Monday, March 31, 2014


Percentages of Persons Under Age 65 Who Had Public Health Plan Coverage, by State Medicaid Expansion Status States Moving Forward With Medicaid Expansion Public Health Plan Coverage 2008 19.4% 2009 20.7% 2010 21.8% 2011 23.1% 2012 23.1% 2013 (Jan.-Sept.) 23.9% States Not Moving Forward With Medicaid Expansion 2008 19.1% 2009 21.3% 2010 22.1% 2011 22.7% 2012 24.0% 2013(Jan.-Sept.) 23.0% Source: CDC/NCHS, National Health Interview Survey


According to a recent study of Emergency Department (ED) visits in Massachusetts during 2004 to 2009, the implementation of health care reform in 2006 was associated with an increase of between 0.2% and 1.2% in ED visits per year during reform and 0.2% and 2.2% after reform, compared with the period before reform. Source: "Increased Use of the Emergency Department After Health Care Reform in Massachusetts," Annals of Emergency Medicine, abstract only, March 24, 2014,

Friday, March 28, 2014

Percentage Under 65 Enrolled in a High-Deductible Health Plan (HDHP) Without a Health Savings Account (HSA), or in a Consumer-Directed Health Plan (CDHP), Among Those with Private Health Insurance Coverage CDHP (HDHP with HSA) HDHP no HSA Total 2008 5.2% 14.1% 19.2% 2009 6.6% 15.9% 22.5% 2010 7.7% 17.6% 25.3% 2011 9.2% 19.9% 29.0% 2012 10.8% 20.3% 31.1% 2013 (Jan.-Sept.) 11.7% 21.7% 33.4% Source: CDC/NCHS, National Health Interview Survey


According to a recent survey, some of the strategies that are currently being used to reduce hospital readmissions include: • home health collaborations (79%) • medication reconciliation (73% ) • use of telephonic monitoring (71%) • aim programs at individuals already assessed at high risk for readmission (47%) Source: "6 Strategies Help Stem Hospital Readmissions, Streamline Processes and Care Transitions," Health Intelligence Network/Blog, February 27, 2014,


According to a recent report, 49% of employers indicate they are extremely or very likely to make a high-deductible health plan their only health insurance option. Source: "Despite delayed key provision, health care reform triggers benefits action among employers," Prudential News Release, March 3, 2014,

Today's Datapoint

20.3% of eligible people have enrolled in insurance exchanges operated by states, compared to 12.4% in states with federally facilitated exchanges, according to an analysis released March 25 by the University of Pennsylvania’s Leonard Davis Institute of Health Economics.

Thursday, March 27, 2014

Open Enrollment Ends March 31 – Just 5 Days Left to Apply

Blog Posted March 26, 2014 By Julie Bataille, Director of Communications, Centers for Medicare & Medicaid Services Open Enrollment for the Health Insurance Marketplace ends in only 5 days. There are just 5 days left for consumers to apply for and enroll in quality, affordable coverage. If you don’t have health insurance and don’t begin to sign up by the deadline—you can’t get coverage again until next year. Right now we are seeing a surge in consumers coming to and calling call centers. We’re working hard to ensure that our systems can handle record-high consumer demand over the next few days. continues to perform well in terms of response time and error rates, even with traffic that is similar to what the site experienced at the end of December, the deadline for consumers who wanted their coverage to begin on January 1. There were over 1.2 million visits to the website and more than 390,000 calls received at our call center yesterday, which confirms that there is tremendous interest in signing up for coverage before the March 31 deadline. We’ve completed the last rounds of system upgrades, including hardware, for this open enrollment period. The site is prepared to accommodate approximately 100,000 concurrent users. Additionally, we’ve resolved the software issues affecting the experience of most consumers. While we are encouraging folks to sign up early, we know many people wait until the last minute. If many consumers come all at once, we’ve built an advanced queuing system that will allow consumers to leave an email and be invited back when there are fewer customers to be helped or to join our system’s virtual waiting room. Beyond the website, we’ve geared up for a surge across our entire operation. Our Call Center is ready with as many as 14,000 customer service representatives, including 800 who speak Spanish. The Call Center also has a queuing mechanism – if wait times get to be too long, we will offer consumers the convenient option to skip the wait and leave their contact information so we can get back to them and help them enroll. We are ready for consumers. It’s now time for you to check out your options and signup by March 31. And don’t worry, for those consumers who are in line by the March 31st deadline to complete enrollment—either online or over the phone – we’ll make sure you get covered. Just like Election Day, if you are in line when the polls close, you get to vote. We won’t close the door on those who tried to get covered and were unable to do so through no fault of their own. So, those who were in line or had technical problems with the website can quickly come back and sign up as soon as possible. Millions of Americans have gotten health coverage through the Marketplace in the last five months. We’re doing all we can to ensure that every American who wants to enroll in affordable coverage by the end of the open enrollment period—March 31, 2014—is able to do so. It is our commitment: we’ll work hard to ensure that all Americans enjoy the security and peace of mind that comes with having quality health coverage. Above Blog is posted here: A consumer fact sheet is posted here: Two assister fact sheets are posted here - The in line policy guidance is posted here – The complex cases guidance is posted here - The Treasury Domestic Violence fact sheet is posted here - New content is live here:

Today's Datapoint

Up to 3.5 million … people have enrolled in Medicaid as a result of the Affordable Care Act (considerably fewer than numbers cited by federal officials), according to a new analysis from Avalere Health LLC that looked at sign-ups between October 2013 and January 2014.

Quote of the Day

“The exchange business is a very small part of any major market-share player. Add the ‘3Rs’ [which protects them from big losses] and there aren’t any big health plan CEOs losing any sleep over Obamacare right now. But they can’t support this long-term if it doesn’t work. 2015 is the year the Obamacare planners have to prove they know what they are doing….”

Today's Datapoint

64% … of Americans now either support the Affordable Care Act (13%) or favor small changes in it (51%), according to a new Bloomberg National Poll.

Today's Datapoint

245% … was the 2014 Medicare Advantage enrollment increase experienced by Health Care Service Corp, which operates Blues plans in five states, according to new CMS data.

Monday, March 24, 2014

Physician Pay Fix?

By a 238 to 181 vote, the House passed a bill on March 15 that would provide a permanent fix to the formulary by which Medicare pays physicians. But chances of the bipartisan legislation becoming law were torpedoed by the inclusion of a last-second GOP amendment that would offset the estimated $138 billion increase in federal spending by delaying the Affordable Care Act’s “individual mandate” provision, according to a March 15 article on the National Public Radio (NPR) website. The Obama administration said the president “would veto” the bill if it contains this funding mechanism, NPR said. “This bill will pass today and go nowhere," Rep. Frank Pallone, (D-N.J.), said, according to NPR. "It will not be taken up by the Senate. It will not be signed by the President. You have single-handedly, in my belief, stomped on months and months of hard work and effort by my colleagues on both sides of the aisle and our staffs.

Network Direction

Health plans operating on the federally run insurance exchanges in 2015 must include broader provider networks, according to a March 14 CMS letter to insurers. Carriers on the exchange in 2015 must include 30% of an area’s “essential community providers,” up from 20% in 2014, CMS said. Essential community providers include hospitals that generally serve low-income patients. In addition, CMS said it would take a more active role in reviewing health plan networks. Among other things, CMS said it will evaluate whether plans on the exchange include enough access to hospitals, primary care doctors, mental health providers and oncologists. In a March 14 interview on WebMD, President Obama said that pressure to keep down costs could mean consumers may not have access to their choice of doctor. “You may find out that network is more expensive than another network, then you have to make choices in terms of what’s right for your family,” Obama told WebMD, according to a March 14 article in The Washington Post. “Do you want to save on costs, or do you want to save on convenience?”

Saturday, March 22, 2014

Wasn’t Signing Up The Uninsured The Entire Point Of Obamacare?

March 10, 2014 | Weasel Zippers/Washington Post The new health insurance marketplaces appear to be making little headway so far in signing up Americans who lack health insurance, the Affordable Care Act’s central goal. A pair of surveys released on Thursday suggest that just one in 10 uninsured people who qualify for private health plans through the new marketplace have signed up for one — and that about half of uninsured adults has looked for information on the online exchanges or plans to look. Taken together, the snapshots shown by the surveys provide preliminary answers to what has been one of the biggest mysteries since and separate state marketplaces opened last fall: Are they attracting their prime audience? One of the surveys, by the consulting firm McKinsey & Co., shows that, of people who had signed up for coverage through the marketplaces by last month, just one-fourth described themselves as having been without insurance for most of the past year. The survey also attempted to gauge what has been another fuzzy matter: how many of the people actually have the insurance for which they signed up. Under federal rules, coverage begins only if someone has started to pay their monthly insurance premiums. And, the survey show, that just over half of uninsured people said they had started to pay, compared with nearly nine in 10 of those signing up on the exchanges who said they were simply switching from one health plan to another. Read original article at Weasel Zippers/Washington Post - See more at:

CMS’s Rapid Retreat on Portions of Proposed MA/Part D Rule: One for the Record Books

By James Gutman - March 14, 2014 It wasn’t just what CMS did March 10 regarding its 678-page proposed Medicare Advantage (MA) and Part D rule that left several industry observers amazed. It was when and how the agency shelved four major portions of the rule that led to such comments from them as “I can’t recall that ever happening before” and “I can’t remember such a complete reversal.” For those who haven’t been following the saga since Jan. 6, when CMS released the proposal rule, here is the “Cliff Notes” summary of the relevant portions involved in the March 10 actions. Among the many changes the agency proposed in the rule were lifting the protected-class definition on two major classes of drugs with a third perhaps coming later, changing requirements for participation in preferred pharmacy networks, limiting to two the number of stand-alone Prescription Drug Plans (PDPs) a sponsor may offer in a region starting in 2016 and allowing CMS to have a role in contract negotiations involving Part D plans and pharmacies. It seemed those provisions contained something to hate for virtually every stakeholder. Patient-advocacy groups and pharmaceutical manufacturers were outraged that the regulations would remove required access to all antidepressants and immunosuppressant drugs in 2015 and perhaps all antipsychotics in 2016. Insurers and some consumer advocates were upset by the limits on the number of PDPs, plans and employers detested that “any willing pharmacy” would be able to join a preferred pharmacy network, and both insurers and employers thought no good could come out of CMS getting involved in contract negotiations for that kind of network. With all of those constituencies yelling in Congress’ ear, it may be no wonder that a majority of the members of the Senate Finance Committee, including both the Democratic chairman and the ranking minority member, sent CMS Administrator Marilyn Tavenner a Feb. 28 letter asking the agency not to “unnecessarily interfere with a successful program.” The deadline for comments on the proposed rule was March 7. On March 10, the very next business day, Tavenner sent Congress a letter saying that “given the complexities of these issues and stakeholder input, we do not plan to finalize these proposals at this time.” She did add that CMS would go ahead with some other provisions of the rule that were less controversial. “While we anticipated that they might pull back on the Part D modifications, we didn’t see that happening before the comments were even fully analyzed,” one attorney who represents the industry tells AIS. “What a circus,” summarizes an industry consultant. They both, though, suggested that time, and not just opposition, might have played a factor in the decision in that CMS probably wanted to make sure it could get the final rule out on or close to the April 7 mandated date for release of the final MA pay rates and 2015 Call Letter that both MA plans and PDPs will use as their guide in preparing the 2015 bids due June 2. Why do you think CMS acted so quickly in reversing itself on four key portions of the proposed rule? Was it more because of the time factors for getting the rule out, or did some potential political fallout in an election year have the key role? Will CMS, as it said March 10, indeed wind up “advancing some or all of the changes in these areas in future years,” or are these proposals dead forever? Is this a lesson in what can happen in those rare times when Democratic and Republican members of Congress can agree on something, or is it just fodder for a brief footnote in Ripley’s Believe It or Not?

Quote of the Day

“I think almost any objective observer with major IT project experience would also say that the time frame most states followed [to develop their insurance exchange] was insufficient for the scope of the work….That was certainly the case for the federal exchange, and a lot of the states didn’t get started as early as the feds because they had to wait for state legislative action to authorize the state-based exchanges. The date was set by statute, not with any thoughtful consideration for how long projects of this magnitude should actually take.” — An executive who asked not to be identified told AIS’s Inside Health Insurance Exchanges.

Today's Datapoint

More than 45,000 … agents and brokers have been trained by HHS to sell policies in the individual exchange market, according to Gary Cohen, Director of CMS’s Center for Consumer Information and Insurance Oversight.

Today's Datapoint

$8.10 … was recovered by HHS and the Department of Justice for every dollar they spent in 2013 on health care fraud enforcement and prevention, with a total of $4.3 billion recovered, up from $4.2 billion in 2012.

Friday, March 21, 2014

7.9 million people with Medicare have saved over $9.9 billion on prescription drugs

CMS NEWS FOR IMMEDIATE RELEASE Contact: CMS Media Relations Friday, March 21, 2014 (202) 690-6145 7.9 million people with Medicare have saved over $9.9 billion on prescription drugs 37.2 million Medicare beneficiaries received free preventive services in 2013 On the 4th anniversary of the signing of the Affordable Care Act into law, new information released today by the Department of Health and Human Services (HHS) shows that millions of seniors and people with disabilities with Medicare continue to enjoy lower costs on prescription drugs and improved benefits in 2013 thanks to the health care law. Since enactment of the Affordable Care Act, 7.9 million seniors and people with disabilities have saved $9.9 billion on prescription drugs, or an average of $1,265 per beneficiary. In 2013 alone, 4.3 million seniors and people with disabilities saved $3.9 billion, or an average of $911 per beneficiary. These figures are higher than in 2012, when 3.5 million beneficiaries saved $2.5 billion, for an average of $706 per beneficiary. Use of preventive services has also expanded among people with Medicare. In 2013, an estimated 37.2 million people with Medicare took advantage of at least one preventive service with no cost sharing, including an estimated 26.5 million people with traditional Medicare, and more than 4 million who took advantage of the Annual Wellness Visit. This exceeds the comparable figure from 2012, when an estimated 34.1 million people with Medicare, including 26.1 million with traditional Medicare, received one or more preventive benefits with no out of pocket costs. “Thanks to the Affordable Care Act, we saw a stronger Medicare program in 2013,” said HHS Secretary Kathleen Sebelius. “Seniors are saving billions of dollars on their needed medications and continuing to enjoy benefits that will lead to healthier lives and lower costs in the long run.” Closing the prescription drug “donut hole” The Affordable Care Act makes Medicare prescription drug coverage more affordable by gradually closing the gap in coverage where beneficiaries had to pay the full cost of their prescriptions out of pocket, before catastrophic coverage for prescriptions took effect. This gap is known as the donut hole. Thanks to the health care law, in 2010, anyone with a Medicare prescription drug plan who reached the prescription drug donut hole got a $250 rebate. In 2011, beneficiaries in the donut hole began receiving discounts on covered brand-name drugs and savings on generic drugs. People with Medicare Part D who fall into the donut hole this year will receive discounts and savings of about 53 percent on the cost of brand name drugs and about 28 percent on the cost of generic drugs. These savings and Medicare coverage will gradually increase until 2020, when the donut hole will be closed. For state-by-state information on discounts in the donut hole, please visit: For more information about Medicare prescription drug benefits, please visit: Medicare Preventive Services By making certain preventive services available with no cost-sharing, the Affordable Care Act is helping Americans take charge of their own health. By removing barriers to prevention, Americans and health care professionals can better prevent illness, detect problems early when treatment works best, and monitor health conditions. For Medicare, the Affordable Care Act eliminated coinsurance and the Part B deductible for recommended preventive services, including many cancer screenings and other important benefits. For example, before the Affordable Care Act, a person with Medicare could pay as much as $160 in cost-sharing for a colorectal cancer screening. Today, this important screening and many others are covered at no cost to beneficiaries (with no deductible or co-pay). This will help many seniors to stay healthy. For state-by-state information on utilization of preventive services at no cost sharing to beneficiaries in Medicare, please visit:

Tuesday, March 18, 2014

According to a recent survey, so far in 2014:

• The percentage of Americans without health insurance has fallen to 15.9%, compared with 17.1% in the fourth quarter of 2013 • The percentage of Americans who get insurance through a current or former employer has fallen to to 43.4%, compared to 44.5% in the 3rd quarter of 2013 • 18.1% of Americans now say their primary health insurance coverage is through a plan fully paid for by themselves or a family member compared with17.2% at the end of 2013 Source: "U.S. Uninsured Rate Continues to Fall," Gallup Inc. Press Release, March 10, 2014,

Market Share of Insurers in California's Individual Market (2012) and Exchange (as of Feb. 28, 2014)

Pre-ACA Individual Exchange Wellpoint 47% 30% Kaiser Permanente 20% 18% Blue Shield of California Group 19% 29% Health Net 3% 18% Other Insurers 10% 5% Source: Kaiser Family Foundation

Monday, March 17, 2014

DADS Introduces New Respite Category

Are you a caregiver who is interested in learning more about how you can get help with your duties? Do you work for an organization that provides respite services to people who care for family members who are older or who have disabilities? If so, you may want to subscribe to the Take Time Texas (Respite Care) email list. The Take Time Texas website site features a searchable database of respite providers who can care for your family member while you take a break. Other resources for caregivers include information on events, workshops and webinars designed especially for them. If your organization provides respite services, the website has publications, marketing materials and other products created by the Texas Respite Coalition, the Texas Department of Aging and Disability Services and Texas Respite Coordination Center. And don't forget to include your services in the searchable database. Sign up now to receive more information about caregiving in Texas -

10 overused tests waste healthcare dollars

1. Nuclear stress tests, and other imaging tests, after heart procedures 2. Yearly electrocardiogram or exercise stress test 3. PSA to screen for prostate cancer 4. PET scan to diagnose Alzheimer's disease 5. X-ray, CT scan or MRI for lower back pain 6. Yearly Pap tests 7. Bone density scan for women before age 65 and men before age 70 8. Follow-up ultrasounds for small ovarian cysts 9. Colonoscopy after age 75 10. Yearly physical Source: AARP

Estimated Reduction in 2015 for Medicare Advantage Organizations

1. ACA quartile impact for 2015: -2.4% 2. Change in plans' star rating for 2015: 0.4% 3. Elimination of bonus for 3.0 and 3.5 stars for 2015: -1.9% 4. Elimination of applicable amount bonus: -0.1% 5. Ratebook change for 2015: -1.9% 6. Projected insurer fee for 2015: -0.8% 7. Coding intensity change for 2015: -0.25% 8. Risk Score normalization factor for 2015: -3.2% 9. Elimination of home assessment visit diagnoses: -2.0% 10. Total Reduction for 2015: -5.9% Source: Oliver Wyman

Breakdown of The More Than 4.2 million Who Selected Marketplace Plans From Oct. 1, 2013, Through Mar. 1, 2014

1. 1.55 percent are female and 45 percent are male 2. 2.31 percent are age 34 and under 3. 3.25 percent are between the ages of 18 and 34 4. 4.63 percent selected a Silver plan (up one percentage point over the prior reporting period), while 18 percent selected a Bronze plan (down one point) 5. 5.83 percent selected a plan and are eligible to receive Financial Assistance (up one point) Source: U.S. Department of Health & Human Services

OIG Reaches $3.75 Million Settlement with Carousel

Carousel Pediatrics has agreed to repay the state of Texas $3.75 million after an investigation by the Health and Human Services Commission Office of Inspector General found a pattern of billing errors.

According to a recent report,

73% of employers say the Affordable Care Act is having an impact on benefits service and support, and 69% report there is an impact on benefits communications. Source: "Despite delayed key provision, health care reform triggers benefits action among employers," Prudential News Release, March 3, 2014,

Health Insurance Marketplace Enrollment Update

More than 4.2 million (4,242,300) people selected Marketplace plans from Oct. 1, 2013, through Mar. 1, 2014, including 1.6 million in the State Based Marketplaces and 2.6 million in the Federally-facilitated Marketplace. About 943,000 people enrolled in the Health Insurance Marketplace plans in the February reporting period, which concluded March 1, 2014. Of the more than 4.2 million: • 55 percent are female and 45 percent are male; • 31 percent are age 34 and under; • 25 percent are between the ages of 18 and 34; • 63 percent selected a Silver plan (up one percentage point over the prior reporting period), while 18 percent selected a Bronze plan (down one point); and • 83 percent selected a plan and are eligible to receive Financial Assistance (up one point). Source: U.S. Department of Health & Human Services

Today's Datapoint

$399 million … is the projected annual Affordable Care Act penalty for Texas employers as a result of the state’s decision to forego Medicaid expansion, according to a recent study by Jackson Hewitt Tax Service Inc.

Quote of the Day

“Our very, very last resort [when faced with cuts for Medicare plans] is to reduce benefits, but first we look at our administration, our unit costs, networks, programs around reducing utilization as a last resort whether to tinker with benefits. Our members rely on us for a comprehensive package; they don’t like change.” — Lisa Rubino, senior vice president of Medicare, duals and marketplace for Molina Healthcare, Inc., told AIS’s Health Plan Week.