HealthCheck, January 2013

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Jan. 30, 2012

Publication Announcement

Starting with the February issue, the publication of HealthCheck will be moving to the second Wednesday of each month.

Academy Activities

The Academy’s Health Practice Council sent letters to President Obama and congressional leaders urging them to appoint an actuary to the new Commission on Long-Term Care that was created as a result of fiscal cliff legislation passed in January. The legislation, the American Taxpayer Relief Act of 2012, also officially repealed the Community Living Assistance Services and Supports (CLASS) Act established under the Affordable Care Act (ACA).

In response to a number of ACA-related regulations released after the 2012 elections, several of the Academy’s work groups submitted comment letters to the Department of Health and Human Services (HHS) at the end of the year:

  • The Academy's Actuarial Value Subgroup submitted comments on the proposed rule, “Proposed Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation.” The subgroup focused on standards for actuarial value determinations under the ACA. In a separate letter, the Individual and Small Group Market Task Force offered comments on the EHB provisions within the rule.
  • HHS released a proposed rule intended to implement the new 2014 market reforms (i.e., guaranteed issue, modified community rating), which would modify the final rules related to rate review and disclosure provisions. The Individual and Small Group Market and the Premium Review Work Group jointly submitted comments on the proposed rule and relevant modifications.
  • The Academy’s Risk Sharing Work Group submitted comments on the proposed rule, “Benefit and Payment Parameters for 2014,” addressing payment methodologies and data collection for risk adjustment, reinsurance, and risk corridor mechanisms in the ACA. The Medical Loss Ratio Regulation Work Group submitted a separate comment letter that addressed proposed changes to the final rule on MLR.

On Dec. 20, the Actuarial Value Subgroup submitted a letter on plan data collection requirements, specifically asking for clarification on whether any AV-related data collection elements will be consistent with those data elements in the AV calculator.

In mid-December, the Academy’s Health Care Quality Work Group updated its Accountable Care Organizations (ACOs) issue brief, highlighting a number of actuarial issues that should be considered when designing and implementing ACOs. The work group also updated a 2011 fact sheet on the Medicare Shared Savings Program (MSSP). The updated fact sheet now provides a comparison between the MSSP and the Pioneer ACO program.

Legislative and Regulatory Updates

check markOn Jan. 25, HHS released the final regulation modifying the Health Insurance Portability and Accountability Act (HIPAA) to strengthen the privacy and security protections for individuals' health information maintained in electronic health records and other formats. The regulation also modifies the HIPAA Privacy Rule as required by the Genetic Information Nondiscrimination Act (GINA) to prohibit most health plans from using or disclosing genetic information for underwriting purposes. The rule is effective March 26.

check markHHS also released a draft, “Risk Adjustment Model Algorithm Instructions,” for benefit year 2014 and a series of tables that provide more details on the proposed risk-adjustment model. The document outlines how risk scores would be calculated based on individual diagnoses, and includes five sections that detail the algorithm used for creating those risk scores. Any questions related to the draft instructions and tables should be submitted to: Log in to read the Academy’s Jan. 16 alert on the release.

check markOn Jan. 14, HHS issued proposed rules providing a structure and options for coordinating Medicaid, the Children’s Health Insurance Program (CHIP), and exchange notices and appeals. The proposed rule also describes additional benefits and cost-sharing flexibility for state Medicaid programs. Comments on the proposed rules are due by Feb. 13. Log in to read the Academy’s Jan. 17 alert on the proposed rules.

In The News/Media Activities

The Academy was mentioned in a column in the Jan. 22 issue of The Coloradoan, “Trozan: Stronger opt-out penalty needed to keep health care reform affordable.”

Contingencies feature on how the implementation of the Affordable Care Act will affect young adults sparked extensive media interest. Coverage about the article and interviews with its authors appeared in Forbes magazine, Politico, the National Review, Kansas City Star, and many other outlets.

News links are to external websites. The Academy is not responsible for the content of these websites.


Upcoming Health Care Reform Events

National Health Policy Conference

Conference: Feb. 4–5, Washington (fee charged)
Sponsor: AcademyHealth

2013 National Policy Forum
Conference: March 13-14, Washington (fee charged)
Sponsor: America’s Health Insurance Plans (AHIP)


For a complete listing of upcoming and recent health care reform events click here.