Health Reform Weekly

A weekly compilation from Aetna of health care-related developments in Washington, D.C. and state legislatures across the country.


Week of February 23, 2015

The Centers for Medicare and Medicaid Services (CMS) has announced it will re-open marketplace enrollment from March 15 to April 30 for people facing the Affordable Care Act’s (ACA’s) individual mandate penalty for being uninsured in 2014. The six-week special enrollment period is intended for individuals who can show they discovered that they were subject to the fine after regular enrollment ended. Also, CMS and a number of states across the country announced a “special enrollment period” last week giving consumers an extra week to sign up for health care coverage through the exchanges. The enrollment window was opened for individuals who experienced technical problems or long wait times at the call center in the final three days of the 2015 open enrollment season, which ended February 15.

In other news, CMS also announced that approximately 800,000 consumers received incorrect form 1095-As from their federally facilitated marketplace. These forms listed the wrong benchmark premium amount. CMS will be sending corrected forms.


A bipartisan group of 53 lawmakers sent a letter last week to CMS Administrator Marilyn Tavenner asking for Medicare Advantage payment levels to be maintained in 2016 to avoid disruptions and confusion among beneficiaries. A number of Senators signed on in support of the letter, including Republicans Susan Collins (ME), Mark Kirk (IL) and Rand Paul (KY), Independent Angus King (ME) and Democrat Jon Tester (MT).

The IRS announced last week that small businesses with fewer than 50 employees will have until July to end arrangements allowing workers to receive tax-free payments to buy coverage on the individual market. Violations could result in large tax penalties. This news follows last year’s announcement that employers who continued offering HRAs without also offering ACA-compliant health insurance would face a fine of up to $100 per day, per employee.

CMS has announced that it will begin reconciling advance cost-sharing subsidy payments in April 2016 instead of April 2015. Made to insurers in 2014, the payments reduce out-of-pocket expenses for ACA enrollees earning less than 250 percent of the federal poverty level. CMS is delaying reconciliation because some insurers may be incorrectly estimating how much they are owed.


CALIFORNIA: Covered California, the state-based insurance exchange, had announced that it anticipated 500,000 consumers would newly enroll for 2015 coverage and, as of February 17, 474,000 Californians signed-up for coverage. A record number of consumers signed up on Friday (25,000) and Sunday (36,000) of the last weekend for open enrollment. Covered California also estimates that 1.1 million residents re-enrolled during the 2015 open enrollment period. Covered California’s open enrollment officially closed February 15, 2015, but anyone who started an application by February 15 was allowed to complete that application by February 20.

CONNECTICUT: Governor Dannel Malloy proposed a biennium state budget last week that would close a $2.5 billion deficit over the next two fiscal years. It includes $914 million in revenues and $1.3 billion in spending cuts, as well as a five-year transportation improvement program branded as Let’s Go CT. Health care related highlights include: increasing hospital tax revenue by basing it on 2013 total net patient revenues instead of 2009 and equalizing the tax rate on inpatient and outpatient services; increasing the Insurance Fund financed by carriers by moving $9.2 million worth of public health programs (such as AIDS services and breast/cervical cancer screening) under the fund; moving about 34,000 Medicaid adults with incomes above 138 percent of FPL from Medicaid to the state’s health insurance exchange along with Medicaid children and families with incomes above 323 percent of FPL; removing funding for the dual-eligible demonstration program; and modifying the current autism mandate to require private insurers to reimburse coverage of autism that mirrors service arrays and durations provided under the state’s Medicaid program for children and youth under 21.

GEORGIA: The Medical Association continues to support legislation that would restrict health plans with regard to network adequacy and changes to provider contracts. The state’s health plan association, including Aetna, has met with the insurance commissioner and key legislators to voice concerns about the proposed restrictions and their anticipated impact on the ability to offer competitive products in the marketplace.

ILLINOIS: The legislature is set to begin debating several measures that would mandate coverage of certain benefits or access to certain providers. H.B. 120 and H.B. 122 would require coverage of intravenous feedings and prescription nutritional supplements. S.B. 97 would require coverage for hearing instruments and related services for individuals with a prescription. S.B. 802 would prohibit health insurers from mandating an optometrist to meet conditions not required of other eye care providers as a condition for participation in the health care plan, or from reimbursing the optometrist at a lower rate than other licensed providers.

NEBRASKA: Deciding when to require vaccinations has become increasingly controversial of late, as state legislators are all too aware. Deliberations over whether to require vaccinations for bacterial meningitis led to a filibuster in the Senate last week. A bill that would require two rounds of meningitis vaccinations for Nebraska students between seventh grade and age 16 is unlikely to become law this year. A motion to postpone debate until June 5 was met with unanimous approval.

NEVADA: The legislature has convened its 2015 legislative session and is considering several health care issues of interest. These proposals include removing the $36,000 per-year cap on benefits from the autism mandate; adopting provisions of the NAIC Model Holding Company System Regulatory Act and Own Risk and Solvency Assessment Model Act, allowing payments to patient-centered medical homes; and changes to the exchange board, including removing the requirements that the exchange be state based.

PENNSYLVANIA: Governor Tom Wolf announced the Department of Human Services (DHS) has been directed to submit a letter to the federal government withdrawing further consideration of “Healthy PA” – a Corbett administration alternative to Medicaid designed to broaden coverage to lower-income adults through the commercial market. Citing confusion among recipients and the plan’s administrative complexities, the Wolf administration will alternatively pursue a single streamlined benefits package for adults. The announcement also noted existing coverage for current enrollees will continue until the transition process toward the new approach is completed.

Governor Tom Wolf also announced that the federal government has agreed that Pennsylvania families enrolled in the Children’s Health Insurance Program (CHIP) Buy-in Plan will not face tax penalties in 2015 while the program is brought into compliance with minimum essential coverage under the ACA. Families now get to keep their CHIP Buy-In coverage and will not be forced to get new insurance on the exchange by April 15. At the same time, the governor has received commitments from insurance companies to work in the coming weeks to ensure that full-cost CHIP meets essential coverage before the end of the year.

WASHINGTON: The state has announced special enrollment opportunities for residents who may become aware of the tax penalty for not having health insurance under the ACA when they file their annual tax return this year. The special enrollment period runs from February 17 to April 17.


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