CMS will release state Medicaid and Children's Health Insurance Program renewal data on a monthly, two-part basis due to data availability. 

The rule updates essential community provider requirements for qualified health plans and adds a special enrollment period for those losing Medicaid or CHIP coverage.

CMS reports that open enrollment through the health insurance marketplaces for 2023 totals 16.3 million people, a 13 percent increase from 2022.

The proposed rule updates essential community provider requirements for qualified health plans and adds a special enrollment period for those disenrolled from Medicaid or CHIP.

The webpage includes renewal instructions for eligible beneficiaries and guidance for ineligible beneficiaries to secure insurance through the marketplaces.

The final rule raises the essential community provider threshold from 20 to 35 percent and uses wait time standards to evaluate qualified health plans for network adequacy.

An estimated 5.8 million people newly gained coverage during this open enrollment period; 32 percent of consumers using the federal marketplace selected a plan that costs them $10 or less per month. Enrollment remains open through Jan. 31 in five states and the District of Columbia.

In response to the proposed rule for the 2023 plan year, the association urged the Department of Health and Human Services to ensure equitable access, finalize nondiscrimination policies, standardize collection of Z codes, and prorate premiums and advanced premium tax credits.

The departments of the Treasury and Health and Human Services proposed extending open enrollment in the Affordable Care Act marketplaces, adding a new special enrollment period, expanding navigator responsibilities, and modifying Section 1332 innovation waivers.

A federal court vacated several policies in the Trump Administration’s 2019 health insurance marketplace rule for violating federal law, including provisions related to review of network adequacy, standardized options, income verification requirements, and reducing medical loss ratio rebates.

The agency is using its discretion to allow premium credits to support continuity of coverage for individuals and families impacted by the COVID-19 public health emergency and facing difficulties paying premiums.

CMS issued the 2021 final notice of benefit and payment parameters rule and letter to issuers updating regulatory and financial standards for plans offered on the health insurance marketplaces. CMS provides detailed options for issuers to adopt value-based designs for marketplace plans.

CMS issued the 2021 notice of benefit and payment parameters proposed rule and draft letter to issuers updating regulatory and financial standards for plans offered on the health insurance marketplaces. CMS is not proposing any changes to network adequacy standards.

A bipartisan group of 300 House lawmakers sent a letter to leadership calling for a two-year delay of Medicaid disproportionate share hospital cuts. The House will vote on a legislative package to expedite the availability of generic drugs and protect parts of the Affordable Care Act.

Hearings focused on rising drug costs and pricing transparency. Sen. Elizabeth Warren (D-MA) reintroduced a measure to bolster consumer protections under the Affordable Care Act. Both chambers will return to legislative business on April 29.

The House also will mark up a dozen bills aimed at lowering health care and prescription drug costs. House and Senate committees move forward on work to address surprise billing.

Long-expected "Medicare-for-all" bill formally introduced; Congressional hearings continue to focus on rising health care costs and prescription drug prices.

The waivers allow each state to create a reinsurance program to lower premiums in the individual market; the waivers will take effect in 2019 and are approved through 2023.

The Department of Labor has issued a final rule expanding the definition of "employer" for purposes of establishing association health plans.

The Centers for Medicare & Medicaid Services noted that the provisions aim to increase flexibility, improve affordability, strengthen program integrity, empower consumers, promote stability, and reduce regulatory burden in the individual and small group marketplaces.

Congress this week is focused on negotiating legislation to stabilize the Affordable Care Act insurance marketplace and efforts to fight the opioid crisis.

The proposal extends to one year the maximum length of short-term, limited duration plans — up from three months, as mandated by the Affordable Care Act.

Republicans from both chambers work on a marketplace stabilization package; Senate Finance Committee Republicans plan to review the Internal Revenue Service's process for designating nonprofit hospitals.

The Centers for Medicare & Medicaid Services is awarding $8.1 million in targeted funding to assess and potentially alter states’ essential health benefits packages.

The association emphasized access to essential community providers within qualified health plan networks in its comments on the 2019 draft letter to issuers.

The association encouraged the Centers for Medicare & Medicaid Services to ensure that state plans cover essential health benefits and include sufficient access to essential community providers.

The proposed rule would expand the role of states in administering marketplace plans and give states additional flexibility to define essential health benefits.

The Congressional Budget Office estimates premiums will increase 20 percent by 2018 and the uninsured population will increase by 1 million; 19 states and the District of Columbia filed a lawsuit arguing that withholding the payments violates current law.

This is the second Section 1332 State Innovation Waiver to receive approval; Alaska is pursuing the waiver to stabilize the state's individual health care market.

Senate Republican leaders aim to submit a draft bill to the Congressional Budget Office early this week and vote on the bill before the July Fourth recess.

CMS aims to eliminate or change outdated, costly, or inconsistent regulations for marketplaces established under the Affordable Care Act.

America’s Essential Hospitals expressed concerns about proposed changes that could harm the integrity of qualified health plan networks.

The proposed rule aims to provide flexibility by targeting network adequacy reviews & inclusion of essential community providers in qualified health plans.

CMS finalized a proposal to continue the current methodology, which qualified health plans use to satisfy the minimum essential community provider standard.

America's Essential Hospitals is taking part in the Provider and Hospital Week of Action to promote open enrollment for insurance marketplaces under the ACA.

America's Essential Hospitals expressed continued concerns about qualified health plan network adequacy in federally facilitated marketplaces.

The letter provides operational and technical guidance to issuers of qualified health plans through the federal health insurance marketplace for 2018.

The open enrollment period runs from Nov. 1 through Jan. 31, 2017. Consumers must enroll by Dec. 15 for coverage that begins Jan. 1, 2017.

CMS will use social video platform Twitch, improve the HealthCare.gov mobile interface, and use #HealthyAdulting to encourage young adults to sign up.

Hospitals eligible for the essential community providers list are participants in the 340B and DSH programs, critical access hospitals, and others.

Comments on the proposed Notice of Benefit and Payment Parameters for 2018 are due by Oct. 6.

The grants to support marketplace navigators come as exchanges gear up for the Nov. 1 start of open enrollment for coverage beginning in 2017.

CMS is concerned that some providers might steer Medicare- and Medicaid-eligible patients into individual market plans to get higher payments.

Individuals must prove they are eligible to sign up for coverage outside of open enrollment. HHS also proposes amending risk adjustment for insurers.

HHS finalizes 2017 Notice of Payment and Benefit Parameters rule and letter to issuers offering qualified health plans on the federally facilitated marketplace.

America's Essential Hospitals and two members systems host congressional staff for round-table discussions about how proposed 340B Drug Pricing Program guidance threatens vulnerable patients and essential hospitals.

Comments urge CCIIO to require that ACA marketplace plans include willing essential community provider (ECP) hospitals and ensure payment rates support access to care.

Congress debates omnibus appropriations measure, considers another stop-gap funding bill, as deadline for government shutdown looms.

Out-of-pocket expenses higher in ACA marketplaces and coverage worse for children, especially those with special needs, HHS reports.

Proposals would make required and recommended changes to how qualified health plans operate in Affordable Care Act marketplaces.

Model law would update requirements for insurance carriers in the health insurance marketplaces, particularly regarding provider directories, mental health services, telehealth, and nondiscrimination.

Report on National Strategy for Quality Improvement in Health Care details progress made toward better care, lower costs, and improved health.

Open enrollment for ACA marketplaces will last from Nov. 1, 2015, to Jan. 31, 2016, with coverage taking effect as soon as Jan. 1. Previously announced HHS enrollment goals include improving consumer experience, retaining and adding customers.

The Basic Health Plan methodology would begin Jan. 1, 2017, and is largely unchanged from current methodology. CMS plans to finalize the rule in Feb. 2016. The BHP is an affordable alternative to marketplace coverage.

The proposed rule extends nondiscrimination provisions to individuals based on sex, sexual orientation, and gender identity. The proposed rule also includes requirements for access for people with disabilities and limited English proficiency.

According to a study, 10 states had a high prevalence of networks that were considered narrow in their health insurance marketplaces, while 12 states did not offer any plans with narrow networks.

Plans must be budget-neutral and cover as many people as traditional ACA reforms. With these waivers, states may forgo certain ACA provisions including the marketplaces and individual mandate.

The Supreme Court ruled in King v. Burwell that the Affordable Care Act makes federal subsidies available to individuals in states that use the federally facilitated marketplace, not just those with a state-based marketplace.

Six justices ruled in favor of the Obama administration, arguing that the overall structure and purpose of the ACA supports the interpretation that Congress intended subsidies to be available in both federally facilitated and state-based marketplaces.

CBO also found that if a full ACA repeal took effect on Jan. 1, 2016, the federal deficit would increase by $137 billion between 2016 and 2025.

America's Essential Hospitals is conducting this member survey to capture the impact of the ACA coverage expansion on essential hospitals.

The funding opportunity will support navigators for up to three years in federally facilitated and state partnership health insurance marketplaces.

Ruling against subsidies could send ACA into "death spiral," according to RAND report.

Congress must pass a homeland security spending bill this week, and health insurance marketplaces are under scrutiny as oral arguments in the King v. Burwell Supreme Court case begin.

Specifically, HHS will evaluate financial assistance programs, Medicaid expansion, pioneer ACOs, and marketplace payment systems.

Feb. 20 final rule and letter to issuers outline benefit and payment parameters for 2016 health insurance marketplace plans

Payment methodology, to start Jan. 1, is largely unchanged from 2015

Plus, more than 3.3 million people who submitted marketplace applications are eligible for Medicaid or CHIP.

Association filed Jan. 28 amicus brief in Supreme Court case supporting insurance subsidies through federally facilitated health insurance marketplace.

The association submitted comments to CCIIO and NAIC calling for more robust standards for including ECPs in health insurance marketplaces.

America's Essential Hospitals urged HHS to improve ECP standards in the marketplaces to ensure patients have access to quality, affordable health care.

America’s Essential Hospitals urged MACPAC to support a four-year CHIP funding extension and during that time, evaluate the marketplaces' network adequacy, affordability, and covered benefits.

CMS, NAIC documents contain important health insurance marketplace provisions, including cost-sharing requirements. Comments due to CMS Dec. 22, to NAIC by Jan. 12, 2015.

New association policy brief describes how cost-sharing assistance by hospitals helps vulnerable patients afford health insurance marketplace coverage and access vital health care services

The commission seeks input on which groups of children would be most affected if CHIP expires and potential policy options through the marketplaces.

Oral arguments for this case are scheduled to begin Dec. 17.

The full U.S. Court of Appeals for the District of Columbia will rehear Halbig v. Burwell, one of the two cases with conflicting results on whether ACA subsidies are available in the federally facilitated marketplace.

Generally, if consumers do nothing, they will be auto-enrolled in the same plan with the same premium tax-credit and other financial assistance as they had in the 2014 plan year.

In preparation for the Nov. 15 start of open enrollment in the health insurance marketplace, CMS issues guidance on certification requirements for navigators, certified application counselors, and others who help consumers with the enrollment process.

Florida, New York, and Wisconsin consider options to allow hospitals to subsidize insurance premiums for individuals. Financial assistance would increase opportunities for coverage and continuous, coordinated care.

The U.S. Court of Appeals for the DC Circuit has ruled that people who purchase health insurance through the federally facilitated marketplace are ineligible for ACA subsidies. The 4th Circuit Court of Appeals in Virginia released a conflicting opinion hours later.

House GOP will move forward with a lawsuit against President Obama on the delay of the employer mandate without congressional approval. Energy and Commerce is marking up a variety of bills and holding hearings on the health insurance marketplaces and anthrax.

CMS outlines three methods for reviewing enrollee coverage eligibility for insurance purchased through the federally facilitated marketplace.

HHS report announces that 87 percent of individuals who purchased health insurance from the federally facilitated marketplace during initial open enrollment have received premium assistance through federal tax credits. The report also shows that 64 percent of individuals enroll in plans with the lowest premiums, despite higher cost-sharing rates.

The Labor/HHS appropriations bill vote was cancelled due to Republican threats to derail the process over ACA funding. House Majority Leader Cantor's loss has House Republicans vying for his seat. MedPAC shares its biannual report to Congress on Wednesday.

The association submitted comments to the Departments of Labor, Health and Human Services, and the Treasury regarding their request for information on provider nondiscrimination.

CMS announced $60 million in additional grants available to support navigators in federally facilitated and state partnership marketplaces. Letters of intent are due June 30, and complete applications are due July 10.

America’s Essential Hospitals released a policy brief June 2 announcing its support for provider-sponsored premium assistance, which the association believes is a logical extension of members' work and facilitates the availability of affordable health care for all.

America's Essential Hospitals describes how provider-supplemented premium assistance for enrollees in the health insurance marketplaces strengthens the marketplaces and furthers the goals of the Affordable Care Act.

HHS reiterates that charitable foundations are not prohibited from making payments on behalf of enrollees in qualified health plans.

CMS issued a final rule Friday, May 16, on 2015 standards for health insurance marketplaces and the insurance market. Among other provisions, CMS finalized measures for a quality rating system that would require health insurance issuers operating through the marketplaces to collect, validate, and report data on quality metrics for qualified health plans.

The Ways and Means Committee reviewed hospital issues as part of the Medicare Program. Two Louisiana delegates urged CMS to accept nonprofit-provided premium assistance. The Senate Veterans Affairs Committee held a hearing featuring Secretary Shinseki.

Comments include requests to allow provider-supplemented premium assistance and cost-sharing for individuals obtaining marketplace coverage and to clarify that QHPs should accept premium and cost-sharing assistance from private, nonprofit foundations.

The expat bill was previously considered but didn't pass due to Democrats fighting against it. The Energy and Commerce Oversight Subcommittee will look at insurance enrollment and the marketplaces from the perspective of insurers. OMB Director Sylvia Burwell will testify before the HELP Committee as she begins her confirmation process to become the next HHS secretary.

CBO estimated 2016 marketplace premiums will be 15 percent less than they were estimated to be in 2009. This should mean the ACA will cost $104 billion less to the federal government over the next decade than previously projected.

The association said that CMS should implement the QRS in a way that protects consumer access to ECPs in the marketplaces. It also urged CMS to ensure the measures used in the QRS are endorsed by the National Quality Forum and risk adjusted for socioeconomic factors.

Association members explained what makes an essential hospital and the key issues facing essential hospitals to their policymakers on the Hill. The event also included reflections from senior Capitol Hill and administration staff and two award ceremonies that recognized members of Congress and congressional staff for their commitment to essential hospitals.

CMS is allowing consumers to enroll in the federally facilitated marketplace under a special enrollment period if they experienced life changes, exceptional circumstances, or technical problems with healthcare.gov. Coverage will be effective for 2014. HHS reported that 7.1 million people enrolled in health insurance through the marketplaces before the March 31 open enrollment deadline.

CMS proposes that QHP issuers collect enrollee satisfaction data for certain QHPs. This data will be one of the components used to determine QHP quality ratings. America's Essential Hospitals will submit comments on CMS' proposal for collecting enrollee satisfaction data.

Labor, Treasury, and Health and Human Services seek comments on the ACA’s provider nondiscrimination provision. Their request includes information on access, costs, other federal and state laws, and feasibility. Comments are due by June 10.

Health care leaders will discuss efforts to enroll patients in health insurance coverage before March 31. Association President & CEO Bruce Siegel, MD, MPH, along with Vice President Joe Biden, U.S. Department of Health and Human Services Secretary Kathleen Sebelius, and other hospital association leaders will participate in the call.

CMS stated that it encourages QHPs to reject payments from hospitals and other health care providers. The agency did not provide information about premium and cost-sharing payments made on behalf of QHP enrollees by private, nonprofit foundations. America's Essential Hospitals will submit comments to CMS urging the agency to allow such payments from private, nonprofit foundations.

For 2015, each qualified health plan (QHP) network must include at least 30 percent (up from 20 percent in 2014) of all available ECPs in its service area to meet network adequacy requirements. CMS is also implementing a reasonable access review standard.

The final rule establishes procedures for enrollment and certification. CMS also released its final methodology for determining federal payments to states establishing a BHP program in 2015.

America’s Essential Hospitals protects access to care among marketplace plans. The association urged CCIIO to ensure an adequate number of ECPs are included in QHP networks. It also asked CCIIO to ensure patients have access to all hospital services in their plan’s network.

Nearly 3.3 million people have selected plans through the marketplaces since they opened Oct. 1, 2013. This number represents 45 percent of the 7.3 million people who were eligible to enroll in a marketplace plan. In addition, 3.2 million people who submitted applications through the marketplaces were determined to be eligible for Medicaid or the Children’s Health Insurance Program (CHIP).

These FAQs further clarify the Nov. 4, 2013 FAQ, which stated that the U.S. Department of Health and Human Services encourages issuers to reject premium payments from third parties such as hospitals, other health care providers, and other commercial entities.

Responding to input from America’s Essential Hospitals to strengthen the essential community provider (ECP) requirements, CCIIO notes an enhanced ECP standard. America’s Essential Hospitals is pleased CCIIO recognizes that more protection is needed for ECP patients’ access to care but believes that the requirements should be strengthened further.

Of particular interest to members of America's Essential Hospitals, we are pleased to see CCIIO account for the concerns raised by our member hospitals and enhance its essential community provider standard.

Republican House leaders are working on a proposal to replace the Affordable Care Act (ACA). On Wednesday, the House Committee on Oversight and Government Reform will hold a hearing on the risk corridors provision in the ACA. Last week, House Energy and Commerce Ranking Member and Former Chair Henry Waxman (D-CA) announced he would retire at the end of his term this fall.

Sen. Jeanne Shaheen (D-NH) urged the U.S. Department of Health and Human Services Secretary Kathleen Sebelius in a Jan 29 letter to “closely examine the provider network adequacy standards” for qualified health plans sold through health insurance marketplaces (exchanges).