One of the biggest problems with Obamacare is the fact that more sick people signed up for coverage under the law than was expected.
That’s ironic since providing coverage for people with pre-existing conditions was a major reason for enacting the Affordable Care Act. But high benefit requirements and other mandates led to high premiums, and too many young, healthy people have stayed away from the ACA exchanges.
Helping insurers manage the risk of covering sick enrollees is a top focus of a Department of Health and Human Services rule governing the exchanges.
For instance, a pilot program that begins in 2017 requires people who sign up for coverage outside of normal enrollment periods to document that they are eligible to do so because of life changes such as marriage, having a child or moving. Insurers argue that claims for people who enroll up during so-called special enrollment periods are higher than for other enrollees, and they have called for more verification of eligibility.
Another provision will force dialysis facilities to disclose the risks of different coverage options to their patients. Some dialysis facilities were steering Medicare- and Medicaid-eligible patients to exchange coverage that wasn’t in the patients’ best interest, but which reimbursed medical providers at rates as much as $100,000 to $200,000 more per patient per year, the HHS said.
Changes were made to the ACA’s risk adjustment rule, under which insurers that cover healthier populations must make payments to insurers that cover sicker groups. Small, new plans have had to make big payments under the rule to big, established carriers that have a longer claims history for their enrollees.
Read the full story at https://www.bna.com/hhs-moves-help-n73014448798/.
Stay on top of new developments in health law and regulation with a free trial to the Health Law Resource Center.
Learn more about Bloomberg Law and sign up for a free trial.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to email@example.com.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to firstname.lastname@example.org.
Put me on standing order
Notify me when new releases are available (no standing order will be created)