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CMS Releases SHOP Program Rule

On May 31, the Centers for Medicare & Medicaid Services (CMS) released a final rule on the Small Business Health Options Program, part of the Affordable Care Act (ACA), as well as simplified application forms for the program. The final rule was published in the Federal Register on June 4. …
Read More Healthcare Update: CMS Releases SHOP Program Rule; White House Memorandum Updates Exchange Progress

Program:

Insurance Linked Securities: The Convergence of Insurance and the Capital Markets

Discussion of the legal and regulatory issues for various ILS structures including CAT Bonds, ILW’s and Side Cars.

Read More PLEASE JOIN US – 12th Annual Half-Day Insurance and Reinsurance Seminar – Complimentary Seminar

Healthcare News from Capitol Hill and the Department of Health and Human Services

In an open letter to the “health care provider community,” Senators Max Baucus (D-MT) and Orrin Hatch (R-UT), the leaders of the Senate Finance Committee, have asked for suggestions on reforming the Medicare physician payment system. The letter notes that the current Medicare sustainable growth rate (SGR) formula is broken and must be repealed.
Read More Senate Finance Committee Leaders Seek Input on Medicare Physician Payment Reform

CCIIO ISSUES BROKER GUIDELINES FOR EXCHANGES
On May 1, the Center for Consumer Information and Insurance Oversight (CCIIO), a part of the Centers for Medicare and Medicaid Services (CMS), issued guidance on the “Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces.” The marketplaces, commonly known as health insurance exchanges, are scheduled to be in operation for open enrollment on October 1, 2013, with coverage to take effect on January 1, 2014. …
Read More Healthcare Update: CCIIO Issues Broker Guidelines for Exchanges; HHS Releases New Insurance Application Forms

Members of the Rhode Island House of Representatives met on May 1, 2013 to discuss H.B. 5459, the Stop-Loss Insurance Act (the “Act”), which was introduced on February 14, 2013. The Act proposes to place further restrictions on the use of stop-loss insurance by employers who self-insure their employee benefit health plans. …
Read More Bill Restricting the Sale of Stop-Loss Insurance Gains Traction in Rhode Island

The Centers for Medicare & Medicaid Services (“CMS”), part of the United States Department of Health and Human Services, has proposed new rules to create conflict-of-interest standards applicable to navigators. Under the Patient Protection and Affordable Care Act (the “Act”), navigators will assist consumers in obtaining coverage from health insurance exchanges to be established under the Act. …
Read More New Rules Proposed to Prohibit Persons Connected with Stop-Loss Insurance Coverage from being Health Insurance Exchange Navigators; New Disclosure Requirements also Proposed

HHS UPS MEDICAID EXPANSION PAYMENTS FUNDING
On March 29, the U.S. Department of Health and Human Services (HHS) issued a final rule under which the federal government will pay the entire cost of covering newly eligible enrollees under the Patient Protection and Affordable Care Act’s Medicaid expansion for the first three years of the program. …
Read More Healthcare Update: HHS Ups Medicaid Expansion Payments Funding; BCBS of MI Antitrust Case Dropped

SEQUESTER TO SQUEEZE MEDICARE PAYMENTS
The automatic spending cuts that went into effect on March 1 under the Budget Control Act, also known as the sequester, included 2% cuts to provider payments under the Medicare program. While cuts to other federal agencies were more substantial – an average of 8% – the new Medicare cuts would nonetheless amount to $11 billion over one year, according to the White House, if the sequester lasts that long. …
Read More Healthcare Update: Sequester to Squeeze Medicare Payments; CMS Announces New Participants in Community-Based Care Program