Bethesda, MD --In the first half of 2014 Health Affairs has released seven new Health Policy Briefs and also has provided updates of five previously released briefs, in order to reflect continuously changing and evolving health policy issues and perspectives.
The following Health Policy Briefs were updated in 2014:
- Transitioning to ICD-10. All health plans, health data clearinghouses, and health care providers that transmit health information electronically will be required to use a new, significantly broader, coding system, called ICD-10, for diagnoses and inpatient procedures.
WHAT’S THE UPDATE? The conversion was originally scheduled to take place on October 1, 2014. However, due to concern over complications and the cost of converting to ICD-10, Congress included a provision in recent legislation delaying the conversion. The Centers for Medicare and Medicaid Services has released a revised conversion date of October 1, 2015.
The Multi-State Plan Program. Qualified insurance companies were invited by the Office of Personnel Management (OPM) to apply for the Multi-State Plan Program (MSPP) created under the Affordable Care Act (ACA). The MSPP was intended to spur competition and keep insurance premiums low for plans offered through state exchanges.
WHAT’S THE UPDATE? In September 2013 the OPM announced that it had entered into a contract with the Blue Cross Blue Shield Association (BCBSA) to offer over 150 plans in thirty states and the District of Columbia for individuals and their families. As of 2014 few other insurance companies were in a position to participate in the MSPP, limiting competition and choice. The OPM recently issued a 2015 Call Letter to interested applicants for the MSPP, aiming to increase the number of plans offered through state exchanges.
- Basic Health Program. The Basic Health Program would allow states to offer public health insurance to people whose incomes are too high to qualify for Medicaid but are also below 200 percent of the federal poverty level.
WHAT’S THE UPDATE? The Basic Health Program was originally going to launch in 2014. However, due to a delay in the final program rules, concerns that the program could undermine the viability of state insurance exchanges and rather than saving money could increase states’ costs, the Basic Health Program will launch in 2015.
- Small Business Insurance Exchanges. Small business exchanges were created under the Small Business Health Options Program (SHOP) to offer group health plans to small companies. The exchanges would offer a variety of group health plans; provide comparative information on benefits, costs, and quality; facilitate employee enrollment in a plan of choice; and reduce administrative burdens on small-business employers.
WHAT’S THE UPDATE? Even though a SHOP currently exists in each state, the online eligibility determinations and enrollment functions have been lacking if not nonexistent. For federally facilitated SHOPs, the Department of Health and Human Services delayed online enrollment until November 2014 and instituted a direct enrollment process through agents, brokers, and insurance companies that offer qualified health plans through SHOPs.
- The CO-OP Health Insurance Program. Recognizing that in some states only a small number of insurance companies would offer coverage for individuals and small businesses, the ACA established a Consumer Operated and Oriented Plan (CO-OP) program, a public option alternative, to increase competition among plans and improve consumer choice. The federal government provided $2 billion in loans to help create twenty-four CO-OPs in twenty-four states.
WHAT’S THE UPDATE? Since the creation of CO-OPs, one has disbanded, but the other twenty-three CO-OPs were organized and offering plans on the exchanges in time for enrollment that began on October 1, 2013. The next significant test will be to see how many CO-OPs are able to keep enough people enrolled and to see if the CO-OPs’ premium rates are realistic enough for them to be sustainable.
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