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Aetna Health Reform Weekly 7/8/13

Story Content Provided by Aetna on 7/9/13

The U.S. Department of the Treasury announced last week that it will delay implementation of the employer mandate penalties and reporting requirements until 2015. It also says it will simplify the reporting requirements. The news is particularly important to large employers (50 or more employees) who will not be subject to penalties in 2014, as originally required under the law, if they do not offer affordable coverage that meets minimum value as defined under the Affordable Care Act (ACA). Formal guidance on this transition is expected later this week. Large employers who are already planning to offer coverage that is affordable and meets minimum value in 2014 may continue with their plans, without an obligation for federal reporting requirements. For small employers, nothing has changed since this requirement did not apply.


CALIFORNIA: A mandate bill has been passed by the Senate Health Committee that would require health plans to cover fertility preservation. In order to avoid violating the federal essential health benefits rules, the bill was amended to limit its reach only to large group coverage. Representatives of the health care industry testified that limiting mandates to large employers would have unintended consequences. The comments sparked a debate among committee members about loading more and more new costs onto the health system. With the amendment, the bill received the chair's support, and the committee passed all of the mandate bills on a partisan vote, with Democrats in favor and Republicans opposed. The full legislature is expected to consider the bill in August.

Half of the legislature (the Assembly) recessed for its summer break last week, while the other half (the Senate) elected to stay for an additional week to finish some policy committee hearings. Both legislative bodies will have a full 30-day break. However, since the legislature could not agree on a summer recess calendar, the Assembly will reconvene a week sooner than the Senate. Both houses must adjourn for the year on August 30.

MASSACHUSETTS: The General Court (the legislature) of the Commonwealth of Massachusetts has passed legislation requiring Governor Deval Patrick to seek a waiver from the U.S. Department of Health & Human Services (HHS) from the ACA's rating rules set to take effect next year. HHS granted Massachusetts a temporary and partial phase-in of the rating rules earlier this year, but the move has not satisfied the Bay State's small employer community. The ACA's rating rules are more restrictive for some but not all of the factors than are Massachusetts' requirements. Business groups such as the Associated Industries of Massachusetts (AIM) urged the legislature to require that the state seek a complete waiver from the federal rules. AIM has estimated that federal rating factors would increase premiums for 60 percent of small firms while others would receive reduced premiums. The bill is expected to be signed into law by Governor Patrick shortly.

MAINE: Governor Paul LePage has vetoed two bills that sought to alter health insurance reforms enacted in 2011. One bill would have rescinded the rate review process enacted as part of "PL 90" and would have imposed a prior approval and rate review process on products in the individual market. Another bill would have permitted only one geographic rating area for establishing rates in the individual and small group markets for plans issued or renewed after January 1, 2015. Veto overrides are expected on both bills. The legislature will conclude its veto override session on July 9.

NEW HAMPSHIRE: Governor Maggie Hassan has announced that all of the state's hospitals have agreed to join Medicaid managed care networks. The state has sought to move from a point-of-service model to a managed-care system for Medicaid, but hospitals and other providers balked at accepting the rates offered by the three managed care companies awarded contracts with the state. The largest hospitals sued the state two years ago, claiming the reimbursement rates under the Medicaid program were too low and had been set illegally. The New Hampshire Hospital Association now notes that moving to a managed care system is "the right thing to do." Governor Hassan said she hopes the new agreement will inform the work of the Commission evaluating Medicaid expansion for New Hampshire.

WASHINGTON: The second special session of the legislature adjourned last week after a bipartisan budget was passed. The $33.6 billion operating budget for 2013-15 passed with nearly universal support and provides more than $1 billion in new revenue for K-12 education and prevents higher education tuition increases for the first time in 27 years.


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