Politics and Policy

Exchanges could bring in millions of potential customers. Insurers need to begin formulating marketing plans now.

While many health plans already have an appeals process in place for self-insured employers under the Employee Retirement Income Security Act, new federal rules clarify the process for consumers to challenge denials and rescissions.

Controversy continues to swirl around Medicare's two-year-old policy of not paying for what it considers preventable hospital-acquired condtions. CMS has decided for now not to expand its list of 12 serious adverse events for which it does not reimburse hospitals.

One of the first visible payoffs of the Patient Protection and Affordable Care Act is the $250 rebate checks sent to thousands of seniors with high drug costs. Other strategies are built on questionable long-term outlooks.

Accountable care organizations have become a hot commodity since the Patient Protection and Affordable Care Act opened the door for health plans to contract through an ACO for commercial enrollees. The momentum of ACOs will likely increase.

Stakeholders seek uniformity of standards for several types of electronic health information transactions and specific operating rules, n one of which will be easy to implement.

President Barack Obama nominated Donald Berwick to head the Centers for Medicare and Medicaid Services, the first confirmed leader in this role since 2006. Berwick has been an outspoken critic of waste and inefficiency.

The American Medical Association released its "Health Insurer Code of Conduct Principles," which defines 10 standards AMA believes will ensure consistent corporate practices.

Federal officials are pressuring insurers to keep premium rates under control for the coming year.

The Office of Health Reform, in fact, is working overtime to meet deadlines for 2010 policies.

The effect of new Medicaid expansion under the Patient Protection and Affordable Care Act will depend largely on federal and state actions to roll out the provisions and encourage enrollment.

Comparative effectiveness research is suddenly flush with fundings. Tucked in last year's American Recovery and Reinvestment Act was $1.1 billion to accelerate CER.

The Patient Protection and Care Act will allow health insurance coverage through state-based health insurance exchanges, expand Medicaid eligibility, and subsidize insurance premiums, all of which involve state implementation.

It's likely that most major health insurers will participate in the insurance exchanges that must be up and running in each state by 2014, according to experts.

Although the most revolutionary health reform provisions do not go into effect until 2014, insurers and payers are scurrying to implement a number of big changes required this year.

The impact of the tax change generated speculation about whether employers would continue to fund retiree drug plans or overall health benefits.

Medicaid rolls will be expanded to include those earning up to 133% of the federal poverty level and adults without children.

The challenge of implementing various components of health reform was immediately apparent as one of the first new programs went into effect: establishing state high-risk pools for individuals with pre-existing condtions.

First on the reform agenda is an overhaul of the formula for calculating Medicare Advantage payments.

PPACA promises to eventually close the coverage gap for seniors.

Under pressure from the Obama administration, insurers say they will not deny health coverage for sick children pending new regulations, and would follow the intent of the law, not the exact language of it.

The reform law provides for and expansion of Medicaid recipients and dependent children as well as an expansion of the Children's Health Insurance Program.

The new Medicare Advisory Board will have broad responsibility to make recommendations to reduce spending in the Medicare program.

Industry executives were grilled at congressional hearings and summoned to a White House meeting called by Health and Human Services (HHS) Secretary Kathleen Sebelius to discuss rising premiums

One of the main revenue-raising provisions in health reform legislation is to revise methods for calculating payments to Medicare Advantage (MA) plans.