CMS Offers $20M in Grants to Help State-run ACA Exchanges Make Improvements
By Robert King | June 22, 2021
The Biden administration is offering $20 million in grants to help states improve their Affordable Care Act insurance exchanges.
The funding announced late Monday and provided by the American Rescue Plan Act is intended to help state-run exchanges modernize or update systems or technology to meet federal requirements.
“This funding available to states will help them to provide consumers with swift eligibility determinations and enrollment into comprehensive healthcare plans,” said Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure in a statement.
Currently, there are 13 states and the District of Columbia that run their own exchanges. There are another six states that have their own exchanges but use the federally run HealthCare.gov for open enrollment and subsidy eligibility. The remaining states rely on HealthCare.gov and do not have their own exchanges.
The funding will award 21 cooperative agreement grants to the currently approved state-run exchanges, even those that use HealthCare.gov for eligibility and enrollment.
“SBMs can prioritize funding to make modifications to systems or technology infrastructure related to the implementation of application federal requirements,” CMS said in a release.
The new funding comes as exchanges have had to implement newly enhanced tax subsidies passed under the American Rescue Plan. The enhanced subsidies are scheduled to expire after the 2022 coverage year, but Congress is considering making the boost permanent.
Exchanges can use the funds to help make consumers aware of the new subsidies, including creating more consumer notifications, education, stakeholder training or other support activities.
State exchanges have until July 20 to apply for the funding, which CMS anticipates doling out in September.
To read more, go to Fierce Healthcare.
US Supreme Court Ruling Leaves ACA Intact
June 17, 2021
On June 17, the United States Supreme Court ruled in a 7-2 majority that plaintiffs did not have standing to challenge the individual mandate in California v. Texas, a challenge to the
Affordable Care Act (ACA) that has been in litigation since 2017. Justice Stephen Breyer wrote for the majority, with Justices Samuel Alito and Neil Gorsuch dissenting. The ruling leaves the ACA intact.
The plaintiffs, led by Texas, argued that the individual mandate was unconstitutional and not severable from the ACA, and thus the entire law must be struck down. The defendants, led by California, argued that the mandate was still constitutional, and even if the court found it was not, it was still severable from the rest of the law. After several appeals, the case ultimately landed before the Supreme Court for oral argument on November 10, 2020.
The court did not have to reach the substantive issues of the ACA, because it found that the parties challenging the ACA did not have a legally protected interest and injury. This leaves the ACA in place with a $0 individual mandate penalty. However, this does not preclude future legal challenges on the same issues, because the Court did not take up issues of constitutionality and severability.
In 2010, when the ACA first became law, it included incentives for states to expand Medicaid and for individuals to purchase health insurance coverage known as “the individual mandate.” While the Medicaid expansion incentives were ruled unconstitutional in 2012 in NFIB v. Sebelius, the Supreme Court in that same case found the individual mandate penalty — which was paid as a tax — to be constitutional. In 2017, however, the Tax Cuts and Jobs Act (TCJA) reduced the tax penalty for the individual mandate to $0. Following the passage of the TCJA, the State of Texas sued the US Department of Health and Human Services. Texas argued that zeroing-out the penalty made the individual mandate unlawful, because by eliminating the additional revenue the penalty previously provided, it no longer could be considered an exercise of Congress’ power to tax.
To read more, go to ASA’s website.
HHS Gives Providers Flexibility on Spending COVID-19 Relief, Funds, Updates Reporting Requirements
By Robert King | June 11, 2021
The Department of Health and Human Services (HHS) left intact a June 30 deadline for providers to use COVID-19 relief funds they accrued from April 10 through June 30 of 2020 after a major push from hospital groups asking for more time.
But the agency did give more flexibility for providers to spend funding if they got it after June 30, 2020.
The Health Resources and Services Administration (HRSA) released revised reporting requirements Friday for the Provider Relief Fund (PRF), which helped providers offset major revenue shortfalls that emerged due to the COVID-19 pandemic.
“These updated requirements reflect our focus on giving providers equitable amounts of time for use of these funds, maintaining effective safeguards for taxpayer dollars, and incorporating feedback from providers requesting more flexibility and clarity about PRF reporting,” said HRSA acting Administrator Diana Espinosa in a statement.
The agency set up new deadlines for when providers must use funding based on when they got it, rather than the June 30 deadline for all payments to be expended.
Any money a provider received from July 1 through Dec. 31, 2020, must be expended by Dec. 31, 2021.
Providers that got money from Jan. 1, 2021, through June 30, 2021, have until June 30 of next year to fully use it. Any funding received from July 1, 2021, through Dec. 31, 2021, has to be spent by Dec. 31, 2022, according to HRSA.
The agency made several other key updates to the reporting requirements for the funding, including requiring that nursing homes now report information to HRSA on how they are using the money.
Recipients are also now required to report for each payment received period where they got one or more payments exceeding $10,000. This is a change from $10,000 cumulatively across all PRF payments, HRSA said.
The agency added that reporting requirements don’t apply to the Rural Health Clinic COVID-19 Testing Program nor the HRSA uninsured program or COVID-19 coverage assistance funds.
A reporting portal will be open to providers to submit information starting July 1.
To read more, go to Fierce Healthcare.
Healthcare Execs Say Digital Transformation is Speeding Up
By Amy Baxter | June 08, 2021
The vast majority of health care executives say digital transformation across their organizations is accelerating, according to a recent survey of 399 executives from six countries.
The faster pace of digital transformation was partly brought on by the challenges of 2020, which also made evident that every business is actually a digital organization. Without being able to connect in person, in offices during the COVID-19 pandemic, businesses quickly adapted and rolled out new collaborative technologies.
In healthcare, where digital adoption has been slow compared to other industries, the circumstances forced many to quicken their plans to bring enterprises up to date. Nearly all (93%) of healthcare executives in the survey said their organization was innovating with urgency and calls to action this year.
The Accenture Digital Health Technology Vision, conducted by Accenture, found five key trends that health care companies will need to address over the next three to five years to accelerate change across their organization.
The five trends include:
Big Business Wants to Take on D.C.’s Hospital Lobby
By Jessie Hellmann | June 07, 2021
Groups representing some of the largest employers in the U.S. are urging Congress to take on hospitals, arguing consolidation and unfair pricing is driving healthcare costs up at an unsustainable rate.
Corporations previously tended to stay out of controversial healthcare fights on Capitol Hill that would create more government intervention in private markets. But with the average cost of an employer-sponsored family healthcare plan increasing 55% over the past ten years, and most Americans getting insurance through their jobs, something has to change, lobbyists and experts say.
“In the past, I think they’ve been kind of skeptical of government solutions, but I think that the frustration has bubbled over to the point now that they’re saying ‘no, we actually need someone to help,” said Shawn Gremminger, director of health policy at Purchaser Business Group on Health, which represents dozens of large businesses who fund their own insurance plans and assume the financial risk of paying for their employees’ healthcare, including Boeing, eBay, The Walt Disney Company, Walmart and others.
Democrats have put more of a focus on “fair” pay and workers benefits as they control Congress and the White House. Employers say healthcare affordability needs to be part of that conversation.
About 83% of covered workers have an annual deductible for individual coverage — an increase of 25% from five years ago — with an average of $1,644 per year, according to the Kaiser Family Foundation. Research shows high-deductible plans can lead people to putting off necessary care, particularly for low-income populations and people of color.
PBGH and the Kaiser Family Foundation released a poll in April that found 87% of the 300 executive decisionmakers surveyed believe the cost of providing health benefits to employees will become unsustainable in the next five to 10 years.
A similar percentage said a greater government role in providing coverage and containing costs would be better for their businesses and their employees.
To read more, go to Modern Healthcare.
2021 ASA Conversion Factor Survey
June 2, 2021
The American Society of Anesthesiologists (ASA) invites you to participate in our 19th annual survey of commercial payment rates. As with previous surveys, we will publish the results in the ASA Monitor later this year. While only those questions marked with an asterisk require a response to complete the survey, the optional questions offer insights into critical practice topics that help to inform ASA prioritize its efforts and create new and relevant materials. We would greatly appreciate your help with this update and hope you will complete it in its entirety.
As a reminder, the Statements of Antitrust Enforcement Policy in Health Care issued jointly by the Department of Justice and the Federal Trade Administration make it possible for us to gather this information as long as certain conditions are met. The most important condition, besides only publishing aggregate statistics, is that the data you provide be AT LEAST THREE MONTHS OLD.
Please provide the following information for your FIVE (5) highest-volume commercial payers (NOT MEDICARE, MEDICAID, OTHER GOVERNMENT PAYERS) based on volume of services provided on an annual basis. If you have fewer than five contracted commercial payers, please enter information for all your commercial payers. AGAIN, PLEASE ENSURE YOUR DATA IS AT LEAST THREE MONTHS OLD.
To assist your participation, we are providing a pdf of the survey so you can gather the information needed to complete the survey via the Survey Monkey link.
TO OUR PHYSICIAN ANESTHESIOLOGISTS: Please ask your practice manager or billing service to complete this questionnaire. It is important that we receive only one response from each anesthesia group. If responding for multiple groups, please contact us and we can send you a multi-response worksheet to facilitate that collection. We ask that you or your staff complete the survey NO LATER THAN JULY 9, 2021.
If you have any questions, please do not hesitate to contact Sharon Merrick, ASA’s Director of Payment and Practice Management at firstname.lastname@example.org.
The survey is available here.
To read more, go to ASA’s website.