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Enrollment Periods in 2015 and Beyond (Research Report)
Stan Dorn

If consumers can enroll in plans offered through health insurance Marketplaces during late winter and early spring, more uninsured are likely to receive coverage than under current enrollment schedules. For 2015, the open enrollment period (OEP) is slated to end on February 15. After that date, uninsured consumers who pay their penalty on tax returns filed by April 15, 2015, could be allowed to enroll into coverage, thereby avoiding additional, steeper penalties. In future years, changing OEPs from the proposed October through December schedule would likely require adjusting Marketplace plan years as well. Such changes offer both gains and risks.

Posted to Web: February 11, 2015Publication Date: February 11, 2015

Characteristics of Those Eligible for Cost-Sharing Reductions and Premium Tax Credits Under the Affordable Care Act (Research Report)
Linda J. Blumberg, Erik Wengle

The Affordable Care Act provides financial assistance via cost sharing reductions (CSR) and premium tax credits to help modest income individuals purchase health insurance and reduce the direct costs of their care. This brief estimates the characteristics of the CSR eligible population using the Urban Institute’s Health Insurance Policy Simulation Model. Researchers found that the CSR eligible individuals are most likely to live in the South, to be single adults without children, and to be White, non-Hispanic. Researchers also estimate the average value of a CSR to be $479 in 2016, with the value varying by the eligible person’s income.

Posted to Web: February 06, 2015Publication Date: February 06, 2015

Risk-Based Managed Care in New Hampshire's Medicaid Program: A Qualitative Assessment of Implementation and Beneficiary Experiences in Year One (Research Report)
Ashley Palmer, Stacey McMorrow, Genevieve M. Kenney

In December 2013, New Hampshire began the statewide transition to risk-based managed care in its Medicaid program. This report provides an overview of managed care implementation for Medicaid acute care services, drawing upon a case study conducted in July 2014. We found that initial implementation of managed care went relatively smoothly, due in part to the state’s active oversight role. However, both providers and Medicaid beneficiaries reported significant problems with prior authorization processes. As Medicaid managed care continues to evolve in New Hampshire, we will continue monitoring these and other issues as part of an ongoing evaluation.

Posted to Web: February 05, 2015Publication Date: February 05, 2015

Medicare Physician Payment Reform: Securing the Connection Between Value and Payment (Policy Briefs/Health Policy Briefs)
Robert A. Berenson, Additional Authors

Last year in a failed legislative effort to end the sustainable growth rate (SGR) formula that governs Medicare fees, Congress reached agreement on statutory language to move Medicare's payment of physicians away from fee-for-service (FFS) to so-called value-based payment. Authors of this paper, who include a former Administrator of the Centers for Medicare and Medicaid Services and two former Vice-Chairs of the Medicare Payment Advisory Commission, have specific recommendations to improve this legislation, now being reconsidered. The recommendations are in three major categories: encouraging movement to effective alternative payment models, improving Medicare's physician FFS payment system and improving and simplifying the quality measures that would be used.

Posted to Web: February 02, 2015Publication Date: February 02, 2015

Insurance Brokers and the ACA: Early Barriers and Options for Expanding Their Role (Research Report)
Sabrina Corlette, Linda J. Blumberg, Erik Wengle

The Affordable Care Act's drafters envisioned a continuing, significant role for brokers in the reformed nongroup insurance markets, but circumstances limited their active participation in the first year of marketplace enrollment. This analysis delineates the early barriers to brokers' full engagement, highlights the main concerns with their having a more prominent role and offers options for making them more effective in enrolling the uninsured. The information presented in this brief is based upon interviews conducted with stakeholders (e.g., providers, insurers, consumer advocates, navigators, assisters, brokers) in 21 states and the District of Columbia during the first half of 2014.

Posted to Web: February 02, 2015Publication Date: February 02, 2015

Appointment Availability after Increases in Medicaid Payments for Primary Care (Article)
Daniel Polsky, Michael Richards, Simon Basseyn, Douglas A. Wissoker, Genevieve M. Kenney, Stephen Zuckerman, Karin Rhodes

This study examines the effect of increased Medicaid reimbursements for primary care services in 2013 and 2014, a key provision of Affordable Care Act, on access to primary care. The researchers measured the availability of and waiting times for appointments for Medicaid enrollees and privately insured individuals in 10 states during two periods: from November 2012 through March 2013 and from May 2014 through July 2014. Between the two time periods, the availability of primary care appointments for Medicaid beneficiaries increased from 58.7 percent to 66.4 percent, while no changes were observed for the privately insured. During the same periods, waiting times to a scheduled new-patient appointment remained stable. These results suggest that increased Medicaid reimbursement to primary care providers was associated with improved appointment availability for Medicaid enrollees without generating longer waiting times.

Posted to Web: January 23, 2015Publication Date: January 21, 2015

Evaluation of the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration (Research Report)
Stephen Zuckerman, Kelly J. Devers, Robert A. Berenson, Rachel A. Burton, Nicole Cafarella Lallemand, Rebecca Peters

For the past three years, Medicare, Medicaid, and private payers in eight states have been paying certified medical home practices monthly care management fees and providing additional support (e.g., data feedback, learning collaboratives, practice coaching) through the Multi-payer Advanced Primary Care Demonstration. In its first year, the demonstration included 3,800 health care providers, 700 practices, and 400,000 Medicare beneficiaries, and produced net savings for the Medicare program that totaled $4.2 million. Interviewees reported that demonstration payments provided needed support to help practices transform the way they deliver care – by adding nurse care managers, adopting electronic disease registries, and enhancing access to care after hours, as well as making other changes.

Posted to Web: January 23, 2015Publication Date: January 23, 2015

Characteristics of Those Affected by a Supreme Court Finding for the Plaintiff in King v. Burwell (Policy Briefs/Timely Analysis of Health Policy Issues)
Linda J. Blumberg, Matthew Buettgens, John Holahan

Following up on our previous analysis of the implications of a Supreme Court finding for the plaintiff in the King v. Burwell, this brief describes the characteristics of those that would be affected, particularly those who would otherwise have nongroup insurance. Of the 9.3 million people estimated to lose tax credits, two-thirds would become uninsured. Most are adults who are low and middle income but not poor, most are white, non-Hispanic, and most reside in the South. Financial burdens would increase substantially for those wishing to continue buying the same coverage they would have under current implementation of the law.

Posted to Web: January 22, 2015Publication Date: January 22, 2015

Transitioning from Medicaid Expansion Programs to Medicare: Making Sure Low-Income Medicare Beneficiaries Get Financial Help (Research Brief)
Matthew Buettgens, Lynda Flowers, Jay Dev

The Affordable Care Act allows states to offer Medicaid coverage to low-income adults who would not have qualified under previous law. This population will face higher cost-sharing requirements when they transition to Medicare, although some may be eligible for traditional Medicaid benefits and/or Medicare Savings Programs (MSPs) that will reduce their costs. This report discusses how Medicare beneficiaries can qualify for traditional Medicaid and MSPs, provides new estimates of the number and characteristics of eligible individuals, and outlines policy options that would make it easier for Medicare beneficiaries to qualify for traditional Medicaid benefits and MSPs.

Posted to Web: January 21, 2015Publication Date: January 21, 2015

The Need to Reform Medicare's Payments to Skilled Nursing Facilities is as Strong as Ever (Research Report)
Carol Carter, Bowen Garrett, Douglas A. Wissoker

Well-documented shortcomings in Medicare's payment system for skilled nursing facilities (SNFs) have prompted many revisions to the system. This study finds that Medicare's payments to SNFs for therapy and non-therapy ancillary (NTA) services are the least accurate they have been since 2006. Payments are less reflective of cost differences across both stays and facilities and payments are less proportional to costs. An alternative design that would base payments on patient characteristics and establish separate payments for NTA services would increase payment accuracy and dampen the incentives to furnish excessive therapy and avoid patients with complex medical needs for financial gain.

Posted to Web: January 15, 2015Publication Date: January 15, 2015

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