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August 1, 2014

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In This Issue
The Healthcare.gov Debate Continues
Income Verification Continues to be a Problem
Energy and Commerce Subcommittee on Health Hearing on Risk Corridors
Reenrollment Rule Raises Concerns
More New Rules and Guidance from our Friends at the IRS
Free Compliance Corner Webinar for NAHU Members on August 7
What We’re Reading
Tools
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The Healthcare.gov Debate Continues

For months, many of us have been asking what went wrong behind the scenes with Healthcare.gov. If you ask us what was wrong with the website, we could develop a laundry list (and we have) of all the things we would like to see improve, but that’s neither here nor there. For now. On Wednesday, the non-partisan Government Accountability Office (GAO) put the spotlight back on the Administration and the contractors responsible for the Healthcare.gov debacle by releasing a report titled, “Contract Planning and Oversight Practices Were Ineffective Given the Challenges and Risks.”

On Thursday, a day after the report was released to the public, the House Energy and Commerce Oversight and Investigations Subcommittee held a hearing further analyzing the report’s findings. Centers for Medicaid and Medicare Services (CMS) Principal Deputy Administrator Andy Slavitt, formerly of Optum (one of the contractors tasked with building Healthcare.gov), and GAO Director of Acquisition and Sourcing Management William T. Woods testified before the subcommittee... Read More

Income Verification Continues to be a Problem

You’ve heard our concerns about subsidy eligibility verification time and time again, both here in the Washington Update and also in the headlines of news sources, such as the Washington Post. These concerns have been echoed repeatedly by lawmakers in Congress. Yet it still remains a problem. Several Senators, earlier this week, tried again to do something about it. Republicans Orrin Hatch (UT), Rob Portman (OH) and Chuck Grassley (IA) sent a letter to Secretary of the Department of Health and Human Services (HHS) Sylvia Burwell urging her to improve the subsidy verification program in light of the recent reports of people receiving exchange subsidies who are not eligible for them. The Senators cited the Government Accountability Office (GAO) report that was released last week stating that GAO undercover agents were able to obtain health insurance and premium subsidies through Healthcare.gov using fictitious identities. Had a functional subsidy verification entity been in place, this would not have happened. The House Ways and Means Committee reviewed the GAO report during a hearing last week. In the letter, the Senators ask Secretary Burwell what her plan is to ensure that the exchanges run a fully functioning income verification system in the future... Read More

Energy and Commerce Subcommittee on Health Hearing on Risk Corridors

The House Energy and Commerce Subcommittee on Health held a hearing earlier this week that focused on the section of the Patient Protection and Affordable Care Act (PPACA) that outlines the risk corridor mechanisms. The committee is also tasked with marking up a bill introduced by Representative Leonard Lance (R-NJ) that would effectively get rid of the risk corridor program altogether. The risk corridor program is a temporary program, scheduled to last from 2014-2016 and only affects carriers that participate in individual and SHOP exchanges to level out adverse selection. The program will be funded via plan to plan transfers where the federal government functions as a bank in holding and redistributing the funds. It will not be financed by taxpayers but by plans, which will either get or pay money depending on how the risk of their population compares to the average risk of plans statewide... Read More

Reenrollment Rule Raises Concerns
Comments were due this week on the Center for Medicare and Medicaid Services' proposed rule on how to reenroll people in state-based and federally facilitated exchanges. NAHU provided detailed comments on the proposal based on concerns articulated by our Board of Trustees and Legislative Council. We weren’t the only one to raise some concerns with the new proposal, which calls for the automatic renewal of millions of exchange consumers in their same or similar policies unless the consumer takes proactive steps to change their plan options... Read More
More New Rules and Guidance from our Friends at the IRS

The IRS released a flurry of paper last week, including the new proposed forms for employers to use when reporting their coverage offerings for purposes of enforcing both the individual and employer mandates. In addition, they released several newly proposed and temporary final rules relative to the health reform law’s premium tax credits.

These rules are identical and the temporary final rules will cease to exist once final rules addressing these issues have been adopted. The proposed rules address several complex situations relative to the premium tax credit that have not previously been addressed by regulation, including the treatment of tax filing requirements for individuals who are suffering from domestic abuse and/or spousal abandonment and wish to receive the premium tax credit, the treatment of the tax credit in the cases of a divorce situation when one parent is responsible for insuring the child and applies for the tax credit and the other parent is the one who is legally permitted to claim the child as a dependent, scenarios for divorcing or newly separated couples who have received the credit and rules for the interaction between the premium tax credit and the health insurance costs deduction for self-employed individuals...
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Free Compliance Corner Webinar for NAHU Members on August 7
Did you know that since 2009 there have been over 100 million dollars in fines levied against health insurance carriers, hospitals, physicians and other parties over HIPAA Privacy and Security requirements? The percent of those fines attributable to lost or stolen computer data, or even not properly disposing of an old computer, is truly scary. And recently, the Obama Administration has announced their intent to conduct thousands of audits of both covered entities and business associates in the next year to ensure compliance. Since agents, brokers and consultants are liable for similar breaches along with a whole set of new rules as business associates for their group clients and various health insurance companies, you have a much higher standard to meet... Read More
What We’re Reading

While completing the surprisingly difficult task of avoiding any health policy stories that include the word Ebola in their title, we found these gems for you lovely readers... Read More

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