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PAHUs Letter to Congress on Health Reform
<<< Click Here >>>
The Health Insurance Underwriter!
PA DECIDES ON EXCHANGES
<<< Click Here >>>
PAHU ISSUES STATEMENT ON CORBETT EXCHANGE DECISION
The Pennsylvania Association of Health Underwriters (PAHU) understands why the Corbett Administration made the decision it did. Despite our preference for a state-based exchange, we realize that the US Department of Health and Human Services (HHS) has not presented clear guidance to states as to the extent to which state regulatory authority would be preserved in a state-based exchange. Other fundamental core questions are how or if the state would be able to oversee marketing of the exchanges particularly by unlicensed Navigators per the Affordable Care Act. A third concern is cost to Pennsylvania taxpayers given the fiscal crisis PA now faces. HHS may provide start-up money for a state-based exchange but the Commonwealth needed to know what costs PA taxpayers would incur to continue operating a state-based exchange. Answers to those questions from the Federal Government were not forthcoming.
Now that the decision has been made by the Corbett Administration, at least insurance agents and brokers can better advise their employer and individual clients as to what to expect from the new insurance system created by the Affordable Care Act effective in 2014.
Consedine Addresses HHS Exchange Implementation Shortfalls
<<< Click Here >>>
PAHU Testifies on Exchanges before House Democratic Policy Committee in Erie August 27
<<< Click Here >>>
HIGH COURT UPHOLDS PPACA
To access the decision, use the following link to the US Supreme Court decision in National Federation of Independent Businesses v. Sibelius
<<< Click Here >>>
Letter from Scott M. Mardis, PAHU President
<<< Click Here >>>
Here is a detailed analysis of the Supreme Court ruling, courtesy of our retained counsel, Ernst & Young
<<< Click Here >>>
Link here to access Supreme Court ruling information
<<< Click Here >>>
IRS Issues FSA PPACA RELIEF
<<< Click Here >>>
HHS Issues Final Rule On Exchanges
<<< Click Here >>>
PAHU Testifies Against PA OCA
<<< Click Here >>>
PPACA Benefits Summary Regulations Issued
<<< Click Here >>>
Link to Federal MLR Legislation
PAHU members were able to gain a majority of the Pennsylvania congressional delegation to sponsor HR 1206 that would exempt agent compensation from the calculation of PPACA's Medical Loss Ratio which has hurt compensation for many insurance agents and brokers.
House: HR 1206 <<< Click Here >>>
Senate S 2068 <<< Click Here >>>
NOTE: These are bill numbers for the 2011-12 Congress. Expect new bill numbers with the new Congress in 2013
HHS Releases Essential Benefits Proposal
<<< Click Here >>>
PPACA Information <<< Click Here >>>
Exchanges <<< Click Here >>>
"PAHU Positions at a Glance" <<<
Click Here >>>
PAHUâ€™S PATH TO CONSTRUCTIVE HEALTH
HHS ISSUES no AGENT MLR DESPITE NAIC VOTE
|Customized Briefing for Vince Phillips
|| November 8, 2012
Leading the News
ACA Expected To Move Forward, But Several Challenges Remain.
As post-election coverage continued, several outlets report on the significance of President Obama's victory for his signature first-term accomplishment, the Affordable Care Act. All sources write that, with this last hurdle out of the way, the health law is certain to be implemented. However, nearly all reports give significant attention to challenges that remain for the Administration to uphold each provision of the ACA, namely time pressure and continued Republican opposition.
The Washington Post (11/8, Aizenman) reports, "President Obama's victory eliminated the last serious threat to the existence of his health-care law, but it didn't remove an array of challenges that will ultimately determine whether the 2010 statute is a policy triumph or a disappointing muddle." The challenges the President and his team still face include "protecting the law from budget cuts Republicans are sure to demand during upcoming negotiations, wrangling wary governors
into going along with the law's expansion of Medicaid, and ensuring that the private insurance markets, or 'exchanges,' at the heart of the law can be rolled out by the law's 2014 deadline."
The New York Times (11/8, Abelson, Thomas, Subscription Publication) reports, "With President Obama's re-election, the sweeping health care legislation signed into law in 2010 has survived what most experts would agree was its last major challenge after the Supreme Court decision in June."
The AP (11/8) reports, "Its place assured alongside Medicare and Medicaid, President Barack Obama's health care law is now in a sprint to the finish line, with just 11 months to go before millions of uninsured people can start signing up for coverage." But, the article continues, "there are hurdles in the way." The AP notes that to deal with some of the upcoming challenges, HHS Secretary Kathleen Sebelius is likely to stay on for another term, providing "a steadying force within the administration."
The Hill (11/8, Baker) "Healthwatch" blog reports that the results of Tuesday's elections "dealt the final blow to Republicans' hope for repealing" the measure. Supporters of the Act are "sure it's here to stay," and that it "will be a success once it's fully in place." The Hill notes, "Conservatives still said Wednesday that they believe the law is bad policy and want to see it repealed, but the avenues to do so are increasingly narrow and far-fetched."
Also covering the story are: the NBC News (11/8, Fox) "Vitals" blog, the NPR (11/8, Hensley) "Shots" blog, the Washington Times (11/8, Richardson), the Wall Street
Journal (11/8, A11, Radnofsky, Mathews, Subscription Publication), the Buffalo (NY) Business First (11/8, Miner, Subscription Publication), the Philadelphia Business Journal (11/8, George, Subscription Publication), the San Antonio Business Journal (11/8, Bailey, Subscription Publication) "AlamoCity Beat" blog, and the Charlotte (NC) Business Journal (11/8, Thomas, Subscription Publication).
Cantor Outlines Strategy To Repeal IPAB.
The Hill (11/8, Viebeck) "Healthwatch" blog reports on a letter from House Majority Leader Rep. Eric Cantor (R-VA) to his GOP colleagues, in which he vowed that outlined ways his caucus "will take aim at President Obama's divisive Medicare cost-cutting board during the new Congress." In the letter, Cantor "said that repealing the health law's Independent Payment Advisory Board (IPAB) is one effort that could garner support in the Senate over the objections of
Democratic Leader Harry Reid (Nev.)." It read, in part, "If we successfully make the case publicly, bills that could reach the president's desk include ... repeal of IPAB."
HHS Expected To Provide Rules On Exchanges, Other Provisions Of ACA.
Modern Healthcare (11/8, Zigmond, Subscription Publication) reports, "While President Barack Obama's victory Tuesday night ensured the continued implementation of the Patient Protection and Affordable Care Act, it also added pressure on the administration to offer healthcare interest groups more clarity on several provisions of the landmark 2010 law." Many in the industry expect the Administration will "release a wave of policies and regulations quickly, especially as states
have just until the end of next week to decide if they will establish a health insurance exchange." Given the immediacy, rules regarding the exchanges are anticipated first. Next "to be issued are a rule on essential health benefits and guidance for employers about what constitutes part-time and full-time employees, as employers will face penalties for not offering coverage to their workers."
Insurance Mandate Seen As More Likely.
Modern Healthcare (11/8, Subscription Publication) reports that Moody's analysts have released an opinion stating that the ACA's insurance mandate is "now more likely to take effect" given President Obama's victory Tuesday. However, "Health policy and funding remains uncertain as the president and Congress grapple with the nation's deficit and spending cuts, known as sequestration, scheduled to go into effect in January under the Budget Control Act enacted last year."
Politico Examines Major Changes Coming From ACA.
Politico (11/8, Nather) examines what will come of the Affordable Care Act, now that President Obama has been reelected and the law is not going to be repealed or gutted. The "big pieces," like coverage of pre-existing conditions and the individual mandate, will begin in 2014; what Americans have seen so far are just "the warm-up acts." Other provisions that are coming in 2014 include the exchanges, subsidies for those without insurance who can't afford it, and
penalties for people without, who can afford it. However, Politico writes, the "odds that everything will go accord to plan" are "pretty close to zero."
USVI Delegate Proposes Expanding ACA To Territories.
The Hill (11/8, Kasperowicz) "Floor Action" blog reports, "A House Democrat from the U.S. Virgin Islands has proposed legislation that would expand a key part of the 2010 healthcare law to U.S. Territories." The measure, "from Del. Donna Christensen (D), would expand the insurance program for people with pre-existing conditions to her territory and others like Puerto Rico and Guam." The post notes, this would "primarily mean an expansion to the more than 4 million
residents of Puerto Rico, which has a higher population than all other territories combined."
Voters In Several States Decided On ACA-Related Measures.
MedPage Today (11/8, Pittman) reports that on election day, five states "voted on measures aimed squarely at the Affordable Care Act (ACA), with one - Missouri - passing an initiative that could hamstring efforts to establish its health insurance exchange under the ACA." Alabama, Montana, and Wyoming also had anti-ACA measures on their ballots, but "opponents say they carry little legal significance even if they pass since federal law trumps state law." In Florida, a
constitutional amendment to nullify the individual mandate failed.
Former HHS Secretaries Offer Advice For Obama.
In a post for the New York Times (11/8, Subscription Publication) "Room for Debate" blog, Louis W. Sullivan, HHS Secretary under President George W. Bush, explains why he is a "vocal supporter of the Affordable Care Act," and implores the President to better explain the law to the people to boost public support. He writes, "I believe our nation has a moral obligation to provide its citizens with coverage for health care and that health promotion/disease prevention services and improving
health care delivery are the best stratagems to reduce health care costs." Sullivan concludes, "With presidential leadership, this health law, with its focus on innovation, prevention, wellness, health care system changes, improving primary care and manpower increases, offers the best chance to reduce health care costs and improve the health of all Americans."
In a separate post for the New York Times (11/8, Subscription Publication) "Room for Debate" blog, Donna E. Shalala, HHS Secretary under President Clinton, offers her advice to President Obama, writing, "Stay the course on health care reform. Don't worry that some states aren't ready to implement the plan. Phasing in implementation and having the federal government offer plans in some states is not such a bad thing." She concludes, however, "We need a substantive and political strategy, which
requires bipartisan leadership."
Physician Warns Of "Brave New World" Of Healthcare Under ACA.
Dr. Constance Uribe, a general surgeon, writes an op-ed for the Washington Times (11/8, Uribe) warning about the "significant rationing of health care resources" that will come from the implementation of the Affordable Care Act. She focuses mainly on IPAB, but also touches upon the cuts to Medicare the law includes, writing, "Under the guise of cutting Medicare spending and improving quality care, the government has made a dangerous
move toward a socialistic form of health care, a form devoid of personal choice." She concludes, "America is becoming a Brave New World composed of young adults with a life expectancy at the mercy of God and God alone."
Legislation and Policy
As Deadline Approaches, States Must Move Forward With Exchanges.
Now that the President's reelection has secured the future of the Affordable Care Act, several reports focus on the immediacy of the HHS deadline for setting up a state-based exchange, which is a little over a week away. In addition to national outlets focusing on the exchange provision, dozens of local outlets reported how their state is treating the deadline.
Bloomberg News (11/8, Wayne, Nussbaum) reports, "State officials who held off implementing some aspects of the 2010 Affordable Care Act now face pressure to make decisions almost immediately." Bloomberg notes, "They have nine days to advise the federal government how they plan to manage state-run exchanges created by the law to provide medical coverage to the uninsured, or face a de facto U.S. takeover of their insurance markets." Bloomberg adds that only 13 states so far
have made their exchange decisions.
The Washington Post (11/8, Kliff) "Wonkblog" also reports that though the law's continuation is now certain, how it is implemented depends on the states. Each must decide "whether to set up a health insurance exchange" or rely on the Federal government to do so, and they must choose whether to opt-in to Medicaid expansion. The blog notes that "the timeline to get this all done, meanwhile, is tight." The post includes a map which delineates which states have made progress toward
exchanges and which have not.
CQ (11/8, Adams, Subscription Publication) reports that much of the implementation of the ACA is now in the hands of states, 30 of which will be led by Republican Governors starting next year. And, "many of those GOP governors are philosophically opposed to the 2010 health care law, including the idea of expanding Medicaid." Six Republican Governors have already said they will not expand the program, with others saying they would wait "for the results of the election to decide." CQ predicts that for these governors, "what to do
about Medicaid will likely figure high on their agendas come January."
Given that "there appears little to stop full implementation of Obamacare, President Barack Obama's signature legislation," the Insurance & Financial Advisor (11/8) provides an overview of where the states stand regarding the insurance exchanges, and Medicaid expansion.
Analysis Shows 20 States Will Run Their Own Exchanges.
The Hill (11/8, Viebeck) "Healthwatch" blog reports that a new analysis, released by Avalere health Wednesday, shows that "twenty states will operate their own insurance exchanges in 2014 under President Obama's healthcare law." Further, "13 states are likely to use the partnership model, while more than a third will default to a federally run exchange."
Virginia, Pennsylvania Still Uncertain About Exchange, Cite Lack Of Guidance.
The Washington Business Journal (11/8, Fischer, Subscription Publication) reports that Virginia Governor Bob McDonnell has still not given "a precise answer" as to which insurance exchange format the state will choose. McDonnell's spokesman Jeff Caldwell explained the delay, saying that the Federal government hasn't provided enough guidance. He said, "States need to understand the federal exchange model and answers remain to be provided as to how the pieces will link together within an
exchange partnership between the federal and the state. We now have 10 days until the first decision is expected. This is not a reasonable timeline given the lack of information provided to states." The article notes that even if HHS does release clarifying regulations, as many expect, it isn't up to McDonnell to decide. Caldwell explained, "For Virginia, the legislature must make the final call regarding the establishment and ultimate structure of a health benefits exchange."
The Allentown (PA) Morning Call (11/8, Darragh) reports that "Pennsylvania has some cramming to do," as Governor Tom Corbett has put off making many decisions regarding the Affordable Care Act. Now that President Obama has been reelected, the law's "deadlines will come fast and furious at the states." The state's Insurance Department, however, places the blame on the Federal government, saying "Commissioner Michael Consedine is still awaiting answers to questions he sent to HHS Secretary
Kathleen Sebelius in August." The article notes that though Pennsylvania received more than $33 million in grants from HHS to establish an exchange, none of the money has been spend and no progress has been made.
Wisconsin Must Act Soon On Exchange Decision.
The AP (11/8, Richmond) reports, "President Barack Obama's re-election is forcing the hand of Wisconsin Gov. Scott Walker, who had stopped all efforts to implement the federal health care reform law in the hopes that Republicans would take over in Washington." With Democrats retaining control of the White House and the Senate, "Walker's administration and Republican leaders in the state Legislature are now scrambling to figure out their next move." Despite the immediacy of the November 16 exchange deadline, Walker "downplayed the
urgency of the situation" in a press conference Wednesday, saying, "Even after notifying them, we have until next fall to make modifications as we see fit. We haven't made a decision yet."
Several More States Yet To Make Exchange Decision.
The Houston Business Journal (11/8, Raji, Subscription Publication) "Houston Biz Blog" reports that "It's still to be determined whether Texas will have its own exchange or if it will opt out, in which case Texans will have access to a federal version."
The Atlanta Journal-Constitution (11/8, Williams) reports that having "put off key decisions tied to the law, hoping it would be repealed," Georgia's Republican Governor Nathan Deal must now decide whether to set up a state exchange and expand Medicaid.
The Columbus (OH) Business First (11/8, Ghose) "Columbus Biz Insider" blog reports that because Ohio Governor John Kasich and Insurance Director Mary Taylor chose to wait until after the election to act on various provisions of the Affordable Care Act, the state is now likely to opt for the Federally-run insurance exchange. Though they will "will release more information by the Nov. 16 deadline to notify the federal government of its plans," Insurance Department spokesman Chris Brock says,
"We're still leaning toward letting the federal government run the exchange in Ohio."
The Casper (WY) Star-Tribune (11/8, Wolfson) reports, "President Barack Obama's re-election clears the way for the Affordable Care Act's implementation in Wyoming, but state leaders must still decide how much they'll comply with the federal health reform law." On the question of exchange, the article notes, "The state won't be ready to operate its own exchange – a virtual marketplace where individuals and small business could shop for insurance – in time to meet federal guidelines."
The Oklahoman (11/8, Campfield) reports, "Oklahoma is one of eight states that have made no significant activity toward the development of a health care exchange." Governor Maryl Fallin's spokesman Alex Weintz said Wednesday, "We are confident we've kept our options open at this point and are going to make a decision based on what's best for Oklahomans, not make a decision necessarily as quickly as possible. During this process, the governor has continued to talk with
health care experts in Oklahoma so that if we were to decide to do a state-based exchange ... we would have the capability, we hope, of doing so."
Scott Still Opposed To Exchanges, Medicaid Expansion.
The Sarasota (FL) Herald Tribune (11/8, Anderson) reports that Florida Governor Rick Scott (R) is still "not ready to get behind President Barack Obama's health care reform." In his first post-election public comments, Scott "continued to criticize the law Wednesday," saying "it will cost taxpayers and business owners too much to expand Medicaid and set up health insurance exchanges as called for under the law." Scott said, "No one has been able to show me that that health care exchange is
going to do anything rather than raise taxes, raise the cost of our companies to do business."
The South Florida Business Journal (11/8, Bandell, Subscription Publication) "Heard Along The Coast" blog explains, "state inaction would mean that the federal government sets up a health exchange for Florida and the rules would be written in Washington, D.C."
Kansas, South Carolina Will Not Implement State Exchanges.
The Kansas City (MO) Star (11/8, Stafford) reports that Kansas Insurance Commissioner Sandy Praeger said of the Affordable Care Act Wednesday, "This is the law of the land. I don't see it going away." However, given how close it is, Kansas is among "dozens of states with legislatures or governors that don't intend to meet the deadline to establish state-based insurance exchanges by 2014."
The Kansas City (MO) Business Journal (11/8, MorningSky, Subscription Publication) reports Praeger said that "the opportunity has passed for Kansas to run its own insurance exchange."
WJBF-TV Augusta, GA (11/8, Kittle) reports that South Carolina Department of Health and Human Services director Tony Keck announced Wednesday that the state will not set up its own insurance exchange. He said, "We've let [HHS] know we're not going to set up a state-based exchange. It's a federal program and it's their responsibility to make it work."
California, Maryland, Illinois Move Forward With Exchanges.
The Los Angeles Times (11/8, Terhune) reports, "With President Obama's reelection lifting a potential roadblock, California officials are rushing to implement the federal healthcare law and revamp the insurance market for millions of Californians starting next fall." On Wednesday, "California officials disclosed plans to spend nearly $90 million next year on marketing and outreach to millions of consumers who may become eligible for premium subsidies and other assistance under the
federal law starting in 2014."
The Sacramento (CA) Business Journal (11/8, Robertson, Subscription Publication) blog reports Peter Lee, executive director of Covered California, the state's insurance exchange responded to Obama's reeelection, saying, "Today, we are at a new starting line, and the focus of the nation and California will be the work we are doing together to expand coverage and make health care more affordable."
The Baltimore Sun (11/8, Walker) reports that because "Maryland continued to move forward with implementing reform despite the uncertainty surrounding the election," its exchange will be ready for open enrollment beginning in October 2013.
The Chicago Tribune (11/8) reports that following President Obama's reelection, Illinois is "racing to meet deadlines and ensure that systems are in place before Jan. 1, 2014, the day the major provisions of the overhaul go into effect." The article notes that "Illinois only recently began taking steps to develop its exchange. Gov. Pat Quinn last month sent official word to Washington that the state will run its insurance marketplace in partnership with the federal government
for at least 2014."
Healthcare Industry Responds To Certainty Of ACA Implementation.
Reuters (11/7, Humer) reports that the medical industry responded to President Obama's reelection Tuesday, and the ensuing assumption that his healthcare law was no longer in danger of being repealed. Many hospital groups saw their stocks rise Wednesday morning, as people anticipated a larger insured population would be good for providers. For example, HCA shares rose over seven percent. However, insurance companies saw their stocks fall, as the ACA limits profits
and requires more coverage than many insurers now offer. UnitedHealth and Aetna both saw drops of around four percent.
Bloomberg News (11/8, Armour, Nussbaum) explains the stock shifts this way: "HCA Holdings Inc. (HCA) and other hospitals will get more paying customers while insurers like UnitedHealth Group Inc. (UNH) will see profits squeezed as U.S. President Barack Obama moves to preserve the health-care overhaul he championed." Analyst Frank Morgan told Bloomberg, "'Volumes of business will improve for hospital companies and bad debt will go down with the reduction in the uninsured' as
the law moves forward. While a Mitt Romney win might have benefited insurers, the Republican would have brought 'a cloud of uncertainty' for hospitals."
The Los Angeles Times (11/8, Terhune) looks further into the insurance "sell-off," with some analysts saying it was "overdone," as "the Affordable Care Act will bring as many as 30 million more Americans into the private-insurance market and state Medicaid programs, which many insurers contract with to provide managed-care plans." However, the article notes, "the federal overhaul also imposes new rules on health insurers, such as forcing them to accept applicants with preexisting
medical conditions starting in 2014 and requiring them to spend a minimum amount of premiums on medical care."
Modern Healthcare (11/8, Kutscher, Subscription Publication), the Memphis (TN) Business Journal (11/8, Epley, Subscription Publication), and the Nashville (TN) Business Journal (11/8, McGee, Subscription Publication) "NashvilleBizBlog" report further on specific stock figures for various
hospital groups and insurance companies.
AHIP Questions Provisions Of ACA.
The Hill (11/8, Baker) "Healthwatch" blog reports that America's Health Insurance Plans (AHIP) released a statement Wednesday, in which it "congratulated President Obama...but said certain pieces of his signature healthcare law should still be repealed or changed." The statement read in part, "Several provisions in the law, such as the new premium tax, minimum coverage requirements and age rating restrictions need to be addressed to keep coverage as affordable as
possible and ensure broad participation in the system."
Companies Facing Full Implementation Of ACA.
The Washington Business Journal (11/8, Fischer, Subscription Publication) reports on the work that employers must to do to prepare for the full implementation of the Affordable Care Act, now that their "last plausible path to repeal...crumbled in President Barack Obama's decisive reelection." The changes companies must expect include "penalties for places with at least 50 workers that don't offer insurance." And, "if you do offer insurance, an available plan must cover at least 60 percent
of medical costs and cost less than 9.5 percent of an employees' income."
The Kansas City (MO) Business Journal (11/8, Stagemeyer, Subscription Publication) carries a similar report, focusing on Kansas City employers.
Expert Says ACA Will Change The "Business Side" Of Medical Practices.
The Columbus (OH) Business First (11/8, Ghose) reports that physicians' "adjustment to the new-normal of the health-care industry in the coming years of implementing the Affordable Care Act will not be easy, says Ken Weixel, Columbus-based leader of Deloitte's US. Healthcare Practice." Weixel says that the law will change the "business side" of running a medical practice. The article says that "with a greater number of insured people, an emphasis on prevention and a shortage of" primary care
physicians "(internists, family docs and pediatricians), the physician's role in primary care will shift to a supervisor of a team that includes nurse-practitioners, physician assistants and allied health professionals who will be delivering most of the annual checkups and strep swabs." According to the publication, "the future is more murky, he says, but it's also possible the independent physician practice will disappear because nearly all doctors will become employed by hospitals or health insurers."
In a separate article, the Columbus (OH) Business First (11/8, Ghose) reports that in a post-election debriefing to the Ohio Society of CPAs, Ken Weixel, said that "a more retail-like environment could prevail in the health-care industry after all the regulatory and market changes to come, starting to settle into a 'new normal' around 2017." The article adds that "two big outcomes," Weixel says, "of the shift to paying for value of care instead of the volume of tests and procedures should help improve quality and
bring down costs: Comparative effectiveness research that will result in preferential payment for drugs and procedures that evidence shows work best, and personal accountability built into health plans that require consumers of to shoulder part of the costs incurred by lifestyle choices like smoking."
Medical Industry Warns Of Impending SGR, Sequestration Cuts.
Modern Healthcare (11/8, Zigmond, Subscription Publication) reports that in addition to implementing the Affordable Care Act, two important healthcare issues face President Barack Obama now that he has been reelected. These are "the 2%, across-the-board Medicare cuts scheduled to take effect Jan. 2; and the anticipated 27% reimbursement cut in Medicare payments to physicians after Feb. 1."
The Hill (11/8, Viebeck) "Healthwatch" blog reports that the American Medical Association congratulated President Obama on his reelection Wednesday, but "warned of looming cuts set to hit Medicare in the new year unless Congress acts." The cuts, to Medicare's sustainable growth rate (SGR), have been avoided with "short-term fixes" since 2003, and the "current fix expires on Dec. 31." Should Congress not act, physicians will see a 27% decrease in Medicare reimbursements
from the government. AMA President Jeremy Lazarus said in a statement, "It is time to transition to a plan that will move Medicare away from this broken physician payment system and toward a Medicare program that rewards physicians for providing well-coordinated, efficient, high-quality patient care while reducing healthcare costs."
Health IT Policy Committee Meets.
Modern Healthcare (11/8, Conn, Subscription Publication) reports that yesterday morning, "the Health IT Policy Committee met to discuss the future course of the federal electronic health-record incentive payment program. The committee, created by the same American Recovery and Reinvestment Act of 2009 that created a program of $27 billion in incentive payments for the adoption and meaningful use of EHRs, was readying for publication and public comment its recommendations for
Stage 3 meaningful-use criteria, which likely won't go into effect until at least 2016." National coordinator for health information technology Dr. Farzad Mostashari "dropped in on his gathered advisers to present them with an addendum of seven suggestions he wanted the committee to make sure were addressed in what is now a 38-page document of Stage 3 rules." Recommendations made by the committee are expected to be published officially in the Federal Register "sometime next week."
Public Health and Private Healthcare Systems
Humana Purchases HIE Technology Provider Certify Data Systems.
Healthcare IT News (11/8, Brino) reports that "the Louisville-based insurer Humana has acquired Certify Data Systems, a health information exchange vendor, on undisclosed terms." According to the article, "Humana executives said they were interested in Certify's 'Health Logix' platform, which allows clinical information exchange across various electronic health record systems and is offered in multiple configurations, with cloud-based options." The report notes that "amid the
search for cost savings, the use of new care models like ACOs and business diversification, Humana is the third insurer in recent years to purchase an HIE technology maker."
Utah May Boost Pay For Tutors In Autism Pilot Program.
The Salt Lake (UT) Tribune (11/8) reports, "Utah's Medicaid department is looking into increasing how much it will pay tutors who will provide free applied behavior analysis (ABA) therapy to children with" autism. The Tribune notes, "Medicaid set the rate for the tutors...at $21.52 an hour" for the pilot program, but the rate could fall to "as little as $14.42 an hour because of insurance and other training costs. Few existing ABA therapists were interested in applying, saying the pay
was too little for their experienced employees and wasn't enough to train less-qualified applicants."
Washington Medicaid To Cover ABA Therapy For Autistic Children.
The Spokane (WA) Spokesman-Review (11/8, Bannach) reports that in what "has been hailed as a turning point for struggling Washington families with autistic children," Washington children with autism who are enrolled in Medicaid "will have access to ABA therapy." The Spokesman-Review adds, "The Washington State Health Care Authority has agreed to cover the cost of the therapy for children diagnosed with autism spectrum disorders, after it settled a lawsuit brought by the Washington Autism
Alliance & Advocacy, the HCA announced last week." The Spokesman-Review notes, "There are 9,000 youth on Apple Health for Kids who have an autism diagnosis and may benefit from the therapy."
Wednesday's Lead Stories
NAHU Newswire is a digest of the most important news selected from thousands of sources by the editors of BulletinHealthcare. The National Association of Health Underwriters does not receive any revenue from the advertising herein. The presence of such advertising does not endorse, or imply endorsement of, any products or services by the National Association of Health Underwriters.
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