HHS Final Rule: Exchanges/SHOP/WebBrokers/Appeals & More...

[AllenChicago]

Thursday, September 12, 2013

Final Rule issued by Health and Human Services at the start of this past Labor Day weekend. Looks like HHS took several interim rules, clarified them, and combined them into one. Several subjects are addressed. (SHOP, WebBrokers, Agent/Brokers, Appeals, Exchange Eligibility, Enforcement Remedies..and more.)

Here's an easy to read article that explains the "Program Integrity: Exchange, SHOP, and Eligibility Appeals" final rule.

Link: http://www.natlawreview.com/article/department-health-and-human-services-hhs-publishes-final-rule-exchanges-shops-and-el

Thankfully, none of these directives negatively affect efforts to the Exchanges operational by October 1st. (I hope!)

-allen

 

[AllenChicago]

October 25, 2013


If there is any doubt that HHS is intentionally trying it's best to destroy the Private Health Insurance Market, glance over the latest rule from HHS effective January 1, 2014.

Link: https://s3.amazonaws.com/public-inspection.federalregister.gov/2013-25326.pdf

Here we are just 2 months from the biggest chunk of ObamaCare going live and HHS is telling health insurers to further tweak their policies, allow SHOP special-enrollments and collect/report data on a quarterly basis on every customer. In fact, they're so bold as to tell insurers that they should be prepared to spend $2.7 Billion and 47,000 hours to comply with this rule (page 152) which is just one of HUNDREDS..., yet insurers must remain within the 80/20 MLR guidelines! It CAN'T BE DONE.

You can't feed someone peanuts and ask them to run marathons. They would eventually die. Let's hope the insurers who care about the solvency of their IFP and Small Group business have self-preservation instincts, and begin to fight this law before it's too late.
ac

 

[bluediamond]

This just come out today?

 

[AllenChicago]

This just come out today?

Thursday 10/24/2013 was the issuance date, according to: http://www.modernhealthcare.com/art...5/hhs-finalizes-program-integrity-rule-on-aca

The most burdensome rules seem to be released while attention of the country is focused on other things. Right now, healthcare.gov news is the diversion.

 

[Yagents]

Ann, add this one to Allen's list of classic quotes.

October 25, 2013
You can't feed someone peanuts and ask them to run marathons. They would eventually die.

 

[houcoogster]

There is NO WAY I would put up with this if If I were a CEO of a health insurance company. I just glazed through it and after seeing the words "Will" "Required" "Must" "By such date" "No later than" Now we know why those CEO's were at the White House yesterday.

Don't you just love the way they tell the insurer it will cost $37 per hour for 200 hours to do something when these same people spend 3.5 years and $630 million for a BS website and are spending more money still.

October 25, 2013


If there is any doubt that HHS is intentionally trying it's best to destroy the Private Health Insurance Market, glance over the latest rule from HHS effective January 1, 2014.

Link: https://s3.amazonaws.com/public-inspection.federalregister.gov/2013-25326.pdf

Here we are just 2 months from the biggest chunk of ObamaCare going live and HHS is telling health insurers to further tweak their policies, allow SHOP special-enrollments and collect/report data on a quarterly basis on every customer. In fact, they're so bold as to tell insurers that they should be prepared to spend $2.7 Billion and 47,000 hours to comply with this rule (page 152) which is just one of HUNDREDS..., yet insurers must remain within the 80/20 MLR guidelines! It CAN'T BE DONE.

You can't feed someone peanuts and ask them to run marathons. They would eventually die. Let's hope the insurers who care about the solvency of their IFP and Small Group business have self-preservation instincts, and begin to fight this law before it's too late.
ac

 

[Yagents]

Just When We Thought We Were Out, They Pull Us Right Back In! You would think that fixing healthcare.gov would be keeping the fine folks at HHS so busy that they wouldn't have time to issue new regulations, but, unfortunately, conventional wisdom doesn't seem to apply when it comes to health reform implementation. HHS released a final rule yesterday on exchange financial integrity and oversight. We are still looking through the 236 pages, but it appears to cover the financial oversight of exchange-based plans and the final details of the law's reinsurance and risk adjustment mechanisms. It also covers special enrollment periods and makes some changes to market reform definitions. Two of our favorite parts include the provisions governing enrollment satisfaction surveys and the numerous references to more rule-making to come on a wide variety of other PPACA issues.
We'll work on a more detailed analysis for you all next week.
CMS also quietly released $146.1 million more exchange grant money to the states this week. Four states and the District of Columbia received grants of between $10 and $48 million. The primary purpose of the money is for technology enhancements. No joke intended!
NAHU Washington Update - 10/25/2013

 

[houcoogster]

There is no private insurance anymore that is a farce.

This is govt run insurance. All the companies have been sterilized and homogenized. They can't make any decisions for their company any more. It's just a matter of time when the govt tells them what brand of toilet paper to use in their restrooms.

What defining characteristics does one insurer have compared to another?

This whole thing makes me sick at my stomach the more I learn about it. I'm beginning to believe there will be death panels in the final analysis. Of course it will be called something else and it will be wired indirectly but the outcome will be the same. Plenty of ways to rig it... if a doc spends to much on dying patients he could get axed from the network. If the carrier spends to much on dying patients there star rating could get hit. So many ways to achieve the same result.

 

[RayNY]

Hou,

Carriers can decide on their network (so long as it's gov't approved). They can also decide on which font to use for their logo, what their company colors are, and what to call themselves. They can even choose their own mascot!

On a serious note, the only differences are network, service, rates/comp, and any "extra's" they throw in. Argument sake, Oscar, NY's newest startup, is including "TelaDoc" in the premium.