"Although the cost of health care is a common concern...

... for the public and health policymakers have recently focused on improving the value of services, those with insurance say they are largely content with the value of the health care services they receive."

— From a recent Kaiser Family Foundation report on its consumer Health Tracking Poll conducted in mid-January.

Today, the Centers for Medicare & Medicaid Services (CMS) issued the final 2017 HHS Notice of Benefit and Payment Parameters for the 2017 coverage year,

Good afternoon - Today, the Centers for Medicare & Medicaid Services (CMS) issued the final 2017 HHS Notice of Benefit and Payment Parameters for the 2017 coverage year, along with related guidance documents, as part of our ongoing efforts to promote healthy and stable markets that works for consumers and for insurers.

 

The rule finalizes provisions to: help consumers with surprise out-of-network costs at in-network facilities, provide consumers with notifications when a provider network changes, give insurance companies the option to offer plans with standardized cost-sharing structures, provide a rating on HealthCare.gov of each QHP’s relative network breadth (for example, “basic,” “standard,” and “broad”) to support more informed consumer decision-making, and improve the risk adjustment formula.  

 

To help stakeholders plan ahead, CMS also finalized the open enrollment period for future years. For coverage in 2017 and 2018, open enrollment will begin on November 1 of the previous year and run through January 31 of the coverage year. For coverage in 2019 and beyond, open enrollment will begin on November 1 and end on December 15 of the preceding year (for example, November 1, 2018 through December 15, 2018 for 2019 coverage).

 

The fact sheet with details on these key provisions and others can be found here: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-29.html.

 

In addition to the final Notice of Benefit and Payment Parameters for 2017, CMS released its final Annual Letter to Issuers. This provides issuers interested in offering coverage in states with a Federally-facilitated Marketplace  information on key dates for the Qualified Health Plan (QHP) certification process; standards that will be used to evaluate QHPs for certification; and oversight procedures, consumer support policies and programs. The letter is available here: https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Final-2017-Letter-to-Issuers-2-29-16.pdf

 

Additionally, CMS released a bulletin on the Rate Filing Justifications for the 2016 Filing Year for Single Risk Pool Compliant Coverage. This bulletin provides guidance on the timing for state Departments of Insurance and health insurance insurers to submit Rate Filing Justifications for proposed rate increases in the individual and small group markets. The guidance, which offers states greater flexibility than the proposed bulletin, is available here: https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Final-rate-filing-justification-bulletin-2-29-16.pdf

 

Key Dates for the 2016 calendar year: https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Final-2016-key-dates-table-2-29-16.pdf

 

CMS released a set of Frequently Asked Questions (FAQs) related to the Moratorium on the Health Insurance Provider Fee (enacted in the Consolidated Appropriations Act of 2016, P.L. 114-113), which suspends collection of this fee for the 2017 plan year. This guidance urges issuers to lower their administrative costs and premiums appropriately to account for the moratorium. The FAQs are available here: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/FINAL_9010_FAQ_2-29-16.pdf.

 

Lastly, CMS released guidance addressing the transitional policy for plans that have been continuously renewed since 2014. To allow for a smooth wind-down of transition relief, States and issuers will have the option to renew non-grandfathered individual and small group health policies, but these policies must end no later than December 31, 2017.  This approach offers flexibility to States and issuers to align the end of these policies with open enrollment and the start of the calendar year, facilitating smooth transitions to Affordable Care Act-compliant policies.  The guidance is available here: https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/final-transition-bulletin-2-29-16.pdf

 

20 ...

... of the country's largest employers (including American Express, Shell Oil, Macy's, Verizon and IBM) are launching an initiative — the Health Transformation Alliance — to combat high costs in health benefits, the group announced recently.

"Let's be clear: opposing a proposal only because ...

... one believes it cannot be passed is usually a dodge. One should judge the merits. Strong leaders prove their skill by persuading people to embrace their visions. But single-payer is different. It is radical in a way that no legislation has ever been in the United States."
— Henry Aaron, Ph.D., a senior fellow in economic studies at The Brookings Institution, a left-leaning think tank, writing about presidential candidate Bernie Sanders' (I-Vt.) support for a single-payer system in the U.S., which Aaron calls "a dream" that has no chance of passage.

18% of Adults Visited the ER in 2014

The CDC recently conducted a study on adult emergency room (ER) use in 2014. Here are some key findings from the report:

·         In 2014, 18% of adults visited the ER one or more times.

·         7% went to the ER because of a lack of access to other providers.

·         3 in 4 (77%) cite seriousness of the medical problem as the reason for the most recent ER visit.

·         12% say they went to the ER because their doctor's office was not open.

·         Adults with Medicaid had the highest prevalence of 2+ ER visits in the past 12 months (18.5%).

·         14.3% of privately insured adults visited the ER in 2014, while 35.2% of adults with Medicaid did.

Source: Centers for Disease Control and Prevention, February 8, 2016

Are your consumers ready for the 2015 tax season?

Don’t miss the upcoming “Tax Season Readiness 101” webinar for agents and brokers on Wednesday, March 9, 2016 from 12:30 PM to 2:00 PM Eastern Time (ET). The webinar will highlight information on how to assist consumers during the 2015 tax season and explain why consumers must reconcile advance payments of the premium tax credit.

To register for the webinar, please log in to www.REGTAP.info. If you have questions on the webinar registration process, visit the new “Upcoming Agent and Broker Webinars” section of the Agents and Brokers Resources webpage for more information.

Wells Fargo recently conducted the second annual Employee Benefits Trends Survey ...

... of C-suite executives and human resources or employee benefits (HR/EB) managers. Here are some key findings from the report:

• Almost 3 in 4 companies intend to make health and wellness changes in 2016-2017.
• 45% of executives plan to increase wellness offerings, compared with 36% of HR/EB managers.
• Half (51%) expect to increase their budget for health and wellness.
• 44% of executives plan to add wellness incentives/penalties, compared with 30% of HR/EB managers
  Managing the overall cost of healthcare benefits is the number 1 priority of employers for 2016 (21%).
• 37% of C-suite executives and 28% of HR/EB managers plan to move employees to the public exchange.

Source: "Employee benefits trends in the workplace and marketplace: Perspectives from the C‑suite and HR/Benefits Managers," Wells Fargo, January 2016, https://wfis.wellsfargo.com/insights/research/2015EBHealthProductivityTrends/Documents/WCS-1968501-WFI-EmplBenefits-Survey-Trends-WhtPaper-FNL.pdf