kbp

Mar 5 2014, 02:35 PM

http://www.theblaze.com/stories/2014/03/03/obamacare-architect-be-prepared-to-kiss-your-insurance-company-good-bye-forever

Obamacare Architect: ‘Be Prepared to Kiss Your Insurance Company Good-Bye Forever’

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http://marylandhealthbenefitexchange.cmail3.com/t/ViewEmail/t/6EFE12014E6A170F/169BE7E23961BC73C67FD2F38AC4859C

February 28 Maryland Health Connection Update

Report from the Maryland Health Benefit Exchange about Maryland Health Connection, the state-based health insurance marketplace

BALTIMORE (February 28, 2014) -- Beginning this weekend, Maryland Health Connection will sponsor a series of enrollment fairs around the state. With the assistance of certified representatives, individuals attending the events will be able to apply for and enroll in Medicaid or qualified health plans. For more information, visit http://marylandhealthconnection.gov/healthconnectnow.

From October 1 through February 22, 2014, there have been more than a million unique visitors to the Maryland Health Connection website. 170,390 Marylanders have created identity-verified accounts. Through February 22, 35,636 Marylanders have chosen to enroll in private health plans through Maryland Health Connection.

Carriers are receiving first premium payments from new enrollees and notifying Maryland Health Connection on a rolling basis. Payment deadlines have not yet passed for many of those individuals who have chosen plans through Maryland Health Connection. According to data received so far from carriers,19,068 individuals who chose plans through Maryland Health Connection have paid the first premium for their policies. Based on information reported nationally, the rate of premium payment in Maryland appears to be similar to other areas....

Baldo

Mar 5 2014, 03:36 PM

kbp

Mar 5 2014, 02:35 PM

http://www.theblaze.com/stories/2014/03/03/obamacare-architect-be-prepared-to-kiss-your-insurance-company-good-bye-forever

Obamacare Architect: ‘Be Prepared to Kiss Your Insurance Company Good-Bye Forever’

Dr. Ezekiel Emanuel has all the charm of Anthony Wiener

I saw him on BOR, is he obnoxious or what?

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http://www.npr.org/blogs/health/2014/02/25/282115303/doctors-offices-get-put-on-hold-trying-to-find-out-whos-insured

Doctors' Offices Get Put On Hold Trying to Find Out Who's Insured

...That doesn't sound like many new customers, but it's presented a major challenge: Each exchange patient has required the practice to spend an hour or more on the phone with the insurance company. "We've been on hold for an hour, an hour and 20, an hour and 45, been disconnected, have to call back again and repeat the process," she explains. Those sorts of hold times add up fast.

In the past, offices have been able to make sure patients are insured quickly by using online verification systems run by the insurance companies. But for exchange patients, offices also have to call to make sure the patient has paid the premium. If it isn't paid, the insurance company can refuse to pay the doctor for the visit or recoup payments already made.

That's because of a provision of the law that gives exchange patients a grace period of up to 90 days to pay. During the first 30 days, insurers have to pay any claims incurred. But for the next 60 days, nothing is guaranteed. If a patient visits the doctor, the insurer can "pend" the claim — it can wait to pay until the patient pays his premium. At the end of the 90 days, the insurer can cancel the coverage and refuse to pay the pended claims, or recoup payments already made. That puts the doctor's office at risk.....

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http://www.forbes.com/sites/michaelcannon/2014/02/28/obama-creates-yet-another-new-entitlement-by-unilaterally-repealing-yet-another-part-of-obamacare/

Obama Creates Yet Another New Entitlement By Unilaterally Repealing Yet Another Part Of ObamaCare

As readers of this blog know, President Obama is disregarding the requirement that recipients of ObamaCare’s private health insurance subsidies enroll in coverage through state-established Exchanges. The president, without any congressional authorization and contrary to the clear language of federal law, is handing out subsidies to people enrolled through HealthCare.gov as well. In effect, the president simply created a $700 billion entitlement all by himself.

As if that wasn’t bad enough, now the president is creating yet another unauthorized entitlement by offering subsidies to people who don’t purchase insurance through an ObamaCare Exchange at all.

The poor guy just can’t help himself.

The Obama administration’s HealthCare.gov web site was (is?) such a disaster that Time magazine reports President Obama considered scrapping it and starting over. Many of the 14 states that established their own ObamaCare “exchanges” are faring no better. In states like Oregon and Maryland, the ObamaCare Exchanges are such a disaster that few if any residents have been able to enroll.

Since ObamaCare offers private health-insurance subsidies only to those who enroll in qualified health plans “through an Exchange established by the State under section 1311,” that means that people who purchase coverage outside their state-established Exchange are likewise ineligible for subsidies.

Don’t bother Barack Obama with such democratic technicalities, however. The president has once again created a new entitlement program and started handing out subsidies (euphemistically, “tax credits”) he has no authority to issue. The Associated Press reports:

• 
  
• HHS said state residents who were unable to sign up because of technical problems may still get federal tax credits if they bought private insurance outside of the new online insurance exchanges.

Unfortunately, the AP makes it sound like the administration is re-interpreting the law, rather than violating it:

• 
  
• The federal policy change is significant because until now the administration has stressed that the only place to get taxpayer-subsidized insurance under President Barack Obama’s health law is through the new online markets, called exchanges. Previously, people who bought outside the marketplace were not eligible for subsidies, although they benefit from consumer protections in the law.

President Obama’s crimes are not victimless. Just as offering unauthorized subsidies through federal Exchanges will trigger illegal penalties against employers, offering unauthorized subsidies to people who purchase coverage outside their state-established Exchanges will likewise trigger illegal taxes against employers. Employers in Maryland, Oregon, and other affected states may want to lawyer up.

Here’s what I wrote to the AP reporter who authored that story:

• 
  
• Section 1401 of the ACA says tax credits are available only to those who enroll in qualified health plans “through an Exchange established by the State under Section 1311.”
  
  As I first brought to your attention in August 2011 — literally, you were the first reporter I called — the IRS is attempting to repeal the “established by the State under Section 1311″ part.
  
  Now HHS is repealing the “through an Exchange” part — even though it is housed in the Internal Revenue Code, over which HHS doesn’t even have interpretive authority, much less the authority to create entitlements that Congress chose not to create.
  
  These dimensions of the story are material.

The media’s lack of curiosity is one of the most frustrating parts of the Obama administration’s taxation without representation.

LTC8K6

Mar 5 2014, 04:39 PM

WSJ has it as official. Delayed for two more years, through 2016.

kbp

Mar 5 2014, 04:51 PM

LTC8K6

Mar 5 2014, 04:39 PM

WSJ has it as official. Delayed for two more years, through 2016.

The non-QHP's?

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Hello HillaryCare: ObamaCare Deadline Extended Beyond Obama's Term

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http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/retroactive-advance-payments-ptc-csrs-02-27-14.pdf

Date: February 27, 2014
Subject: CMS Bulletin to Marketplaces on Availability of Retroactive Advance Paymentsof the PTC and CSRs in 2014 Due to Exceptional Circumstances

Background
This guidance is being provided to Marketplaces that, due to technical issues in establishing automated eligibility and enrollment functionality, have had difficulty in providing timely eligibility determinations to applicants and enrolling qualified individuals in Qualified Health Plans (QHPs) through the Marketplace during the initial open enrollment period for the 2014 coverage year. Such a circumstance may be considered an exceptional circumstance for individuals who were unable to enroll in a QHP through the Marketplace due to these issues. In this guidance, we discuss the availability of advance payments of the premium tax credit (APTC) and advance payments of cost-sharing reductions (CSRs) on a retroactive basis to an issuer once the Marketplace has provided a qualified individual with an appropriate eligibility determination and has determined that the individual is eligible for such assistance and the individual has enrolled in a QHP through the Marketplace. We also clarify the attendant responsibilities of the QHP issuer in this circumstance.

Provision of APTCs and CSRs
In accordance with applicable Federal regulations under 45 CFR 155, Subpart D, individuals must receive an eligibility determination from the Marketplace to enroll in a QHP offered through the Marketplace and in order to receive CSRs and the premium tax credit (PTC) made available through the Affordable Care Act. In order for the Marketplace to perform a determination of eligibility for coverage offered through the Marketplace, an individual must have submitted an application for coverage to the Marketplace using an HHS-approved single, streamlined application during the open enrollment period.

Not otherwise enrolled in coverage
First, if an individual in the exceptional circumstance described above has not been enrolled in any health coverage continuously since January 1, 2014, including QHP coverage offered outside of the Marketplace or otherwise, before a successful eligibility determination is obtained, when he or she receives a determination of eligibility for coverage through the Marketplace and enrolls in a QHP through the Marketplace, the Marketplace may allow for coverage retroactive to the date, established by the Marketplace, on which coverage would have been effective absent the exceptional circumstance described above, as provided under 45 CFR 155.310(f)(1) and 45 CFR 155.420(b)(2)(iii).

For instance, the Marketplace may establish an effective enrollment date based on the date that the individual originally submitted an application for coverage to the Marketplace. The individual will be treated for all purposes as having been enrolled in the QHP since the effective enrollment date. The individual will be responsible for the enrollee’s portion of the premium for the retroactive coverage period. If the Marketplace determines the individual eligible for APTCs and CSRs, and assigns the individual to a cost- sharing reduction plan variation, CMS will pay advance payments of the PTC and CSRs to the Marketplace QHP issuer on a retroactive basis, based on the effective enrollment date established by the Marketplace. The Marketplace QHP issuer must collect and adjudicate the claims incurred by the individual starting from the retroactive enrollment date as if the individual had been enrolled in the applicable plan variation since that date, and then must credit or refund any excess cost sharing as further detailed below. Cost-sharing reduction reconciliation will occur with respect to the Marketplace QHP for all cost-sharing reductions provided beginning with the (retroactive) effective date of coverage.

Enrolled in a QHP outside the Marketplace
Additionally, if an individual in the exceptional circumstance described above is enrolled in QHP coverage offered outside of the Marketplace, when he or she receives a determination of eligibility for coverage through the Marketplace, the Marketplace may deem the individual to have been enrolled in the QHP through the Marketplace retroactive to the date on which the individual first enrolled in the QHP outside of the Marketplace. In that case, the individual will be treated for all purposes as having been enrolled through the Marketplace since the initial enrollment date. The individual will be responsible for the enrollee’s portion of the premium for the retroactive coverage period. If the Marketplace determines that the individual is eligible for APTCs and CSRs, and the individual is assigned to a cost-sharing reduction plan variation, CMS will provide advance payments of the PTC and CSRs to the issuer on a retroactive basis back to the effective date of Marketplace enrollment. In addition, the issuer must re- adjudicate the claims incurred by the individual starting from the retroactive enrollment date under the QHP as if the individual had been assigned to the applicable plan variation since that date, and then must credit or refund any excess cost sharing or premium amounts, as further detailed below. Cost-sharing reduction reconciliation will occur for all cost-sharing reductions provided beginning with the (retroactive) effective date of coverage.

In this case, the Marketplace will also provide a special enrollment period (SEP) under 45 CFR 155.420(d)(9) to allow these individuals the opportunity to change QHPs prospectively at the time the eligibility determination is received. When this SEP is made available, and should an individual elect to change QHP issuers, CMS would provide advance payments of the PTCs and CSRs to the new issuer prospectively based on the coverage effective date provided under the SEP.

Reimbursement of the enrollee for premiums and cost-sharing paid
In both of the situations described above, if an individual is determined eligible for retroactive CSRs or advance payments of the PTC, the issuer of the QHP will be required to adjudicate or re-adjudicate, as applicable, the enrollee’s claims incurred during the retroactive period, and refund or credit to the enrollee any excess cost sharing or premiums paid if applicable, and ensure the provision of refunds or credits of any excess payments made by or for the enrollee for covered benefits and services incurred during the retroactive coverage period. Unless the individual requests the issuer provide a refund, the issuer may elect to provide a credit toward the individual’s premium payment for each subsequent month for the
remainder of the period of enrollment or benefit year until the credit is fully applied. Any refund or credit for any excess cost-sharing or premium paid for or on behalf of the individual must be provided (or begin to be provided in the case of a credit) within 45 calendar days of the date of discovery of the excess cost- sharing or premium paid, as detailed in 45 CFR 156.410(c)(1). If a credit remains at the end of the period of enrollment or benefit year, the issuer must refund the enrollee any remaining excess cost sharing or premium paid by or for the enrollee within 45 calendar days of the end of the period of enrollment or benefit year, whichever comes first.

Arrangements between the State and the QHP issuer
If the State has been providing premium or cost-sharing subsidies to an individual who has existing QHP coverage outside of the Marketplace, upon the individual receiving an eligibility determination, any reimbursement to the State for premium subsidies and reductions in out-of-pocket expenses provided on behalf of the individual prior to the individual’s enrollment in the QHP through the Marketplace will be the responsibility of the QHP issuer and the State.

Information reporting regarding APTCs
It is anticipated future guidance by the Treasury Department and the Internal Revenue Service will provide that the reporting under section 36B(f)(3) of the Internal Revenue Code of any APTCs paid on a retroactive basis must show the APTC amounts properly allocated to the month(s) for which they were paid. For example, if in April 2014 an individual is enrolled with a retroactive enrollment date of January 1, 2014, and APTCs are paid for retroactively for January through March, then the reporting would show the retroactive APTC amount properly allocated among January, February, and March.

Nondiscrimination
The Marketplace must not discriminate among issuers participating in the Marketplace, and should be consistent in its treatment of issuers when applying effective date rules. In accordance with 45 CFR 155.120(c), the Marketplace must treat enrollees in similar circumstances in a consistent manner and ensure that accessibility requirements under 45 CFR 155.205(c) are met.

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Here is a specific example from the document:

“Example 3. Family without minimum essential coverage.

"(i) In 2016, Taxpayers H and J are married and file a joint return. H and J have three children: K, age 21, L, age 15, and M, age 10. No member of the family has minimum essential coverage for any month in 2016. H and J’s household income is $120,000. H and J’s applicable filing threshold is $24,000. The annual national average bronze plan premium for a family of 5 (2 adults, 3 children) is $20,000.

"(ii) For each month in 2016, under paragraphs (b)(2)(ii) and (b)(2)(iii) of this section, the applicable dollar amount is $2,780 (($695 x 3 adults) + (($695/2) x 2 children)). Under paragraph (b)(2)(i) of this section, the flat dollar amount is $2,085 (the lesser of $2,780 and $2,085 ($695 x 3)). Under paragraph (b)(3) of this section, the excess income amount is $2,400 (($120,000 - $24,000) x 0.025). Therefore, under paragraph (b)(1) of this section, the monthly penalty amount is $200 (the greater of $173.75 ($2,085/12) or $200 ($2,400/12)).

"(iii) The sum of the monthly penalty amounts is $2,400 ($200 x 12). The sum of the monthly national average bronze plan premiums is $20,000 ($20,000/12 x 12). Therefore, under paragraph (a) of this section, the shared responsibility payment imposed on H and J for 2016 is $2,400 (the lesser of $2,400 or $20,000).”

No wonder Obama is unilaterally and unconstitutionally suspending the individual mandate until after the 2016 elections.

LTC8K6

Mar 5 2014, 09:34 PM

http://www.zerohedge.com/news/2014-03-05/hello-hillarycare-obamacare-deadline-extended-beyond-obamas-term

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Hello HillaryCare: ObamaCare Deadline Extended Beyond Obama's Term

Why do I feel certain that BCBSNC or AETNA will not be offering the insurance plans that we had last year...