Empowering patient voices through voter registration
While roughly 83% of adults in the United States will visit a health care provider in the next year, an estimated
News
6-23-11 Affordable Care Act Update
June 24, 2011
Federal Update
External Appeals Regulation Released
External appeals are critical in resolving disputes patients may have with their health plan if a claim is denied, to ensure that health insurance works for consumers. This week the Administration released an amendment to its previous regulation on external appeals. The good news is that as a result of the regulation, virtually all people enrolled in private insurance, including ERISA self-insured plans, have the right to appeal, and the decision the external review panel makes is binding. (The requirement does not apply to people enrolled in plans that were in existence before March 23, 2010 -– so called “grandfathered plans” -- and they remain largely unchanged in their benefits and cost-sharing.)
Unfortunately, the regulation let consumers down, especially cancer patients who need to have disputes resolved quickly and fairly. Most notably, the scope of what can be appealed is limited to issues of "medical judgment.” While medical judgment encompasses many possible disputes, the requirement fails to address a significant proportion of claims that are based on other factors, such as an administrative coding errors, failure to receive pre-authorization, and plans arguing that a benefit is not covered by the plan. Of further concern is the reduced timeframe to file an appeal and time delay for resolution. In addition, there are several other provisions of the regulation where the administration could have made the external appeals process stronger and easier for patients and consumers to understand but did not do so.
Because this is an interim final regulation it takes effect as written now; however, it can also be amended at a later time based on public comments. ACS CAN intends to prepare comments arguing for enhancements that would make the external appeals process more consumer-friendly. Read the ACS CAN press release and read the Kaiser Health News story.
Preventive Services in Medicare
On Tuesday, the Centers for Medicare and Medicaid Services (CMS) released a report showing that as of June 10, 2011 more than 5 million Americans with traditional Medicare took advantage of one or more of the recommended preventive benefits now available for free such as mammograms and colorectal cancer screening. Earlier this year, Medicare eliminated the Part B deductible and copayments for a host of preventive services, including some cancer screenings, tobacco cessation, diabetes and cholesterol tests, and flu and hepatitis B shots. CMS also eliminated out-of-pocket costs for the “Welcome to Medicare” preventive visit, and, for the first time since the Medicare program was created in 1965, Medicare now covers an annual wellness visit with a participating doctor, also at no cost. CMS has also launched an outreach and education campaign to ensure that everyone eligible for Medicare uses these benefits. The campaign, Share the News, Share the Health, will run throughout the summer, with online ads and community events all over the country starting in July. Read the Los Angeles Times article.
State Update
Exchange Legislation
Nevada Governor Brian Sandoval signed a bill that requires state officials to set up a health insurance exchange as called for in the Affordable Care Act. Nevada joins four other states where governors have signed legislation signaling the intent to establish an exchange (Virginia), study establishing an exchange, (Mississippi and Wyoming) or create an appropriation for the establishment of an exchange (North Dakota). In addition, the governors of Alabama, Georgia and Indiana have issued executive orders to create panels to study exchanges.
Four states--Connecticut, Hawaii, Illinois and North Carolina – are awaiting their governor's signature on legislation that has passed both Houses establishing a health insurance exchange. They would join the seven states--California, Colorado, Maryland, Oregon, Vermont, Washington and West Virginia--where legislation has passed and the governor has signed it into law. See The Commonwealth Fund’s progress report and nationwide map on the status of state exchange legislation.
State Medicaid and Cancer Fact Sheets
Numerous federal and state legislative proposals threaten to drastically reduce funding and prevent access to Medicaid, including removing the maintenance of effort (MOE) provision or limiting its financing through block grants and global spending caps. Without adequate Medicaid funding, cancer patients may lose medical coverage. Thousands of women receive their breast and cervical cancer treatment through the Medicaid program, after having been diagnosed through the breast and cervical screening program. If the MOE is repealed, states will be allowed to reduce or eliminate the eligibility of any categorically optional group. As a result, thousands of low-income women across the nation diagnosed with breast and cervical cancer could lose access to adequate treatment.
Block granting the Medicaid program, or global caps could also cause states to lose millions in federal money. Since block grants and global spending caps can restrict federal payments for Medicaid, states may have no other choice but to impose enrollment freezes, waiting lists, and co-pay increases to reduce program costs.
For specific information on each state and the potential impact of proposed Medicaid cuts, go to the Medicaid and Cancer – State Fact Sheets folder on the LINK and select the state you need. You can also access it by going to the ACS CAN community on the LINK. Select the Policy Documents folder and then select the Medicaid and Cancer State Fact Sheets sub-folder under Medicaid.
As always, thank you for all you do every day to support laws and policies that help cancer patients and their families.
Christopher W. Hansen
President
American Cancer Society Cancer Action Network (ACS CAN)