Rural Health Information Hub Latest News

Judge Orders Fed to Pay Insurers $1.6B

A federal judge in a final judgement issued last week ordered the federal government to reimburse nearly 100 health insurers about $1.6 billion in unpaid cost-sharing reduction payments called for under the Affordable Care Act. The ruling is the latest of several decisions stating that the federal government is required to make the payments, which total billions of dollars, but the Department of Justice has appealed those rulings. (Source: Modern Healthcare, 10/24)

Federal Health Insurance Exchange 2020 Open Enrollment

Window shopping begins with quality rating information displayed on HealthCare.gov across states for the first time

The Federal Health Insurance Exchange (also known as the Marketplace) Open Enrollment Period runs from November 1, 2019 to December 15, 2019, for coverage starting on January 1, 2020. Similar to previous years, the Centers for Medicare & Medicaid Services (CMS) is taking a strategic and cost-effective approach to inform individuals about Open Enrollment, deliver a smooth enrollment experience, and use consumer feedback to drive ongoing improvements across the Exchange platform. Consumers can visit HealthCare.gov and CuidadodeSalud.gov to preview 2020 plans and prices before Open Enrollment begins and for the first time HealthCare.gov will also display quality rating information in states that use HealthCare.gov, expanding the information available for consumers in their decision-making when comparing health coverage choices.

NEW THIS YEAR

Key Updates and Enhancements to Healthcare.gov for the 2020 Open

Enrollment

Quality Rating Information Displayed in HealthCare.gov States

Quality ratings will be displayed on HealthCare.gov when consumers view the list of plans available in their area in HealthCare.gov states this year. Under the five-star Quality Rating System, Exchange health plans are given an overall rating on a 1 to 5 scale, with 5 stars representing highest quality. The overall star rating is based on three categories: Medical Care, Member Experience and Plan Administration. In some cases — such as when plans are new to the Exchange or have low enrollment — ratings may not be available.

Star ratings in the Exchange help make it easy for consumers to compare health coverage choices by giving consumers a snapshot of how each health plan’s quality compares to that of other Exchange plans in each state in a given year. A quality rating of 3 or above means that a health plan is considered average or above average as compared to other plans across the country. For the 2020 coverage year, 80 percent of plans eligible to receive a rating of at least 3 stars. Similar to national quality reporting programs due to the time needed to collect and analyze survey and clinical quality measure data, the data CMS uses to calculate star ratings is based on plan performance data from two years prior. When shopping for a plan in 2020, consumers should keep in mind that star ratings displayed on HealthCare.gov are generally based on how the plan performed in prior years.

HealthCare.gov will display the Overall Rating with the number of stars from 1 to 5 filled in towards the top of each plan, or let the consumer know if the individual plan hasn’t been rated. Consumers can see three additional star ratings for Member Experience, Medical Care, and Plan Administration which comprises the Overall Rating when selecting an individual plan’s detailed information along with other coverage and benefits. The Overall Rating and the three additional quality rating categories are also displayed when consumers choose to compare up to three plans side-by-side.

For more information, please see the Exchanges Quality Rating System fact sheet.

Summary information is provided in the Plan Year 2020 quality ratings results at a glance.

Expanded Streamlined HealthCare.gov Application

As part of the continued commitment to improving the customer experience, the streamlined application on HealthCare.gov is expanded this year to handle nearly all consumer applications, both simple and more complex eligibility scenarios. The streamlined application provides improved content and integrates help information throughout the application in order to provide a more seamless enrollment experience from start to finish, as well as enhanced mobile optimization. CMS will continue to make enhancements to the application based on consumer feedback and testing.

Visual Refresh of Consumer Shopping Experience

This year, the visual experience for consumers when they preview plans (“See plans & prices”) and shop, compare and enroll on HealthCare.gov has been refreshed based on consumer research and feedback. The visual refresh provides a more consistent user experience throughout the entire enrollment process on HealthCare.gov that includes updates to filters, the plan results list, improved help content and enhanced mobile optimization.

Enhanced Direct Enrollment (EDE) Expanded

Enhanced Direct Enrollment (EDE) will be available throughout the entire Open Enrollment Period for the first time this year. This key development allows CMS to partner with the private sector to provide more avenues for consumers to apply and shop for Exchange coverage. Through the EDE pathway, consumers have the option to apply for and enroll in an Exchange plan directly through an approved issuer or web-broker without the need to be redirected to HealthCare.gov or to contact the Exchange Call Center. This year, more approved partners are offering EDE-capable websites. As of October 25, CMS has approved more than 5 private sector partners to operate an EDE pathway.

The safety and security of consumer information is our number one priority. Enhanced direct enrollment partners are required to undergo rigorous audits to ensure compliance with strict privacy and security controls prior to being certified to use this new platform. CMS continuously monitors each partner to ensure they remain in compliance with CMS requirements.

For more information please see the Enhanced Direct Enrollment Pathway for Health Insurance Exchange Coverage fact sheet.

New resources about Health Reimbursement Arrangements (HRA)

New rules released this year permit employers to fund individual market premiums for their employees through a new type of HRAs – Individual Coverage HRAs. CMS is adding educational information and a consumer worksheet tool to assist employees in determining whether to use an individual coverage HRA from their employer to help pay for coverage. HRAs are employer-funded accounts from which employees are reimbursed tax-free for qualified medical expenses.

For more information please see the Health Reimbursement Agreements webpage.

Consumer Tools and Support

Window Shopping

On October 25, 2019, CMS launched updates to window shopping (the “See plans & prices” page on HealthCare.gov) which allow consumers to preview 2020 plans and prices before Open Enrollment begins. As in previous years, window shopping lets consumers browse plans without logging in, creating an account, or filling out the official application. Starting November 1, consumers can log in to HealthCare.gov and CuidadodeSalud.gov or call 1-800-318-2596 to fill out an application and enroll in a 2020 Exchange health plan.

Consumer Call Center

The Call Center is often the front line of assistance for consumers as they apply for coverage and compare plan options. For the last two consecutive Open Enrollments, the consumer satisfaction rate remained at all-time high – averaging 90 percent – throughout the entire Open Enrollment Period. In order to help prepare the Call Center representatives to handle high consumer demand, CMS will continue providing extensive training to Call Center staff prior to Open Enrollment and weekly refreshers throughout the Open Enrollment Period.

In addition to the Call Center, in-person assistance will continue to be available to help consumers with enrollment. This includes local agents and brokers, Certified Application Counselors, and federally-funded Navigators.

Helping Consumers Connect with Agents & Brokers

CMS will continue to partner with a third party to offer the “Help On Demand” services from agents and brokers. This service allows consumers to choose to request that an agent or broker in their area contact them directly for help applying and enrolling. Registered agents and brokers are able to set times when they’re available and then reach out to consumers who expressed interest in assistance.

Learn more about Help On Demand services.

Find Local Help

Find Local Help is a tool that allows consumers to search by city and state or ZIP code to see a list of local people and organizations who can help them enroll in coverage. Consumers can search for a specific person or organization by entering their name and can filter the results based on their preferences and services provided. Additionally, consumers can filter agents and brokers by their minimum years of participation on the Federal Exchange.

Financial Assistance

Premium tax credits will be available in 2020 for individuals who qualify. Consumers can continue to use Exchange coverage and take advantage of its benefits, including premium tax credits. Plans available from insurance companies will continue to reflect reduced copayments, coinsurance, and deductibles for eligible consumers.

Small Business Health Options Program (SHOP)

Similar to previous years, employers will be able to enroll directly with an issuer, or with a SHOP-registered agent or broker. HealthCare.gov allows small business employers to preview available SHOP plans and find an issuer or agent/broker to work with to offer SHOP coverage to their employees. Quality rating information will also be available for SHOP plans.

Open Enrollment Notices

Each year, the Federal Health Insurance Exchange sends notices to consumers who are currently enrolled in a plan prior to November 1 about the upcoming Open Enrollment Period. This notice provides consumers with the dates for this year’s Open Enrollment and the importance of returning during this time to update their application and actively re-enroll in a plan for 2020. The notice also provides consumers with customized messaging for their situation, such as if they’re at risk of losing tax credits. Consumers receive additional notices from their current issuer with important information about premiums, coverage and benefit changes, and plan availability for 2020.

To see examples of consumer notices, visit: https://marketplace.cms.gov/applications-and-forms/notices.html

Automatic Re-enrollment Process

Similar to previous years, current enrollees who don’t update their application and enroll in a plan by the December 15, 2019 deadline generally will be automatically enrolled in the same plan or another plan offered by the same issuer that is intended to be similar, and if that is not available, another plan with a different insurance company. Consumers who are currently enrolled are strongly encouraged to come back and update their information, shop, and pick a plan that best suits their health care needs before the deadline. Consumers who miss the deadline to actively re-enroll in a plan of their choice during Open Enrollment will not be able to make any plan changes until the next coverage year unless they qualify for certain Special Enrollment Periods.

The Exchange sends a notice alerting consumers who were automatically re-enrolled.

Consumers whose 2019 issuer doesn’t have a plan available to them for 2020 will receive a discontinuation notice from their current issuer by the start of Open Enrollment. Those consumers may also receive a letter from the Exchange notifying them that they have been matched with an alternate plan from a different issuer to help avoid a gap in coverage. These consumers generally will need to pay their premium for January in order for their 2020 coverage to begin. Consumers are not under any obligation to stay with the new plan and are encouraged to take action and choose a plan by December 15. Consumers whose issuer isn’t offering their plan in 2020 are eligible for a Special Enrollment Period due to losing coverage and have the opportunity to choose a different plan.

Marketing and Outreach

CMS plans to spend $10 million on marketing and outreach for the upcoming Open Enrollment Period, matching the same level of spending for the past two years. CMS will continue to use similar marketing tactics that focus funding and attention on the most strategic and efficient ways to reach consumers. This year’s outreach and education campaign will target people who are uninsured as well as those planning to reenroll in health plans, with a special focus on young and healthy consumers. CMS has committed resources to proven high impact, low cost digital outreach efforts including short YouTube videos, social media, and mobile and search advertising.

CMS will also continue to use direct response methods including email, text messaging and autodial messages. Targeted email has proven to be the most cost efficient and effective way to reach consumers. As part of this effort, CMS will send most consumers emails throughout each week, with increasing frequency as the December 15 deadline approaches. CMS will also reinforce educational messaging through ongoing text messages and provide reminder calls encouraging consumers to take action before the deadline.

HealthCare.gov Operations

HealthCare.gov Scheduled MaintenanceWindows

Every year, CMS establishes scheduled maintenance windows that provide periods of time when CMS and its partners can make updates or resolve issues. Maintenance will only occur within these windows when deemed necessary to provide consumers with a better shopping experience. Consumer access to HealthCare.gov may be limited or restricted when this maintenance is required. Regularly scheduled maintenance will continue to be planned for the lowest-traffic time periods on HealthCare.gov, which are Sunday mornings.

The purpose in scheduling these times is to minimize any consumer disruption. Like other IT systems, these scheduled maintenance windows are how CMS updates and improves our system to run optimally and are the normal course of business.

For more information on the scheduled maintenance times, visit: https://marketplace.cms.gov/technical-assistance-resources/healthcaregov-maintenance-windows.pdf

HealthCare.gov Waiting Rooms

Similar to previous years, CMS may deploy a “waiting room” for some consumers who are logging in or creating an account on HealthCare.gov if website traffic becomes high enough to impact the consumer experience.

The waiting room is one tool CMS utilizes to optimize a consumers’ experience because it allows CMS to control the volume of users on HealthCare.gov resulting in better performance of the website. If they are in a waiting room, consumers will see a message asking them to stay on the page. The waiting room will refresh when a consumer can continue to apply and enroll with a smooth experience.

Additional Resources

Weekly Enrollment Snapshots Similar to previous years, CMS plans to release weekly enrollment snapshots throughout the Open Enrollment Period.

2020 Health Insurance Exchange Premium Landscape Issue Brief

To view the 2020 Health Insurance Exchange Premium Landscape Issue Brief, visit: https://www.cms.gov/CCIIO/Resources/Data-Resources/QHP-Choice-Premiums.html

2020 Plan Landscape Data

For more information on 2020 individual and family health plans available in the Federal Health Insurance Exchange, visit: https://www.healthcare.gov/health-and-dental-plan-datasets-for-researchers-and-issuers/

2020 Health Insurance Exchange Public Use Files

To see the 2020 Health Insurance Exchange Public Use Files, visit: https://www.cms.gov/cciio/resources/data-resources/marketplace-puf.html

2020 Quality Rating System Public Use Files

To see the Plan Year 2020 Quality Rating System Public Use Files, visit: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/ACA-MQI/ACA-MQI-Landing-Page.html

2020 Issuer Participation County Map

To see the 2020 Issuer Participation County Map, visit: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Health-Insurance-Exchange-Coverage-Maps.html

Oral Health Advocates Flood Capitol Hill

On October 24, 2019, members of the Oral Health Progress and Equity Network (OPEN) from across the nation met with Congressional offices to talk about the importance of oral health. Advocates presented each office they met with three policy asks to improve oral health outcomes; include oral health coverage under Medicare Part B, include oral health as a mandatory component of pregnancy-related benefits in Medicaid, and increase funding for the CDC Division of Oral Health to support an oral health program in every state.

Federal Appropriations Watch

A series of serious obstacles stand in the way of FY20 appropriations bills in the Senate, and during the week of October 21, 2019, the Coalition for Health Funding reports that Chairman of the Senate Appropriations Committee Richard Shelby has floated the possibility that the next Continuing Resolution (CR) might stretch into 2020.

NBC Spotlights Shortages of EMS Personnel in Rural America

In a powerful piece titled “What if You Call 911 and No One Comes?”, NBC shined a spotlight on the growing shortage of EMS personnel in rural areas across the country. The story focuses its narrative on the challenges to maintaining reliable EMS services in Hebron and Marmarth, North Dakota, but it explains that their stories are not isolated incidents. The situations in Hebron and Marmarth aren’t isolated; they come at a time when demand for health care in rural America far exceeds the supply of people necessary to provide that care. Fewer rural hospitals mean ambulances need to travel even farther distances, often in rough terrain or on unmarked roads, causing even more challenges in emergency situations.

Toolkit for Reducing Diagnostic Errors in Primary Care Pediatrics

Research from a recent American Academy of Pediatrics, Agency for Health Research & Quality (AHRQ) Improvement Innovation Network, showed that diagnoses for pediatric elevated blood pressure and adolescent depression improved and sustained with interventions developed during the project. It showed that missed or delayed actions for laboratory tests with abnormal results improved during the maintenance phase and after the intervention. The results were used to develop AHRQ’s Reducing Diagnostic Errors in Primary Care Pediatrics Toolkit.

Pharmacy Drone Delivery

After receiving approval earlier this month from the Federal Aviation Administration to operate a commercial drone fleet that will carry small metal boxes, UPS announced this week that it’s expanding drone-delivery services to include CVS Pharmacy, Kaiser Permanente, wholesale pharmaceutical distributor AmerisourceBergen and the University of Utah health system.  UPS is hitting the healthcare business on all sides, from patients to providers and suppliers, for faster deliveries of lab testing, prescriptions and medical supplies. UPS expects the unmanned aircraft to cut down a 30-minute truck drive to 3 minutes and 15 seconds.

New Study Quantifies Opioids Cost to U.S. Economy at $631 Billion

The opioid crisis cost the U.S. economy $631 billion from 2015 through last year, according to a study by the Society of Actuaries. The biggest driver of the cost over the four-year period is unrealized lifetime earnings of those who died from the drugs, followed by healthcare costs. While more than 2,000 state and local governments have sued the drug industry over the crisis, the report finds that governments bear less than one-third of the financial costs. The rest are borne by individuals and the private sector.

Progress Made, Progress Lost with Covering Kids

An analysis of new census data shows the number of children in the United States without any kind of insurance rose by more than 400,000 between 2016 and 2018 after decades of progress, the N.Y. Times reports. The article indicates that there is growing evidence that administrative changes and rising fears of deportation in immigrant communities are pushing large numbers of children out of coverage under federal programs.