and prescription drug plans and gain access to health coverage on the exchange immediately if eligible for a special enrollment period.

To learn more, click here.

Risk adjustment modifications in view of potential CSR subsidy termination

If the cost-sharing reduction (CSR) subsidies of the Patient Protection and Affordable Care Act (ACA) were eliminated, it could expose insurance carriers to a substantial increase in selection risk related to their particular mixes of business. In August, the Centers for Medicare and Medicaid Services (CMS) announced its intention to propose a set of risk adjustment modifications for states in which insurance carriers raise silver premiums in response to potential CSR subsidy termination.

In this paper, Milliman’s Jeffrey Milton-Hall, Doug Norris, and Jason Karcher explore the CMS proposal along with the current ACA risk adjustment program and three other potential alternative modifications to risk adjustment in response to the possible elimination of CSR funding.

The “Rxisk” of adjustments in 2018 ACA risk adjustment

The Centers for Medicare and Medicaid Services (CMS) is adding a new prescription drug category classification system to the 2018 risk adjustment model. Starting in 2018, a condition will be identified through a Hierarchical Condition Category with associated medical diagnosis codes, a prescribed medication, or both—each one affecting the final risk member score differently. This paper by Milliman consultants approximates the likely CMS mapping based on the publicly available information to date.

How the Medicare Advantage 2018 RxHCC risk score model update impacts plan risk scores

The Centers for Medicare and Medicaid Services finalized a Part D risk score model for payment year 2018. How does this model update affect plan risk scores? This paper by Milliman consultants Adrian Clark and David Koenig summarizes the changes in member risk scores that are due to the RxHCC risk score model update.