Health care spending rose modestly in 2015 In 2015, per-capita health care spending grew by 5 percent and overall health spending grew by 5.8 percent, according to a new study by the Office of the Actuary at the Centers for Medicare and Medicaid Services. While overall expenditures increased, the rate of growth is still substantially lower than the 9 percent average rate seen in the three decades before 2008. On a per-enrollee basis, overall spending increased in 2015 by 4.5 percent for private health insurance, 1.7 percent for Medicare and 3.8 percent for Medicaid. According to the ... December 14, 2016 General Affordable Care Act 0 0 Comment Read More »
U.S. divided about what should be done with ACA A Kaiser Family Foundation poll has found that Americans are divided on the future of the Affordable Care Act (ACA). The survey found that 26 percent of the country wants to repeal the entire law. Meanwhile, 30 percent want to expand the law, 19 percent want to keep it as-is and 17 percent want to scale it back. The poll found that Republican respondents were more likely to want to scale back the law, rather than fully repealing it. Among the 26 percent of Americans who want to see the ... December 14, 2016 General, Managed Care Affordable Care Act, ACA 0 0 Comment Read More »
Are you in compliance with federal nondiscrimination rule? The California Medical Association has published answers to the most frequently asked questions regarding the new nondiscrimination rules recently published by the U.S. Department of Health and Human Services Office for Civil Rights. The final rule, which implements the nondiscrimination provision of the Affordable Care Act, Section 1557, requires covered physician practices to post nondiscrimination notices and inform patients with disabilities and limited English proficiency (LEP) about the right to receive communication assistance, including the availability of language assistance services. These requirements aim to provide important protections for individuals with disabilities ... October 14, 2016 General Affordable Care Act, Discrimination 0 0 Comment Read More »
Blue Shield implements system fix to correctly pay HPV9 claims Under the Affordable Care Act, health plans are required to provide “first dollar” coverage for preventive services. This means that the plan cannot apply patient cost sharing, such as copays, coinsurance or deductibles, to these services. However, in September 2015, the California Medical Association (CMA) was alerted by a physician practice that Blue Shield of California was applying patient cost sharing when it processed HPV9 claims with CPT code 90651. CMA escalated the issue to Blue Shield and has been working with the payor since then to correct the ... August 9, 2016 Managed Care Affordable Care Act, Blue Shield, ACA 0 0 Comment Read More »
Covered California announces plan offerings for 2017 Covered California, the state marketplace for health insurance under the Affordable Care Act, recently announced the qualified health plans that were approved to offer coverage in the exchange market for 2017. All of the plans that offered coverage in 2016 will continue to do so in 2017. Three of the plans will also be expanding into new regions this year. Molina is expanding its HMO coverage into Orange County (region 18) through delegated relationships with Monarch and Heritage Network ... August 8, 2016 Managed Care Affordable Care Act, Covered California, Exchange Plans, Molina, Oscar, ACA, Kaiser Permanente 0 0 Comment Read More »
Covered California announces sharp rate hike Covered California has announced an average 13.2 percent hike in insurance premiums for 2017, a sharp increase that is likely to reverberate nationwide in an election year. The California Medical Association (CMA) is concerned the premium increases may hinder the ability of some patients to obtain insurance and access necessary medical treatment. The rise in Covered California premium rates was driven largely by its two biggest insurers, which account for about half of its enrollment. Blue Shield of California said its average rate hike is 19.9 percent, the biggest statewide ... August 5, 2016 Managed Care Covered California, Exchange Plans, Health Insurance Exchange, Affordable Care Act 0 0 Comment Read More »
Supreme Court sends contraceptive coverage under ACA case back to lower court On May 16, 2016, the U.S. Supreme Court issued an unsigned unanimous opinion announcing that it would not rule on the merits of the case regarding the contraceptive coverage requirement under the Affordable Care Act (ACA). The move is seen as an effort to avoid a four-to-four deadlock. The Court instead vacated the judgments of the lower courts and instructed the courts to afford the parties an opportunity to arrive at compromise. The opinion instructs the courts to allow the parties sufficient time to resolve any outstanding issues between ... June 8, 2016 General Contraception, Legal Advocacy, United States Supreme Court, Affordable Care Act 0 0 Comment Read More »
Last chance to appeal payments under ACA primary care physician rate increase The California Department of Health Care Services (DHCS) announced that it would provide a 90-day appeal window for physicians who believe they were not paid, or paid incorrectly, under the Affordable Care Act’s (ACA) primary care rate increase. In late February 2016, DHCS announced a streamlined appeal process, which opened on March 1. The appeal window is only available under the following conditions: The provider successfully attested for the ACA incentive by December 31, 2014 For previously paid Medi-Cal claims For ... April 12, 2016 General Affordable Care Act, Department of Health Care Services, DHCS, ACA 0 0 Comment Read More »
CMS announces second cycle of Medicare revalidation Since the passage of the Affordable Care Act (ACA), all Medicare providers and suppliers have been required to revalidate their Medicare enrollment information under new enrollment screening criteria in an effort to prevent fraud within the Medicare system. Once a Medicare enrollment application is validated, the clock starts ticking on a five-year revalidation cycle. Now that five years have passed since the ACA's revalidation requirement took effect, the Centers for Medicare and Medicaid Services (CMS) is initiating a second cycle of revalidation requests. According to CMS, Medicare Administrative Contractors (MAC) ... March 31, 2016 Medicare Affordable Care Act, Medicare, ACA 0 0 Comment Read More »
Reminder: Exchange patients, eligibility and the 90-day grace period Practices are reminded that under the Affordable Care Act, exchange enrollees who receive federal premium subsidies (approximately 90 percent of enrollees) to help pay their premiums are entitled to keep their insurance for three months after they have stopped paying their premiums. In the first month of the grace period, federal law and California regulations require plans to pay for services incurred even if the patient fails to pay the premiums due by day 90 (CCR §1300.65.2(b)(1)(A)). But in months two and three of the grace period, plans can ... February 3, 2016 General, Managed Care Affordable Care Act, Grace Period, ACA 0 0 Comment Read More »
