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Thursday, April 5, 2012
Today's Datapoint
94% of employers surveyed recently by Aon Hewitt said they are committed to offering and financially supporting health coverage for their employees, with 70% very or somewhat interested in exploring a private corporate exchange model.
Tuesday, April 3, 2012
Today's Datapoint
$1 billion a year more is paid for health insurance by women for similar coverage to men, due to gender rating by insurance companies, according to a report released by the National Women’s Law Center.
From HEALTH PLAN WEEK.
From HEALTH PLAN WEEK.
Monday, April 2, 2012
Justice Department requires Divestitures in Humana's Acquisitiion of Arcadian Management Services Inc
JUSTICE DEPARTMENT REQUIRES DIVESTITURES IN HUMANA INC.'S ACQUISITION OF ARCADIAN MANAGEMENT SERVICES INC.
Divestitures and Additional Relief in Arizona, Arkansas, Louisiana, Oklahoma and Texas Preserve Competition for Medicare Advantage Plans Sold to Medicare Beneficiaries
WASHINGTON — The Department of Justice today announced that it will require Humana Inc. and Arcadian Management Services Inc. to divest assets relating to Arcadian's Medicare Advantage business in parts of five states in order for Humana to proceed with its acquisition of Arcadian. The department is requiring divestitures of health plans in 51 counties and parishes in Arizona, Arkansas, Louisiana, Oklahoma and Texas. The department said that the transaction, as originally proposed, would likely have resulted in higher prices, fewer choices and lower quality Medicare Advantage plans purchased by Medicare beneficiaries.
The department's Antitrust Division filed a civil lawsuit today in the U.S. District Court in Washington, D.C., to block the proposed acquisition. At the same time, the department filed a proposed settlement that, if approved by the court, would resolve the lawsuit and the department's competitive concerns.
"Protecting competition in health care has been and continues to be a top priority of the Antitrust Division," said Acting Assistant Attorney General Sharis A. Pozen in charge of the Department of Justice's Antitrust Division. "These divestitures preserve competition so that Medicare beneficiaries, primarily senior citizens, in Arizona, Arkansas, Louisiana, Oklahoma and Texas, benefit from lower prices, better quality services and more innovative products for their health care needs."
Individuals eligible for Medicare, primarily senior citizens, may elect to enroll in a privately provided Medicare Advantage plan instead of traditional Medicare. In establishing the Medicare Advantage program, Congress intended that vigorous competition among private Medicare Advantage insurers would lead insurers to offer seniors a rich set of affordable benefits, provide a wide array of health-insurance choices, and be responsive to the demands of seniors. Approximately 71,000 people are enrolled in Medicare Advantage plans in these 51 counties and parishes, accounting for more than $700 million in annual commerce.
According to the complaint, the original transaction would have eliminated competition between Humana and Arcadian, two of the few significant sellers of Medicare Advantage plans in 45 of the counties and parishes, allowing Humana to increase prices and reduce the quality of Medicare Advantage plans sold to seniors there. The original deal would have created a combined company controlling between 40 and 100 percent of the Medicare Advantage health insurance market in these counties and parishes.
Under the proposed settlement, Humana must promptly divest the Medicare Advantage plans in the 51 counties and parishes to one or more acquirers approved by the department that has the intent and capability to be an effective competitor. The department is requiring divestitures of health plans in five additional counties and one additional parish to facilitate the divesture of the plans in the other 45 counties and parishes and make those plans more administrable. Under the terms of the proposed settlement, current enrollees of Humana and Arcadian's Medicare Advantage plans will continue to have substantially the same access to providers, including doctors, hospitals and other medical services, after the divestitures as before the divestitures were required. The proposed settlement contains provisions that ensure the buyers of the divested
Medicare Advantage plans will have contracts with substantially all of the health care providers included in the Humana and Arcadian plans at substantially the same rates. The department said the requirements are important because to compete effectively, a health insurer needs a network of health care providers at competitive rates.
Humana Inc., a leading health insurer in the United States, is a Delaware corporation headquartered in Louisville, Ky. In 2010, Humana reported revenues of approximately $33.6 billion.
Arcadian Management Services Inc., with approximately 62,000 Medicare Advantage members in 15 states, is a Delaware corporation headquartered in Oakland, Calif. In 2010, Arcadian had revenues of $622 million.
The proposed settlement, along with the department's competitive impact statement, will be published in the Federal Register, as required by the Antitrust Procedures and Penalties Act. Any person may submit written comments concerning the proposed settlement within 60 days of its publication to Joshua H. Soven, Chief, Litigation I Section, Antitrust Division, U.S. Department of Justice, 450 Fifth St., N.W., Suite 4100, Washington, D.C. 20530. At the conclusion of the 60-day comment period, the court may enter the settlement upon a finding that it is in the public interest.
Divestitures and Additional Relief in Arizona, Arkansas, Louisiana, Oklahoma and Texas Preserve Competition for Medicare Advantage Plans Sold to Medicare Beneficiaries
WASHINGTON — The Department of Justice today announced that it will require Humana Inc. and Arcadian Management Services Inc. to divest assets relating to Arcadian's Medicare Advantage business in parts of five states in order for Humana to proceed with its acquisition of Arcadian. The department is requiring divestitures of health plans in 51 counties and parishes in Arizona, Arkansas, Louisiana, Oklahoma and Texas. The department said that the transaction, as originally proposed, would likely have resulted in higher prices, fewer choices and lower quality Medicare Advantage plans purchased by Medicare beneficiaries.
The department's Antitrust Division filed a civil lawsuit today in the U.S. District Court in Washington, D.C., to block the proposed acquisition. At the same time, the department filed a proposed settlement that, if approved by the court, would resolve the lawsuit and the department's competitive concerns.
"Protecting competition in health care has been and continues to be a top priority of the Antitrust Division," said Acting Assistant Attorney General Sharis A. Pozen in charge of the Department of Justice's Antitrust Division. "These divestitures preserve competition so that Medicare beneficiaries, primarily senior citizens, in Arizona, Arkansas, Louisiana, Oklahoma and Texas, benefit from lower prices, better quality services and more innovative products for their health care needs."
Individuals eligible for Medicare, primarily senior citizens, may elect to enroll in a privately provided Medicare Advantage plan instead of traditional Medicare. In establishing the Medicare Advantage program, Congress intended that vigorous competition among private Medicare Advantage insurers would lead insurers to offer seniors a rich set of affordable benefits, provide a wide array of health-insurance choices, and be responsive to the demands of seniors. Approximately 71,000 people are enrolled in Medicare Advantage plans in these 51 counties and parishes, accounting for more than $700 million in annual commerce.
According to the complaint, the original transaction would have eliminated competition between Humana and Arcadian, two of the few significant sellers of Medicare Advantage plans in 45 of the counties and parishes, allowing Humana to increase prices and reduce the quality of Medicare Advantage plans sold to seniors there. The original deal would have created a combined company controlling between 40 and 100 percent of the Medicare Advantage health insurance market in these counties and parishes.
Under the proposed settlement, Humana must promptly divest the Medicare Advantage plans in the 51 counties and parishes to one or more acquirers approved by the department that has the intent and capability to be an effective competitor. The department is requiring divestitures of health plans in five additional counties and one additional parish to facilitate the divesture of the plans in the other 45 counties and parishes and make those plans more administrable. Under the terms of the proposed settlement, current enrollees of Humana and Arcadian's Medicare Advantage plans will continue to have substantially the same access to providers, including doctors, hospitals and other medical services, after the divestitures as before the divestitures were required. The proposed settlement contains provisions that ensure the buyers of the divested
Medicare Advantage plans will have contracts with substantially all of the health care providers included in the Humana and Arcadian plans at substantially the same rates. The department said the requirements are important because to compete effectively, a health insurer needs a network of health care providers at competitive rates.
Humana Inc., a leading health insurer in the United States, is a Delaware corporation headquartered in Louisville, Ky. In 2010, Humana reported revenues of approximately $33.6 billion.
Arcadian Management Services Inc., with approximately 62,000 Medicare Advantage members in 15 states, is a Delaware corporation headquartered in Oakland, Calif. In 2010, Arcadian had revenues of $622 million.
The proposed settlement, along with the department's competitive impact statement, will be published in the Federal Register, as required by the Antitrust Procedures and Penalties Act. Any person may submit written comments concerning the proposed settlement within 60 days of its publication to Joshua H. Soven, Chief, Litigation I Section, Antitrust Division, U.S. Department of Justice, 450 Fifth St., N.W., Suite 4100, Washington, D.C. 20530. At the conclusion of the 60-day comment period, the court may enter the settlement upon a finding that it is in the public interest.
New York Releases Proposal to Integrate Benefits and Financing for Dual Eligibles
State proposals to integrate coverage for dually eligible individuals, or people with both Medicare and Medicaid, under the Centers for Medicare and Medicaid Services’ (CMS’) new demonstrations and financing models continue to be made public for comments by stakeholders. Last week, the New York State Department of Health posted its demonstration proposal, under which, beginning in 2014, dual eligibles will be automatically enrolled into private insurance plans that provide both Medicare and Medicaid benefits, including pharmacy and long-term care benefits.
The proposal describes New York’s plan in general terms: the state will pursue an integrated financing pathway, under which it will enter into a three-way contract with CMS and private insurance companies that receive capped payments to administer both Medicare and Medicaid benefits.
According to the proposal, although beneficiaries subject to the demonstration will be passively enrolled into plans, they will have the ability to disenroll or opt out of the model. The proposal also states that New York will engage independent enrollment brokers to help affected individuals navigate plan choices and enroll into plans. In addition, New York hopes to establish an integrated appeals process for both Medicare and Medicaid benefits, though the state did not provide specifics about the new appeals structure. Implementation of the demonstration will occur in eight designated counties throughout the state, including the five counties that comprise New York City.
Beginning July of this year, New York plans to enroll dual eligibles requiring long-term care under Medicaid into managed long-term care plans. The demonstration proposal released last week largely builds on this existing framework, which sees the conversion of the Medicaid long-term care benefit from a fee-for-service model into a private managed care model.
Many details about New York’s dual eligible integration demonstration remain unclear, requiring further clarification from the state. The public can comment on New York’s proposal until April 20, 2012.
New York was one of several states that released proposals last week. The National Senior Citizens Law Center (NSCLC) has developed a new website that provides information on state demonstration proposals as they become available. NSCLC’s website also features additional resources designed to help advocates engage in stakeholder processes and provide meaningful input on state plans.
The proposal describes New York’s plan in general terms: the state will pursue an integrated financing pathway, under which it will enter into a three-way contract with CMS and private insurance companies that receive capped payments to administer both Medicare and Medicaid benefits.
According to the proposal, although beneficiaries subject to the demonstration will be passively enrolled into plans, they will have the ability to disenroll or opt out of the model. The proposal also states that New York will engage independent enrollment brokers to help affected individuals navigate plan choices and enroll into plans. In addition, New York hopes to establish an integrated appeals process for both Medicare and Medicaid benefits, though the state did not provide specifics about the new appeals structure. Implementation of the demonstration will occur in eight designated counties throughout the state, including the five counties that comprise New York City.
Beginning July of this year, New York plans to enroll dual eligibles requiring long-term care under Medicaid into managed long-term care plans. The demonstration proposal released last week largely builds on this existing framework, which sees the conversion of the Medicaid long-term care benefit from a fee-for-service model into a private managed care model.
Many details about New York’s dual eligible integration demonstration remain unclear, requiring further clarification from the state. The public can comment on New York’s proposal until April 20, 2012.
New York was one of several states that released proposals last week. The National Senior Citizens Law Center (NSCLC) has developed a new website that provides information on state demonstration proposals as they become available. NSCLC’s website also features additional resources designed to help advocates engage in stakeholder processes and provide meaningful input on state plans.
Health Care Reform on Trial
*Views expressed are not necessarily those of the poster*
This week, the Supreme Court heard arguments over the constitutionality of the Affordable Care Act (ACA, or healthcare reform). As we wrote last week, ACA helps millions of American families by extending health care to those who are either uninsured or underinsured.[1] As the arguments before the Court have revealed, the path to health care reform has been tortuous and contentious.[2] This Alert outlines several of the key elements and concerns that are in play.
What Might be Lost
If the entire law is found unconstitutional, with no parts severable (able to continue individually), it will set back a variety of important gains – for example, a finding that the whole law fails would eliminate a variety of protections and directions of import to an improved healthcare system, such as:[3]
• Pre-existing condition exclusions;
• The loss of the opportunity to buy insurance in insurance pools;
• Waste, fraud, and abuse protections;
• Medicaid expansions;
• Development of Best Practice standards for health care delivery;
• A focus on quality measures;
• Expanded data collection activities designed to achieve health equity for racial and ethnic minorities (as well as Lesbian, Gay, Bisexual, and Transgender (LGBT) people);
• Shared savings programs designed to hold down healthcare costs;
• Integration of the delivery of services for MMEs (people eligible for Medicare & Medicaid);
• Greater emphasis on care coordination;
• Health exchanges (allowing people to shop for healthcare coverage options);
• Insurance market reforms requiring insurers to provide more information about coverage and claims and pay-out history.
Importance to Low-Income People
Expanding services, particularly ACA's expansion of access to the Medicaid program, is very important. This expansion will allow more people to have access to health insurance by requiring states that choose to participate in the Medicaid program to cover nearly all non-disabled adults under age 65 with household incomes at or below 133% of the federal poverty level (FPL) as of January, 2014. Further, as shown below, states that take advantage of this expansion will receive significant increases in their Federal Medical Assistance Percentage (FMAP) toward the cost of providing expanded Medicaid coverage.
The Anti-Injunction Act
The key question here is whether a court has jurisdiction to hear a challenge to a federal law that is essentially a tax raising vehicle or instrument. Whether the ACA-prescribed penalties for not having insurance is a tax, given that the penalties are enforced through the tax code, is of major concern. If the Tax Anti-Injunction ACT (AIA)[4] does apply, it would mean that the Supreme Court doesn’t have jurisdiction to hear the case, and that challenges to the law would have to wait until after 2014, when someone would first experience a tax penalty because of the mandate.
People on both sides of the constitutionality of the ACA, would prefer that the Court find that the AIA does not apply. There needs to be clarity and continuity in program and system development for ACA implementation. Planners at the state and federal level need to feel that they are on solid ground in going forward with implementing the ACA's complicated rules for health exchanges. Likewise, insurance companies need clarity and certainty in building products and markets based on rules that are reasonably reliable and relatively certain.
Severability
Those in favor of the ACA are hopeful the Supreme Court will find that the several major provisions of the Act are severable. This means that if one or more parts of the law are found to be unconstitutional, the whole law is not struck down, allowing the unaffected portions to go forward.
The Individual Responsibility Provision
The individual responsibility provision or "the individual mandate" is the heart of the ACA. The law is predicated on the notion that everyone must have some level of health insurance or there will not be a sufficient number of people in the healthcare systems created by the ACA to make the law's delivery systems sustainable. Further, those who are uninsured and suffer a health incident add to the costs for society as a whole. Our notions of a civil society and our sense of good public policy is that we want a healthy population. Since few can afford to self-insure or set aside sufficient resources to cover a health crisis on their own, requiring that everyone enter the insurance pool is the best way to ensure coverage at reasonable cost, relative to health care costs in general.
Expanding Medicaid
States will get an increase in their Federal medical assistance percentage (FMAP) as follows: 100% of costs from 2014-2016, 95% in 2017, 94% in 2018, 93% in 2019 and 90% in 2020 and beyond.[5] Plus, states generally understand the Medicaid program and have the infrastructure on which to build and expand. Moreover, Medicaid participation is optional, but if a state decides to participate, it has to follow federal rules and standards.
Acknowledging the Cost of Reform
There are always unforeseen costs to implementing major programs involving health and social services. States and private entities stand to gain billions of dollars through ACA, which will help the overall economy. The general embrace of best practice paradigms in the ACA helps the government to be a "smarter payer" by paying for care and services that have some proven merit. In addition, ACA's focus on such goals as care coordination, physician and practitioner engagement, and registration and accountability add to bringing down the general costs of health care. Moreover, the timeline for program implementation will allow for greater individual participation in the system which will increase revenues and resources by expanding the pool of people using and paying into the healthcare system.
Making the Case for Congressional Action
The major issue is one of whether the Congress has laid out sufficient and factual groundwork to support its claims that it is acting within its powers. An affirmative answer to this central question by the Supreme Court is necessary in order to find that the ACA is a valid exercise of Congressional power under the Commerce clause, which would then allow it to take the "necessary and proper" steps to effectuate its intent with respect to the Commerce clause.
Conclusion
Those who have studied court arguments over the years know that it is folly to use the "ups and downs" of oral argument as an indication of how a court will in fact rule on an issue. Advocates on all sides remain vigilant. Access to healthcare for millions of Americans and their families is at stake. We at the Center for Medicare Advocacy continue to stand by the Affordable Care Act and the many innovative and patient-centered reforms that the law brings to the Medicare and Medicaid programs, and to the healthcare industry as a whole. ACA is already bringing much-needed relief to families. It will continue to do so if allowed to go forward.
For more information, contact attorney Alfred Chiplin (achiplin@medicareadvocacy.org) in the Center for Medicare Advocacy's Washington, DC office at (202) 293-5760.
This week, the Supreme Court heard arguments over the constitutionality of the Affordable Care Act (ACA, or healthcare reform). As we wrote last week, ACA helps millions of American families by extending health care to those who are either uninsured or underinsured.[1] As the arguments before the Court have revealed, the path to health care reform has been tortuous and contentious.[2] This Alert outlines several of the key elements and concerns that are in play.
What Might be Lost
If the entire law is found unconstitutional, with no parts severable (able to continue individually), it will set back a variety of important gains – for example, a finding that the whole law fails would eliminate a variety of protections and directions of import to an improved healthcare system, such as:[3]
• Pre-existing condition exclusions;
• The loss of the opportunity to buy insurance in insurance pools;
• Waste, fraud, and abuse protections;
• Medicaid expansions;
• Development of Best Practice standards for health care delivery;
• A focus on quality measures;
• Expanded data collection activities designed to achieve health equity for racial and ethnic minorities (as well as Lesbian, Gay, Bisexual, and Transgender (LGBT) people);
• Shared savings programs designed to hold down healthcare costs;
• Integration of the delivery of services for MMEs (people eligible for Medicare & Medicaid);
• Greater emphasis on care coordination;
• Health exchanges (allowing people to shop for healthcare coverage options);
• Insurance market reforms requiring insurers to provide more information about coverage and claims and pay-out history.
Importance to Low-Income People
Expanding services, particularly ACA's expansion of access to the Medicaid program, is very important. This expansion will allow more people to have access to health insurance by requiring states that choose to participate in the Medicaid program to cover nearly all non-disabled adults under age 65 with household incomes at or below 133% of the federal poverty level (FPL) as of January, 2014. Further, as shown below, states that take advantage of this expansion will receive significant increases in their Federal Medical Assistance Percentage (FMAP) toward the cost of providing expanded Medicaid coverage.
The Anti-Injunction Act
The key question here is whether a court has jurisdiction to hear a challenge to a federal law that is essentially a tax raising vehicle or instrument. Whether the ACA-prescribed penalties for not having insurance is a tax, given that the penalties are enforced through the tax code, is of major concern. If the Tax Anti-Injunction ACT (AIA)[4] does apply, it would mean that the Supreme Court doesn’t have jurisdiction to hear the case, and that challenges to the law would have to wait until after 2014, when someone would first experience a tax penalty because of the mandate.
People on both sides of the constitutionality of the ACA, would prefer that the Court find that the AIA does not apply. There needs to be clarity and continuity in program and system development for ACA implementation. Planners at the state and federal level need to feel that they are on solid ground in going forward with implementing the ACA's complicated rules for health exchanges. Likewise, insurance companies need clarity and certainty in building products and markets based on rules that are reasonably reliable and relatively certain.
Severability
Those in favor of the ACA are hopeful the Supreme Court will find that the several major provisions of the Act are severable. This means that if one or more parts of the law are found to be unconstitutional, the whole law is not struck down, allowing the unaffected portions to go forward.
The Individual Responsibility Provision
The individual responsibility provision or "the individual mandate" is the heart of the ACA. The law is predicated on the notion that everyone must have some level of health insurance or there will not be a sufficient number of people in the healthcare systems created by the ACA to make the law's delivery systems sustainable. Further, those who are uninsured and suffer a health incident add to the costs for society as a whole. Our notions of a civil society and our sense of good public policy is that we want a healthy population. Since few can afford to self-insure or set aside sufficient resources to cover a health crisis on their own, requiring that everyone enter the insurance pool is the best way to ensure coverage at reasonable cost, relative to health care costs in general.
Expanding Medicaid
States will get an increase in their Federal medical assistance percentage (FMAP) as follows: 100% of costs from 2014-2016, 95% in 2017, 94% in 2018, 93% in 2019 and 90% in 2020 and beyond.[5] Plus, states generally understand the Medicaid program and have the infrastructure on which to build and expand. Moreover, Medicaid participation is optional, but if a state decides to participate, it has to follow federal rules and standards.
Acknowledging the Cost of Reform
There are always unforeseen costs to implementing major programs involving health and social services. States and private entities stand to gain billions of dollars through ACA, which will help the overall economy. The general embrace of best practice paradigms in the ACA helps the government to be a "smarter payer" by paying for care and services that have some proven merit. In addition, ACA's focus on such goals as care coordination, physician and practitioner engagement, and registration and accountability add to bringing down the general costs of health care. Moreover, the timeline for program implementation will allow for greater individual participation in the system which will increase revenues and resources by expanding the pool of people using and paying into the healthcare system.
Making the Case for Congressional Action
The major issue is one of whether the Congress has laid out sufficient and factual groundwork to support its claims that it is acting within its powers. An affirmative answer to this central question by the Supreme Court is necessary in order to find that the ACA is a valid exercise of Congressional power under the Commerce clause, which would then allow it to take the "necessary and proper" steps to effectuate its intent with respect to the Commerce clause.
Conclusion
Those who have studied court arguments over the years know that it is folly to use the "ups and downs" of oral argument as an indication of how a court will in fact rule on an issue. Advocates on all sides remain vigilant. Access to healthcare for millions of Americans and their families is at stake. We at the Center for Medicare Advocacy continue to stand by the Affordable Care Act and the many innovative and patient-centered reforms that the law brings to the Medicare and Medicaid programs, and to the healthcare industry as a whole. ACA is already bringing much-needed relief to families. It will continue to do so if allowed to go forward.
For more information, contact attorney Alfred Chiplin (achiplin@medicareadvocacy.org) in the Center for Medicare Advocacy's Washington, DC office at (202) 293-5760.
A Recipe for Medicare Advantage Chaos
By James Gutman - March 30, 2012
It is a timetable from hell in 2012 for Medicare Advantage plans. As usual, they will be submitting to CMS their bids for next year by the first Monday in June. The difference this time is that is likely to be before the ruling by the Supreme Court on the health reform law, and the decision could change everything for MA. While most of the focus during this week of Supreme Court hearings was on the individual mandate for commercial coverage and on the Medicaid expansion, MA also has a huge stake in this decision.
Let’s review what goes up in the air for MA if the high court throws out the entire reform law — a result for which chances seemingly moved from remote to not remote after hearing the justices’ questions and comments during oral arguments this week. First, that means the CMS star-rating bonus payment program may be over since it was created by the reform law.
Second, the payment phasedown to 100% of fee-for-service rates would be out, since that also was established in the law. What would replace it? Plans can guess, but they probably won’t actually know anything by when their bids are due June 4.
In addition, there are all those tremendous opportunities in the new programs for Medicare-Medicaid dual eligibles. These demonstration programs are to be run by the CMS duals office and funded by the agency’s Center for Medicare and Medicaid Innovation, both of them created in the reform law. If the statute is gone, so are those entities, and it is doubtful that many states could fund these demos on their own. And then there’s the new accelerated Oct. 15-Dec. 7 Annual Election Period for MA and Part D. That was created by the reform law. If the statute is gone, does this mean we go back to the old Nov. 15-Dec. 31 dates and to the plan-to-plan switch period at the beginning of the next year?
How do you plan for these kinds of quantum changes? Is it safe to assume that CMS could find other ways to keep the new programs and schedules going? Is the roller-coaster ride just beginning?
It is a timetable from hell in 2012 for Medicare Advantage plans. As usual, they will be submitting to CMS their bids for next year by the first Monday in June. The difference this time is that is likely to be before the ruling by the Supreme Court on the health reform law, and the decision could change everything for MA. While most of the focus during this week of Supreme Court hearings was on the individual mandate for commercial coverage and on the Medicaid expansion, MA also has a huge stake in this decision.
Let’s review what goes up in the air for MA if the high court throws out the entire reform law — a result for which chances seemingly moved from remote to not remote after hearing the justices’ questions and comments during oral arguments this week. First, that means the CMS star-rating bonus payment program may be over since it was created by the reform law.
Second, the payment phasedown to 100% of fee-for-service rates would be out, since that also was established in the law. What would replace it? Plans can guess, but they probably won’t actually know anything by when their bids are due June 4.
In addition, there are all those tremendous opportunities in the new programs for Medicare-Medicaid dual eligibles. These demonstration programs are to be run by the CMS duals office and funded by the agency’s Center for Medicare and Medicaid Innovation, both of them created in the reform law. If the statute is gone, so are those entities, and it is doubtful that many states could fund these demos on their own. And then there’s the new accelerated Oct. 15-Dec. 7 Annual Election Period for MA and Part D. That was created by the reform law. If the statute is gone, does this mean we go back to the old Nov. 15-Dec. 31 dates and to the plan-to-plan switch period at the beginning of the next year?
How do you plan for these kinds of quantum changes? Is it safe to assume that CMS could find other ways to keep the new programs and schedules going? Is the roller-coaster ride just beginning?
Today's Datapoint
14% of Americans think the health reform law has already been overturned, according to the results of a national telephone survey of 1,000 people conducted for the Kaiser Family Foundations health Tracking Poll. 58% understand it remains intact.
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