Academy Activities

The Academy's Health Care Quality Work Group commented on proposed regulations to implement the Medicare Shared Savings Program in a June 6 letter [1] to the Centers for Medicare & Medicaid Services (CMS). The program was created by the Affordable Care Act (ACA).

The Health Care Quality Work Group also released two new publications in June:

• A fact sheet [2] that provides an overview of the Medicare Shared Savings Program and how accountable care organizations (ACOs) are addressed in the ACA; and

• A new issue brief [3], An Actuarial Perspective on Accountable Care Organizations, that outlines a number of issues that stakeholders should evaluate as ACOs are implemented.

In a new issue brief [4], Risk Adjustment and Other Risk-Sharing Provisions in the Affordable Care Act, the Academy's Risk Sharing Work Group looks at the three risk-sharing mechanisms in the ACA—risk adjustment, reinsurance, and risk corridors—and examines the risks each of the mechanisms can mitigate.

Legislative and Regulatory Updates

The CMS has requested [5] public comments on the revised preliminary justification form and consumer disclosure form. Insurers are required to complete these forms to disclose and justify a rate increase that meets or exceeds 10 percent. The final rule implementing the rate review process under the ACA was published on May 19. Comments on the revised forms must be submitted by June 27.

"Mini-med" plans may apply for or renew a temporary waiver from annual limit restrictions until Sept. 22, the CMS announced in guidance [6] issued on June 17. (The temporary waiver from annual limits is applicable through 2013.) No new applications for waivers will be considered after Sept. 22. Plans receiving a waiver will have to comply with more stringent disclosure requirements—they will have to disclose that the coverage has a lower annual limit than what is allowed under the ACA which could result in higher out-of-pocket spending. The ACA eliminates annual dollar limits for health plans in 2014.

In The News/Media Activities

The Academy's May 27 Capitol Hill briefing [7] on Medicare was discussed in the Congressional Quarterly [8] on May 28 and National Underwriter Life and Health [9] on May 31. Coverage included statements made by Academy Senior Health Fellow Cori Uccello, who told attendees that there is not a silver-bullet fix and that a combination of solutions will be necessary to restore the long-term solvency and sustainability of Medicare.

The Academy's new issue brief [10] on Medicare's financial condition served to moderate partisan rhetoric in a Washington Post [11] Fact Checker piece on June 9. The issue brief also was cited to underscore the need for action to address Medicare's financial condition in a Pottstown Mercury [12] op-ed by Rep. Jim Gerlach (R-Pa.) on June 12.

Karen Bender, the chairperson of the Academy's Individual and Small Group Market Task Force, discussed the development of an essential health benefits package in the June 2011 issue of Managed Healthcare Executive [13]. Bender said that the ultimate cost of the Affordable Care Act will be shaped by the richness of the essential benefits package, because premiums will reflect the comprehensiveness of the benefits and the government will offer subsidies to help pay for premiums.

An AHIP HI-Wire [14] article on June 15 discussed a letter [15] from U.S. Health and Human Services Sec. Kathleen Sebelius to Rep. Charles Boustany (R-La). In her letter, Sebelius outlined possible changes to the Community Living Assistance Services and Supports (CLASS) program. Sebelius wrote that the "modifications are consistent with the types of improvements that have been recommended [16] by outside experts such as the American Academy of Actuaries."

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

Upcoming Health Care Reform Events

Cash for Care [17]

Policy Forum: June 27 in Washington (free, live feed available)

Sponsor: CATO Institute

For a complete listing of upcoming and recent health care reform events click here [18].