Healthcare Trends: ICD-10, Mergers, Part B Premiums & MA-VBID
ICD-10
We are into our third week of ICD-10, and so far, reviews of implementation woes have been mixed. Some reports tout a smooth rollout process, with few problems — at least from the side of payers and clearinghouses. However, providers have noted several issues they are encountering from the transition, such as not being able to complete referrals, long wait times with insurance company calls, and possible delays in payment.
Merger Updates
Both the House and Senate held hearings on the pending health insurer mergers, with light grilling of the executives and less than anticipated contention during the Senate hearing. There is a suggestion that the less than rigorous questioning of the executives meant a “win” for the CEOs. Only Senators Franken and Blumenthal seemed to show any serious concern over the consumer impact of the mergers. However, it is important to note that until the DOJ weighs in on the matter, the status of these mergers is still unclear, and the questions posed during both hearings were just the tip of the iceberg. These insurance giants will face much more scrutiny within the near future, with a careful analysis and rigorous review of potential market impacts from the deals.
HHS’ Updated Shutdown Plan
HHS finally released its most updated contingency staffing plan, likely preparing for the possibility of a government shutdown in December. HHS estimates that 51% of staff would be on furlough. CMS would continue large portions of Affordable Care Act (ACA) activities, and the Medicare program will largely continue without disruption. CMS fraud and abuse activities will be curtailed, and fewer recertification and initial surveys for Medicare and Medicaid providers would be completed. The 2016 Contingency Staffing Plan is available here: http://www.hhs.gov/about/budget/fy-2016-hhs-contingency-staffing-plan/index.html
Reconciliation
The House of Representatives has moved forward with its reconciliation package that would repeal major provisions of the ACA — including the individual and employer mandate, Cadillac tax, medical device tax, IPAB — effectively dismantling the law. The package would also deny funding to Planned Parenthood. It is still unclear whether the Senate will vote on this legislation, and it is all but guaranteed to be vetoed by President Obama.
Part B Premiums
The 2015 Medicare Trustees Report estimates that Part B premiums will increase by 52% next year, from $104.90 to $159.30. Although beneficiaries purchasing Part B through Social Security deductions will be shielded from this increase, due to a likely no cost of living adjustment (COLA) in 2016, the remaining 30% will face a significant rate hike. This is because a “hold harmless” provision shields Social Security recipients from Part B premium increases which outweigh the Social Security COLAs. However, this means the 30% not qualifying under the hold-harmless provision will be on the hook for the entire increase in 2016.
Medicare Advantage Value-Based Insurance Design Model
The Centers for Medicare & Medicaid Services (CMS) has released the Request for Applications (RFA) for the Medicare Advantage Value-Based Insurance Design model. Applications are due on January 8, 2016. Interested organizations should begin conducting in-depth data analyses now in order propose a benefit plan in the RFA.
Resources
Download a copy of the recording from the October 5 webinar titled “Medicare Advantage Value-Based Insurance Design Model (MA-VBID)“, hosted by John Gorman.
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