Short-Term Health Insurance Plans Charge Less than Half as Much in Premiums as ACA Plans By Excluding Pre-Existing Conditions and Severely Limiting Benefits

	Just Released
Short-Term Health Insurance Plans Charge Less than Half as Much in Premiums as ACA Plans By Excluding Pre-Existing Conditions and Severely Limiting Benefits Short-term health insurance plans offer a trade-off for consumers: substantially lower premiums than plans that comply with the Affordable Care Act, but much less protection if they get sick and need care. Just how much cheaper are the premiums and what are consumers giving up to get them? A new KFF (Kaiser Family Foundation) analysis finds short-term plans are able to charge premiums 54 percent lower than ACA-compliant plans, by excluding pre-existing conditions and severely limiting benefits. Specifically, it finds: Plans achieve 38 percent lower premiums by simply denying insurance altogether to people with pre-existing conditions, or refusing to cover such conditions for those offered a policy. A further 16 percent reduction relative to ACA-compliant plans arises from short-term plans’ exclusion of, or severe restrictions on, potentially costly benefits such as coverage for prescription drugs, maternity care and mental health and substance abuse treatment. The Trump administration has expanded the availability of such plans, which can offer coverage for up to 364 days and do not have to comply with the ACA’s rules. The lower premiums will likely lure healthy people away from ACA-compliant plans, especially consumers with incomes too high to qualify for ACA premium subsidies.  As a result, ACA-compliant plans will be left with a sicker pool of enrollees and higher premiums. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.
Contact: Chris Lee | (202) 347-5270 | clee@kff.org
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CMS Takes Action to Modernize Medicare Home Health

CMS NEWS FOR IMMEDIATE RELEASE October 31, 2018 Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries    CMS Takes Action to Modernize Medicare Home Health Administrator Verma: “Today’s rule overhauls how Medicare pays for home health, refocusing on the needs of patients, promoting innovation, and reducing burden for physicians and home health providers.” Today, the Centers for Medicare & Medicaid Services (CMS) finalized significant changes to the Home Health Prospective Payment System to strengthen and modernize Medicare. Specifically, CMS made changes to improve access to solutions via remote patient monitoring technology, updated payments for home health care with a new case-mix system, begin the new home infusion therapy benefit, and reduce burden. “This home health final rule focuses on patient needs and not on the volume of care,” said CMS Administrator Seema Verma.  “This rule also innovates and modernizes home health care by allowing remote patient monitoring. We are also proud to offer new home infusion therapy services.  Using new technology and reducing unnecessary reporting measures for certifying physicians will result in an annual cost savings and provide home health agencies (HHAs) and doctors what they need to give patients a personalized treatment plan that will result in better health outcomes.” Beginning with calendar year (CY) 2020, CMS is implementing changes required by law, including a new case-mix system called the Patient-Driven Groupings Model (PDGM) that puts the focus on patient needs rather than volume of care. The PDGM relies more heavily on patient characteristics to more accurately pay for home health services. Changes in data collection under the new case-mix system, coupled with the changes below regarding meaningful measures and the Home Health Quality Reporting Program, will reduce burden for HHAs by approximately $60 million annually, beginning in CY 2020.  CMS is promoting innovation and modernization of home health care by allowing the cost of remote patient monitoring to be reported by home health agencies as allowable costs on the Medicare cost report form. This is expected to help foster the adoption of emerging technologies by home health agencies and result in more effective care planning, as data are shared among patients, their caregivers and their providers. The use of such technology can allow for greater patient independence and empowerment. Supporting patients in sharing their data will advance the MyHealthEData initiative, led by Jared Kushner and the White House Office of American Innovation. This final rule implements the temporary transitional payments for home infusion therapy services for CYs 2019 and 2020, as required by the Bipartisan Budget Act of 2018, until the new permanent home infusion therapy services benefit begins on January 1, 2021.  In addition, the final rule establishes the health and safety standards for qualified home infusion therapy suppliers of the new permanent home infusion therapy service benefit.  The final rule also establishes the approval and oversight process for accrediting organizations of these suppliers as required by the 21st Century Cures Act. We are finalizing our proposal and also seeking further comments on our interpretation of “infusion drug administration calendar day” and on its potential effects on access to care. CMS is eliminating the requirement that the certifying physician estimate how much longer home health services are needed when recertifying the need for continued home health care.  This results in an estimated reduction in burden for physicians of $14.2 million, annually, and would allow physicians to spend more time with patients rather than on unnecessary paperwork. The final rule helps advance CMS’s Comprehensive Meaningful Measures Initiative. CMS is removing seven Home Health Quality Reporting Program measures. As noted above, changes in data collection under the new case-mix system, coupled with the changes from these seven measure removals, will reduce burden for HHAs by approximately $60 million annually, beginning in CY 2020. The final rule can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection. For a fact sheet on today’s final rule, please visit: https://www.cms.gov/newsroom/fact-sheets/cms-finalizes-calendar-year-2019-and-2020-payment-and-policy-changes-home-health-agencies-and-home. For additional information about the Home Health Prospective Payment System, visit https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/index.html and https://www.cms.gov/center/provider-Type/home-Health-Agency-HHA-Center.html. For additional information about the Home Health Quality Reporting Program, visit https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Reporting-Requirements.html. ### Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS, @CMSgov, and @CMSgovPress.

Social Security Observes National Disability Employment Awareness Month

In October, we observe National Disability Employment Awareness Month (NDEAM) in the United States. For more than 70 years, NDEAM has promoted disability inclusion in the workforce and celebrates the contributions of workers with disabilities. This year’s theme “America’s Workforce: Empowering All” is near and dear to us at Social Security.

We are with you throughout life’s journey and as we’ve said before, we understand that for millions of people, work is more than a source of income, it’s a part of who they are — it gives them purpose, pride, and another connection with their fellow Americans. While many of our beneficiaries have disabilities and are unable to work, we know that some may want to try. If you’re ready to return to the workforce or work for the first time, we can help. Our work incentives rules make it possible for people with disabilities to work and still receive monthly benefits and Medicare or Medicaid.

For disability beneficiaries, work incentives include a trial work period, an extended period of eligibility for Medicare coverage, and more. For Supplemental Security Income recipients, work incentives include work-related expenses if you are blind, earned income exclusions, educational training exclusions, and, in many states, continued coverage under Medicaid. Read our Ticket to Work blog— particularly our posts on “Work Incentives Wednesdays”— or The Red Book: A Guide to Work Incentives for more information.

Being prepared is the key to success. Our Ticket to Work program offers beneficiaries with disabilities access to meaningful employment with the assistance of employment service providers called employment networks. Employment networks prepare you for the workforce. Our beneficiaries get help finding a job and staying employed, as well as receive instruction on their wage-reporting responsibilities to Social Security. Learn more about our Ticket to Work program to see if it works for you.

Improving our work incentives programs to better support the work efforts of people with disabilities is important to us. We are collaborating with other partners like the Department of Labor and Department of Health and Human Services to test new programs that can help individuals remain in the workforce after acquiring a disability. We’re also testing simpler work options to our current work incentives to encourage disability beneficiaries to try work. These tests rely on volunteers — learn about these demonstration projects and look out for your chance to participate.

Remember that Social Security is here to help you secure today and tomorrow. You can help us empower all by sharing this information with family and friends.

https://blog.ssa.gov/social-security-observes-national-disability-employment-awareness-month/?utm_campaign=&utm_content=&utm_medium=email&utm_source=govdelivery

Idaho's GOP governor endorses Medicaid expansion

By Susannah Luthi  | October 30, 2018

Idaho's Republican Gov. Butch Otter has endorsed the state ballot initiative to expand Medicaid in a new ad that also features his wife Lori urging Idahoans to support the measure.

Otter's public support is the latest sign of an opinion shift favoring expansion in GOP-led states. Voters in Nebraska, Montana and Utah will vote on similar initiatives next week. Democratic gubernatorial candidates in several states including South Dakota, Iowa, Kansas, Oklahoma, Florida and Georgia are polling neck and neck with Republicans. None of these states have expanded Medicaid and Democrats are making it a core campaign issue.

"Proposition 2 is an Idaho-grown solution," Otter says in a new ad by the group "Idahoans for Healthcare" that was released Tuesday. Proposition 2 is the expansion initiative that will extend coverage to about 62,000 Idahoans, according to estimates.

Otter could not seek re-election this year because of term limits, but his Republican Lt. Gov. Brad Little is expected to win the bid to succeed him. 

In Idaho, healthcare policy has pitted Republicans against Republicans over the last year. While Otter has expressed support for the initiative, the conservative Freedom Foundation continues to fight it, devoting its website with opposition messages.

The Idaho Statesman reported in early September that a new political action committee formed to combat the measure. The Work, Not Obamacare PAC was formed by an active member of the Freedom Foundation, although the two entities are separate, according to the report.

A fight between moderate and conservative Republicans echoes what happened earlier this year when Otter and GOP leadership in the Legislature tried to pass a bill to create a so-called super-waiver —a merged 1332 State Innovation waiver and 1115 Medicaid waiver—to try to close the state's coverage gap without expansion.

The measure, backed by the state's hospital and other industry groups, aimed to cover about 35,000 of the roughly 68,000 uninsured Idahoans. Otter and Little drove the measure against sharp opposition from the Legislature's conservative wing.

Essentially, Otter and his supporters wanted to offer plans on the Obamacare exchanges that would not include all the mandated essential health benefits while still offering rich enough coverage to draw people who were currently opting out of individual market insurance altogether. Medicaid would have been used as a high-risk pool to guarantee coverage of people with chronic conditions.

Officials estimated that this would shave about $200 million off claims costs for private insurers and lower premiums for those who remained in the individual market.

Viewed as a compromise alternative to Medicaid expansion, the measure was spiked by the Legislature after conservatives succeeding in defeating it.

Susannah Luthi covers health policy and politics in Congress for Modern Healthcare. Most recently, Luthi covered health reform and the Affordable Care Act exchanges for Inside Health Policy. She returned to journalism from a stint abroad exporting vanilla in Polynesia. She has a bachelor’s degree in Classics and journalism from Hillsdale College in Michigan and a master’s in professional writing from the University of Southern California.

https://www.modernhealthcare.com/article/20181030/NEWS/181039998?itx[idio]=8812325&ito=792&itq=972e2bf1-a3ee-4125-b309-bd025375c7ce

Average Cost Of Deer Repair Is $4,500

Tulsa World (OK) October 30, 2018 

Fall is in the air, and so is love - a kind of love that can be oh so costly, especially if you own a newer-model car.

Vehicle-deer collisions will become more common in weeks to come, according to AAA Oklahoma and the Oklahoma Department of Wildlife Conservation - with a robust white-tailed deer population in Oklahoma, cooler weather that sends deer searching for more food sources and the mating season just around the corner.

Tim Wolf, owner and president of Floyd and Son's Body Shop in Tulsa, has a lifetime of experience in the deer woods. He said he sees vehicles damaged by collisions with deer - and feral swine - all year long, but odds of collision increase in November. On the way to a deer hunt last weekend, his party counted five deer on the side of the road in one 30-mile stretch.

"It's just starting to pick up now," he said. "I think we'll start seeing more and more of them now. The Wildlife Department has done a good job conserving our deer populations."

Hunters observing deer in the field now are reporting some early chasing of does and other behaviors that indicate the mating season is heating up. That sort of movement, and distraction, will only increase through the month.

"Deer are on the move now seeking new food sources, which often require them to travel further distances during the fall and winter. Typically, the greatest number of deer-vehicle crashes occur in mid-November when the rut, or mating season, peaks," said Colin Berg, information education supervisor for the Oklahoma Department of Wildlife.

According to the Oklahoma Highway Safety Office, 186 vehicle crashes reported in 2017 were deer-related. That is, crashes in which a deer and vehicle actually collided or the presence of a deer was a contributing circumstance.

"In addition to injuries and loss of life, deer collisions often cause significant vehicle damage that can lead to large expenses for the vehicle owner if not properly insured," said Mark Madeja, public and government affairs senior specialist for AAA Oklahoma. "Of the animal strikes reported by AAA Insurance policy holders in 2017, the average cost per claim was more than $4,500."

Wolf said costs of vehicle repairs are only rising with new technology that is installed in front and rear bumpers, side mirrors, around headlamps, and on windshields. A $2,000 repair is almost a bare minimum.

"One of the newer trucks on a turnpike hitting a deer, it's going to be $10,000 easy," he said. "You're talking about some pretty expensive venison."

AAA Newsroom reported last week its testing has shown that although vehicles with advanced driver assistance systems improve safety, the costs for vehicle damage may inevitably increase.

Repair for minor front or rear collisions on such cars can cost nearly 2.5 times that of a car without those systems, AAA reported. The company urged consumers to perform an insurance policy review and consider the potential added costs.

Added costs for something like front radar sensors used with emergency braking and adaptive cruise control systems are about $900-$1,300. Rear radar sensors used with blind-spot monitoring and rear cross-traffic alert systems can run $850 to $2,050 in additional costs. Other items included $1,300 to $1,650 added to windshield replacement or $500 to $1,100 for side mirrors.

A bit of good news for Oklahoma drivers is the odds a driver will hit a deer here still ranks in the middle compared to other states, and those odds decreased just slightly this season, according to State Farm Insurance's annual survey.

State Farm estimated that animal collisions nationwide dropped slightly to 1.33 million between July 1, 2017, and June 30, 2018 - compared with 1.34 million in 2017 - and adjusted the odds that a driver might hit a deer accordingly.

Average risk across the nation is 1 in 167. The company put Oklahoma's risk at 1 in 165. For the 12th consecutive year West Virginia posted the highest odds, at 1 in 46, and Hawaii, which always is the lowest, at 1 in 6,379.

https://insurancenewsnet.com/oarticle/average-cost-of-deer-repair-is-4500#.W9nOYyX4-JA

On the Record

"Our perspective is knowing the list price through an advertisement just helps patients have better conversations with their doctor — and we think pricing should be an important part of the conversation with that doctor."

— AHIP spokesperson Kristine Grow talked the Trump administration's direct-to-consumer advertising guidelines for drug manufacturers with AIS's RADAR on Drug Benefits. The new rules are set to take effect in April 2019.

CMS this month said major changes may be ahead for...

...Medicare Part D's catastrophic coverage rules, shifting drug costs from the federal government to private insurers when Part D members reach a $5,000 out-of-pocket limit for drug costs. The Trump administration's 2019 budget includes a proposal to increase the private insurer's risk from 15% to 80% of members’ negotiated retail drug cost. Humana Inc. holds the largest Part D market presence of insurers that also provide medical benefits, at 4,857,992 lives.

For Third Quarter, Centene Touts Exchange Business, Fidelis Care

by Judy Packer-Tursman

In reporting third-quarter earnings on Oct. 23, Centene Corp., the largest player in the Affordable Care Act (ACA) marketplace, said its exchange membership now tops 1.5 million — up from 1.02 million a year ago. The insurer said its major expansion of the profitable business line will result in coverage in 20 states for 2019, including entry into four new states and expansion in six others.

Overall, Centene's earnings beat Wall Street's expectations, but its stock slumped due to mixed full-year guidance and a medical loss ratio of 86.3%, among other issues.

Chairman and CEO Michael Neidorff noted the third quarter was the first full quarter with Fidelis Care, New York's largest Medicaid plan, officially acquired by Centene in July after securing regulatory approvals.

Centene also remains focused on building a successful Medicare business, he added. As of Sept. 30, the insurer covered 417,000-plus Medicare enrollees, up 86,000 or 26% year over year. The insurer expanded its geographic footprint and expects to be in 21 states in 2019, he said.

Neidorff stressed that Centene's "operating metrics in the quarter were strong" — a point that he says may have been "obscured" by three offsetting adjustments: a $110 million charge related to an expired contract with Veterans Affairs, a $140 million pre-tax benefit related to a California Medicaid in-home support services program reconciliation, and a $30 million contribution to its charitable foundation.

For the quarter ended Sept. 30, Centene's adjusted net earnings increased 56% to $375 million, up from $239 million a year ago. Third-quarter revenues rose 36% year over year to $16.2 billion, and total managed care membership rose 17% or 2.1 million to 14.4 million.

With the process of integrating Fidelis well under way, Centene may be ready for more merger and acquisition activity since the company "appears to have bandwidth to integrate additional assets," Jefferies analyst David Windley said in a note to investors after the call.

 From Health Plan Weekly

Subscribers may read the in-depth article online. Learn more about subscribing to AIS Health's publications.

Enroll in SHOP Coverage

Treat your employees to SHOP coverage this Fall! The Small Business Health Options Program gives you the flexibility and power to control the health coverage you offer to your employees.    When reviewing coverage for your business, consider: 1. Can I get help paying for SHOP? You may qualify for the Small Business Health Care Tax Credit, which could be worth up to 50% of the costs you pay toward employees’ premiums. 2. What benefits do health plans cover? All SHOP plans cover the same set of essential health benefits. 3. Can I control my premium contributions? Yes, you can decide exactly how much you contribute toward premiums and if you’ll offer coverage to your employees’ dependents.

Questions? Contact the SHOP Call Center at 1-800-706-7893 (TTY: 711) weekdays from 9 a.m. to 5 p.m. Eastern Time.  Thank you, The SHOP Team

Who is eligible for Medicare?

Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance). You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:

·         You are receiving retirement benefits from Social Security or the Railroad Retirement Board.

·         You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.

·         You or your spouse had Medicare-covered government employment.

To find out if you are eligible and your expected premium, go the Medicare.gov eligibility tool.

If you (or your spouse) did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:

·         You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months. (Note: If you have Lou Gehrig's disease, your Medicare benefits begin the first month you get disability benefits.)

·         You are a kidney dialysis or kidney transplant patient.

While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.

Prescription Drug Coverage

Since January 1, 2006, everyone with Medicare, regardless of income, health status, or prescription drug usage has had access to prescription drug coverage. For more information, you may wish to visit the Prescription Drug Coverage site.

https://www.hhs.gov/answers/medicare-and-medicaid/who-is-elibible-for-medicare/index.html

The Loneliness Epidemic

Posted on October 30, 2018

By Ken Burdick

Did you know loneliness poses the same health risk as smoking 15 cigarettes a day? In fact, new research indicates weak social connections and feelings of extreme isolation could shorten a person’s life by 15 years. With more than one-third of U.S. adults age 45 or older indicating they are lonely, we’ve reached a critical number of individuals who are at risk for serious health outcomes.

What makes loneliness a significant health issue?

·         Loneliness can increase risk for heart failure.

·         Persistent loneliness can reduce lifespan.

·         Loneliness can contribute to cognitive decline.

Beyond the health-related impact, social isolation and loneliness also have enormous fiscal implications. Every month, Medicare spends $134 more for socially isolated older adults than those adults who are more connected to their communities. This additional care translates into an estimated $6.7 billion in Medicare spending annually.

What can we do as an industry to address this issue? At WellCare, we are looking at these areas:

·         Care in the Home. We must leverage care at home or outside of a clinical setting with support like the Program for All-inclusive Care for the Elderly (PACE), a federal initiative offered through a combination of Medicare and Medicaid funding. The goal is to keep seniors in their homes versus a nursing home. The program also comprises 255 PACE day centers called “PACE without Walls.”

·         Social Connections. We need to help members build a stronger community – being connected is one of the leading predictors of extended life.

·         Caregiver Support. We must also look at programs to address the impact loneliness is having on caregivers and their ability to assist. Some of the ways WellCare supports caregivers include paid training courses, certifications to enable pay for services and care management support.

·         New Technology. We should consider social media communities as an aid for those individuals with low mobility.

·         Loneliness Data. We also need processes to capture data around loneliness. For example, as part of WellCare’s onboarding process, we ask members specific questions regarding loneliness and caregiver support. This practice enables WellCare to understand our members better by uncovering mitigating factors and determining more holistic care..

We see positive industry changes through the Centers for Medicare and Medicaid Services (CMS) to expand reimbursement of non-medical benefits for this growing population. Previously, CMS defined supplemental healthcare benefits under narrower guidelines. The new 2019 guidance broadens the definition, which WellCare sees as positive step in allowing health plans to offer more primarily health-related benefits that address social issues such as loneliness.

But what more should be done? Could loneliness become the rallying cry for a targeted public health campaign designed for individuals to act – similar to campaigns that address immunizations or obesity?

Kenneth A. Burdick is the CEO of WellCare Health Plans

https://blog.wellcare.com/2018/10/30/the-loneliness-epidemic/