The One That Got Away – Glitch in Reform Law Will Allow Middle Class to Join Medicaid

While speaking at a professional society meeting recently, Richard Foster, Medicare’s chief actuary, revealed that early retirees would have access to Medicaid under the health reform law as it is currently written. This glitch would enable a married couple with an annual income of $64,000 to apply and receive Medicaid. Under new rules effective in 2014, Social Security benefits will be discounted toward income thresholds when individuals apply for Medicaid, which would allow middle-class people to enroll. Currently, retirees can begin accessing Social Security at age 62, but are not able to enroll in Medicare until they reach age 65, leaving three years where they may be without coverage.

Two Birds, One Stone – Reducing Hospital Readmission Rates

Two of the main goals of the health reform legislation are to improve the quality of care delivered to Americans and to reduce the overall costs of the healthcare system. A provision in PPACA aims to kill two-birds with one stone, by improving the quality of care delivered to Medicare patients discharged from hospitals and reducing the unnecessary costs associated with readmissions.

How Does Your Provider Measure Up? “Report Cards” Ranking Provider and Supplier Performance Coming Soon

Earlier this week, the Centers for Medicare and Medicaid Services released a proposed rule that would make Medicare information regarding provider cost and quality available to certain organizations. The non-identifying claims data would be used to produce public reporting on physicians, hospitals and other healthcare providers to enable consumers and employers to select higher-quality, lower-cost physicians. The Medicare data would be combined with claims data from the private sector and allow consumers and employers to determine which providers and facilities provide the highest-quality at the lowest cost.

Health Reform Update: Rule Requiring Reviews of Unreasonable Rate Increases Finalized

Last week, CMS released the final rule implementing a requirement in health reform that directs the Secretary of HHS to establish a process for the annual review of unreasonable increases in premiums for health insurance coverage. Per a provision in PPACA, premiums that would increase more than ten percent would be subject to an automatic review by either the state insurance regulator or by CMS. States that are determined by CMS to have a comprehensive rate review program will continue to complete reviews of the proposed increase and report their decision to CMS for public posting. If a state’s review program does not meet the CMS criteria, the review will be conducted by CMS. The final rule applies to small group and individual commercial plans.