August 6, 2015
Leading the News
CMS Picks NAHU As HealthCare.gov Training Vendor
LifeHealthPro
(8/6) reports that the Centers for Medicare and Medicaid Services “has picked the National Association of Health
Underwriters (NAHU) to help provide training for public exchange agents and brokers” ahead of the 2016 open enrollment period for
HealthCare.gov, which runs from Nov. 1 through Jan. 31. The NAHU Online Learning Institute system will provider training for producers
in states that use the Federal marketplace. NAHU “says that it believes it will be one of three CMS-approved producer training vendors
for the 2016 open enrollment period.”
From NAHU
To the extent permitted by states, licensed agents and brokers may assist consumers in applying for qualified health plans
(QHPs) and insurance affordability programs including premium tax credits and cost-sharing reductions. They play a crucial role
in educating consumers about the health insurance marketplaces, both during open enrollment and throughout the coverage
year.
Some states have set up a state-based marketplace, while others work with the federal government in a state-partnership
marketplace or federally facilitated marketplace (FFM). Agents and brokers can help consumers, no matter what state the
consumers live in, as they apply for and choose insurance options. Agents and brokers who wish to participate in the FFM must
first complete a two-part registration process. The first part is federally facilitated marketplace agent and broker registration for
plan year 2016 through the CMS Agent/Broker portal. The second step is to select NAHU as a preferred provider of the FFM
training.
NAHU Approved as a CMS Vendor for Federal Marketplace Broker Training
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Comprehensive training on exchanges
Meets CMS reporting verification requirements
CE credits filed in 50 states
Superior help-desk services
Ease of use through NAHU’s Online Learning Institute
2016 open enrollment runs November 1, 2015, to January 31, 2016
NAHU is one of the three vendors, and the only broker association, chosen to provide the CMS-approved FFM agent/broker
training.
NAHU's Online Learning Institute is a premier resource for brokers in need of continuing education.
Following CMS guidelines, the training provides online instruction with webinar modules, a final exam and CE credits issued
state by state.
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Legislation and Policy
Upshot: ACA’s Coverage Expansion Won’t Reduce Healthcare Spending Overall.
Margot Sanger-Katz writes in the New York Times
(8/6, Subscription Publication) “The Upshot” on the “oft-expressed view” that
the coverage expansion under the Affordable Care Act could actually save the healthcare system money as more people seek preventive
care and rely less on emergency departments. In fact, there’s “strong evidence from a variety of sources that people who have health
insurance spend more on medical care than people who don’t.” Sanger-Katz notes that actuaries at the Centers for Medicare and
Medicaid Services last week estimated that health spending jumped by 5.5 percent in 2014, the biggest rise in five years. One of the
reasons they cited “was Obamacare’s coverage expansion.” Meanwhile, research shows “a lot of the preventive health measures that we
tend to value a lot — mammography, screening for diabetes — tend to cost more than they save.”
Half Of Physicians Say Penalties For Hospital Readmissions Have Negative Effect On
Care.
The Washington Examiner
(8/6) reports that half of physicians “don’t like Obamacare-mandated penalties for hospital
readmissions and poor healthcare quality, a new survey finds.” Fifty-two percent of physicians said those penalties are having a negative
effect on care, compared with 12 percent who said they are having a positive effect, according to the survey
from the Kaiser
Family Foundation and the Commonwealth Fund. Additionally, about 50 percent of primary care physicians “say the increased use of
quality metrics to assess provider performance will negatively affect care,” compared with 22 percent who said it will positively affect
care.
CNN Fact-Checks ACA Claims.
CNN Money
(8/6) “sets the record straight” on the Affordable Care Act ahead of the Republican presidential debate tonight,
presenting a list of facts and dispelling some myths about the health law. The article states that insurance premiums are higher under the
ACA, though “85% of the 10.2 million Obamacare enrollees receive federal subsidies” to help pay for them. Additionally, “43% view
Obamacare favorably, while 40% have an unfavorable opinion, according to a Kaiser Family Foundation poll conducted in late June.”
CNN adds that the ACA has helped cut the uninsured rate to 11.9 percent, though “health care spending is on the rise, thanks in part
because more people have coverage under Obamacare.”
HCA Earnings Jump On Higher Admissions Under ACA.
The Wall Street Journal
(8/6, Stynes, Subscription Publication) reports that HCA Holdings Inc. reported a 5-percent jump in
earnings in the second quarter as the hospital operator continues to benefit from higher admissions under the Affordable Care Act.
Nashville-based HCA said admissions increased 4.1 percent in the quarter, while revenue per equivalent admission rose 2.8 percent.
Reuters
(8/6, Shaji) reports HCA suggested, however, that benefits from the ACA would taper off over the rest of 2015.
Blue Shield Of California To Pay Out $83M In ACA Rebates.
In continuing coverage, the San Francisco Business Times
(8/6) reports in its “Bay Area BizTalk” blog that Blue Shield of California
“owes nearly $83 million in 2014 rebates to Obamacare enrollees and small businesses in California, after running afoul of a key
Affordable Care Act” rule that requires insurers to spend 80 percent or more of premiums from individual and small business consumers
on medical care. Blue Shield “missed that mark, spending about 76.8 percent of premium dollars on medical care last year in those
business segments.”
HealthSource RI Walk-In Center Will No Longer Offer Enrollment Help In Person.
The AP
(8/6) reports that Rhode Island’s health insurance exchange announced Wednesday that it has stopped helping people
enroll for coverage in person at its walk-in center because traffic has slowed. HealthSource RI said the walk-in center in Providence is
now a drop-off location. According to the AP, “people can deliver documents needed to enroll in coverage and make payments, but not
get in-person help enrolling.”
The Providence (RI) Journal
(8/6) reports that HealthSource RI spokeswoman Maria Tocco said in-person service could start
up again when demand rises during the upcoming fall enrollment period, “but acknowledged there are no current plans to do so.”
According to the article, officials also cited budget cuts as one reason for the change.
Vermont Exchange May Need $3.5M, Additional Staff To Fix Enrollment Problems.
VTDigger (VT)
(8/6) reports that Vermont Gov. Peter Shumlin’s (D) administration “may need to hire up to 200 employees in
October and November to help Vermonters manually change their insurance policies for next year.” The announcement is part of a threepart contingency plan the Shumlin administration released to help resolve issues affecting Vermonters’ ability to purchase coverage
through Vermont Health Connect. Lawrence Miller, chief of healthcare reform for the administration, said in a memo sent to the
Legislature Aug. 1 that the exchange’s staff is currently about 100 people. The memo also “tells the state to be prepared to spend up to
$3.5 million more on the health exchange.”
Meanwhile, Vermont Public Radio
(8/6) reports that planned upgrades to the state’s Medicaid Management Information
System have been put on the back burner “because of the technological train wreck of Vermont Health Connect.” In fact, “efforts to get
back on track with the health care exchange after its faulty rollout are consuming so much of the state’s resources that all other big
health-related IT projects are on hold.”
The Rutland (VT) Herald
(8/6) also reports the story.
Public Health and Private Healthcare Systems
Banned Medicaid Providers Still Participating In Other States’ Programs, Audit Finds.
The Washington Times
(8/6, Howell) reports in continuing coverage that healthcare providers “banned from state Medicaid
programs for fraud or other serious reasons are still doing business in other states despite Obamacare’s prohibition on the practice,
according to a government audit that said $7 million in payments would have been withheld if the states had a better way to
communicate.” Investigators with the HHS Office of Inspector General found that 12 percent of providers, or 295, that were terminated in
2011 were still participating in Medicaid programs in 2012, and 172 of them were still participating as of January 2014. Medicaid
programs “paid $7.4 million to 94 of these providers for services they performed after they were kicked out of the program in another
state.”
The Hill
(8/6, Sullivan) reports the inspector general “reiterated a previous recommendation that the Centers for Medicare &
Medicaid Services (CMS) require states to report all terminations of providers for cause, rather than have reporting be voluntary, in order
to make a comprehensive list of all terminated providers.”
Modern Healthcare
(8/5, Subscription Publication) also reports the story.
Medicare Approves Two Of Six Requests For New Technology Add-On Payments.
Congressional Quarterly
(8/6, Subscription Publication) reports that Medicare last month “approved only two of six pending
requests for special payments that are meant to encourage hospitals to more quickly adopt expensive new breakthrough products.”
According the article, the Centers for Medicare and Medicaid Services’ “historically low acceptance rate” has prompted industry
complaints about the new technology add-on payment program (NTAP). CQ adds that the “biggest hurdle to securing NTAP
payments...appears to be persuading Medicare officials that a new drug or medical device offers a true advantage to existing
treatments.”
A related Congressional Quarterly
(8/6, Subscription Publication) article reports that the two add-on payments approved last
month were “for a cancer drug and for devices developed by rival companies for treating poor blood flow in legs.” In the case of the
cancer drug, CMS decided that Amgen’s Blincyto (blinatumomab) “does offer a ‘substantial clinical improvement over existing
technologies’ for people with a rare form of leukemia.” The agency “also approved a maximum NTAP payment of $1,035 for drug-coated
balloon devices from Bard Inc. and Medtronic Inc. for use in leg arteries.”
Arizona Launching Tech Tools To Help Medicaid Recipients Get Care.
Modern Healthcare
(8/6, Subscription Publication) reports that Arizona is launching a “technology outreach strategy to help
Medicaid beneficiaries better manage their illnesses, including a mobile app.” Gov. Doug Ducey (R) announced the effort Monday, “but
released few details other than that the strategy involves the use of apps, texts and an online portal.” Patients would use these channels
to receive reminders about appointments and find primary care physicians or urgent care centers. Meanwhile, experts say the initiative
may be of limited use to a population that might not have smartphones. Health Net said in a comment, “The Medicaid population does
not generally have widespread access to computers.”
Pennsylvania Medicaid Expansion Enrollment Within “Budgeted Range.”
The Harrisburg (PA) Patriot-News
(8/6) reports that about 440,000 Pennsylvanians have enrolled in the state’s Medicaid
expansion program since Jan. 1. While more than a dozen other states “are seeing far bigger than expected enrollments,”
Pennsylvania’s enrollment “remains well within the budgeted range of up to about 605,000 enrollees, said Kait Gillis, a spokeswoman for
the state human services department.” Stephen Miskin, a spokesman for state House Republicans, “agreed enrollment remains ‘in the
realm’ of estimates cited when former Gov. Tom Corbett agreed to the expansion.”
Alabama House Passes Budget With $156M Cut To Medicaid.
The AP
(8/6) reports that the Alabama House on Wednesday “narrowly approved a deep cut to the state’s Medicaid program as
lawmakers continue to deadlock on a solution to the budget shortfall.” Lawmakers voted 46-44 for the budget amendment, which will cut
Medicaid funds by $156 million. According to the AP, the budget cut “is largely seen as a way to build pressure on lawmakers to find
some sort of compromise,” but opponents “called it a dangerous gamble with the health care of the state’s most vulnerable people.”
The Anniston (AL) Star
(8/6) reports that the state Senate is set to consider the House-passed budget on Friday.
Live
Stephen C. Miller, executive director of the Manuel H. Johnson Center for Political Economy at Troy University, writes in Alabama
(8/6) that Medicaid spending in Alabama “has grown steadily and will continue to grow out of control without major reform.” He
suggests that Alabama lawmakers “try new ideas like block granting — especially when other states have had success.”
Alabama Live
(8/6) and the Birmingham (AL) Business Journal
(8/5, Subscription Publication) also report on the story.
Jindal Administration Delays Implementation Of Managed Long-Term Care.
The Baton Rouge (LA) Advocate
(8/6) reports that Louisiana Gov. Bobby Jindal’s (R) administration “will leave to a new governor a
decision on the privatization of Medicaid long-term care services for the elderly and developmentally disabled.” State Department of
Health and Hospitals Secretary Kathy Kliebart said Wednesday, “We did not think we could get all the (federal) approvals and get the
contract in place prior to a new administration.” The article adds that advocates for the elderly “immediately criticized Jindal’s decision” to
delay the implementation of managed long-term care.
Kentucky Medicaid Patients Got More Preventive Care Following Expansion, Data Show.
The Louisville (KY) Courier-Journal
(8/6) reports that Kentucky residents on Medicaid “were far more likely to get cancer
screenings, physicals and dental check-ups after the state expanded the government program for the poor and disabled through the
Affordable Care Act, new state data shows.” The number of Medicaid patients “receiving breast cancer screenings rose 111 percent,
from 24,386 in 2013 to 51,292 in 2014; the number receiving cervical cancer screenings rose 88 percent, from 41,613 to 78,281; and the
number receiving colorectal cancer screenings rose 108 percent, from 17,164 to 35,633.” The new data from the state Department of
Medicaid Services were presented “during a meeting Wednesday of the oversight team for kyhealthnow, an initiative launched by Gov.
Steve Beshear” (D).
Florida Orders Group Home Closed, Seeks To Pull Medicaid Funding.
The Florida Times-Union
(8/6) reports that the Florida Agency for Persons with Disabilities “issued an emergency closure order
Wednesday for an Orange Park-area group home that houses six men with profound disabilities.” The closure stemmed “from complaints
about how BASCA, which runs that group home and three others, and founder John Cone handled repeated violence by a particular
resident toward other residents and staff members, according to the order.” The state also launched a 90-day process to terminate the
Pine Forest facility’s Medicaid waiver, according to agency spokeswoman Melanie Etters.
Vermont Official Touts Medicaid Innovations.
In an op-ed for the Rutland (VT) Herald
(8/6), Hal Cohen, secretary of the Vermont Agency of Human Services, writes that many of
Vermont’s Medicaid reforms over the past few decades “have been first-in-the-country successes and have provided the model for future
Medicaid innovation across the country.” Most recently, with the “2014 transition to the Affordable Care Act, Vermont and federal partners
have worked to combine a variety of state and federal innovations into one consolidated Medicaid agreement.” Cohen adds that his
agency “and its staff are dedicated to keeping the consumer at the center of all its innovations and to achieving seamless, integrated and
holistic public health and human service networks for all Vermonters.”
North Carolina DHHS Chief Announces Resignation.
The Fayetteville (NC) Observer
(8/6) reports that Dr. Aldona Wos, secretary of the North Carolina Department of Health and
Human Services, “announced her departure at an emotional news conference Wednesday with” Gov. Pat McCrory (R). Rick Brajer, “a
longtime health care company executive with no public sector experience, will take over Aug. 17.” The piece notes that this came the day
after DHHS announced that Medicaid ended the fiscal year with a $131 million cash balance. “We have stabilized and we have
redirected the department and made significant progress,” Wos said at the event.
According to the Winston-Salem (NC) Journal
(8/6), Wos’ resignation “could be the catalyst for breaking the logjam over state
Medicaid reform, analysts said Wednesday.” Under Wos’ oversight, DHHS “has struggled with major inefficiency issues,” and Senate
Republican leaders have argued that Medicaid is too big for the department to handle. “I suspect (Wos’ resignation) will make the Senate
more willing to keep Medicaid in DHHS, which is probably a more efficient way to run the program,” said Adam Linker, a policy analyst
with the N.C. Justice Center.
The Triangle (NC) Business Journal
(8/5, Subscription Publication) also reports the story.
Florida’s Convey Health Adds Staff For Medicare Enrollment.
The South Florida Sun Sentinel
(8/6) reports that Convey Health Solutions, based in Fort Lauderdale, Florida, “is hiring 500
workers in Deerfield to enroll people in Medicare.” Stephanie Jones, Convey’s general manager for Medicare Part D, said, “Our business
is highly cyclical. Between October and March, we have to staff up our labor pool.”
Editorial Backs “Personal-Responsibility-Enhancing Requirements” For Arizona
Medicaid Recipients.
In an editorial, the Arizona Republic
(8/6) praises much of Arizona Gov. Doug Ducey’s (R) “plan to infuse the state’s Medicaid
program, now covering an estimated 350,000 healthy adults, with personal-responsibility-enhancing requirements.” The paper notes that
proposals like requiring recipients to take advantage of wellness programs “are practices that employers have urged for their employees
for many years, too.” Still, the Republic questions the requirement that Medicaid beneficiaries pay 2 percent of their income into health
savings account, saying it would “be an imposition” for low-income people.
WellCare Reports Strong 2Q Earnings After Winning Medicaid Contracts.
Reuters
(8/6, Penumudi) reports that WellCare Health Plans Inc reported better-than-expected quarterly profit on Wednesday and
raised its full-year forecast. Membership in the managed care company’s Medicaid plans rose 10.8 percent to 2.4 million in the second
quarter.
Modern Healthcare
(8/6, Subscription Publication) reports that earnings were $51.7 million in the quarter, compared with a
$7.5 million loss a year earlier. WellCare “won its rebid as a managed-care company for Kentucky’s Medicaid program,” and also won
Medicaid contracts in New York and Florida.
Wednesday's Lead Stories
• Tax Return Problems Jeopardizing 2016 ACA Subsidies For 1.8 Million.
• Senate Bill Would Let Businesses, Religious Nonprofits Buy Plans Without Some Contraception Coverage.
• Banned Medicaid Providers Still Participating In Some States, OIG Report Finds.
• Aetna Raises Earnings Forecast As Government Business Grows.
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