Supreme Court to hear ACA challenge by religious nonprofits The U.S. Supreme Court announced last week that it would hear another group of court cases that challenge the Affordable Care Act (ACA) requirement that health plans provide a full range of contraceptive coverage to women at no cost. Under the law, religious institutions, including churches, temples and mosques, are automatically exempt from the ACA's contraceptive coverage requirement and do not have to file any paperwork. Nonprofit faith-based charities and religiously affiliated educational institutions and hospitals, however, must notify the health plan or the U.S. Department of Health and Human ... November 19, 2015 Managed Care Affordable Care Act, Contraception, United States Supreme Court, ACA 0 0 Comment Read More »
Gallup poll says rates of uninsured continue to drop in most states According to a Gallup poll released Monday, the national uninsured rate has fallen to 11.7 percent, down from 17.3 percent in 2013. The poll shows that states that have expanded Medicaid under the Affordable Care Act – and have at least helped in the running of their health insurance marketplaces, rather than leaving it entirely to the federal government – have seen larger drops in uninsured rates. In the 22 states that took both of those measures, including California, the uninsured rate dropped to an average of 7.1 percent. California's uninsured ... August 17, 2015 Managed Care, Medi-Cal, Medicare Affordable Care Act, Health Insurance Exchange, Uninsured, ACA, Insurance 0 0 Comment Read More »
Anthem Blue Cross begins medical chart reviews in July In July, Anthem Blue Cross will begin chart reviews on enrollees who purchased Affordable Care Act (ACA)-compliant plans in either the individual and small group insurance markets (both on and off the exchange, known as “Covered California”). The records requests are a result of the commercial risk adjustment program created by ACA Section 1343. The primary goal of the risk adjustment program is to spread the financial risk borne by payors more evenly in order to stabilize premiums and provide issuers the ability to offer a variety of plans to ... July 6, 2015 General, Managed Care Affordable Care Act, Anthem Blue Cross, Covered California, ACA, Health Insurance Exchange 0 0 Comment Read More »
Supreme Court upholds ACA subsidies In a major victory for the Obama administration, the U.S. Supreme Court upheld a key provision of the Affordable Care Act (ACA), reaffirming that 6.4 million people in 34 states can continue to receive subsidies to purchase health care insurance. The question in the case, King v. Burwell, was what to make of a phrase in the law that seems to say the subsidies are available only to people buying insurance on “an exchange established by the state.” Chief Justice John Roberts and Justice Anthony Kennedy joined the court’s four Democratic ... June 26, 2015 General Affordable Care Act, United States Supreme Court, ACA 0 0 Comment Read More »
DHCS reopens window for NICU/PICU claims submission under ACA PCP rate increase On May 18, the California Department of Health Care Services (DHCS) released additional information about Medi-Cal payment increases for primary care physicians under the Affordable Care Act (ACA) who file claims for patients treated in neonatal intensive care units (NICU) or pediatric intensive care units (PICU). In the past, NICU/PICU claims were billed to Medi-Cal using a local code. In order to be eligible for the ACA enhanced payments, physicians were required to submit claims with ACA modifiers beginning April 11, 2014, that linked the local code to an eligible ... May 26, 2015 Medi-Cal Affordable Care Act, Medi-Cal, Pediatrics, ACA 0 0 Comment Read More »
Survey: ER visits continue to climb under Affordable Care Act A recent survey conducted by the American College of Emergency Physicians (ACEP) shows that emergency room (ER) visits are continuing to climb since the implementation of the Affordable Care Act (ACA), despite predictions that the law would result in less crowding. According to a news release, about three-quarters of the 2,098 ER physicians surveyed said that visits have risen since January 2014 — a significant increase from a year earlier, when less than half said they saw an upturn. More than one-quarter reported “significant increases in all emergency patients” since ... May 15, 2015 General, Managed Care Affordable Care Act, Emergency Rooms, Health Care Reform, ACA 0 0 Comment Read More »
CHDP group providers must re-attest by April 17 to receive ACA primary rate increase The California Department of Health Care Services (DHCS) has experienced various difficulties issuing the Affordable Care Act (ACA) primary care rate increase funds on Child Health and Disability Prevention (CHDP) Program claims. Most recently, the California Medical Association learned that CHDP providers practicing as part of a group would be required to re-attest as a group to get paid. Previously, physicians had been instructed to only attest as individuals. DHCS issued an updated “NewsFlash” on March 30 to explain the additional steps that will be required. Groups and clinics that ... April 14, 2015 General Affordable Care Act, CHDP, Child Health and Disability Prevention Program, ACA 0 0 Comment Read More »
NEJM study shows primary care rate increase for Medicaid patients increased access to care A study published in the New England Journal of Medicine last week shows that the increase in Medicaid reimbursement for primary care providers, a key provision of the Affordable Care Act (ACA), resulted in a 7.7 percent increase in new patient appointment availability without longer wait times. The study, conducted by the University of Pennsylvania and the Urban Institute, used “secret shoppers” to call primary care doctors offices seeking new appointments in 10 states: Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania and Texas. Calls were made in ... February 4, 2015 Medi-Cal Affordable Care Act, ACA, Medi-Cal, We Care for California 0 0 Comment Read More »
Poll shows people want Congress to act to make all states eligible for ACA subsidies A new poll has found that nearly six in 10 people believe that Congress or states should act to restore health insurance subsidies if the U.S. Supreme Court strikes them down when it rules on King v. Burwell, a case that questions whether premium subsidies can be provided under the Affordable Care Act (ACA) to individuals purchasing health insurance coverage on exchanges run by the federal government. The poll, conducted by the Kaiser Family Foundation in early January, found that 64 percent wanted Congress to act to make all states ... January 29, 2015 General Affordable Care Act, Health Insurance Exchange, United States Supreme Court, ACA 0 0 Comment Read More »
U.S. Supreme Court to hear ACA subsidy case on March 4 The U.S. Supreme Court has scheduled oral arguments for March 4, 2015, in King v. Burwell; a case that questions whether premium subsidies can be provided under the Affordable Care Act (ACA) to individuals purchasing health insurance coverage on exchanges run by the federal government. The lawsuit has the potential to affect 36 states that use the federal health care exchange, but would not change the subsidies in states like California that run their own exchanges. If the subsidies are struck down, some 5.4 million Americans who signed up for ... January 6, 2015 General Affordable Care Act, Health Insurance Exchange, ACA, U.S. Supreme Court 0 0 Comment Read More »
