KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Final ACO Regs Face Last Looks Before Public Release

Also in the news, more analysis regarding the law's essential benefits package and insurers' responses to rate hike reviews.

Modern Healthcare: ACO Regs Enter Final Review Stages
The final regulations to implement the accountable care organization provisions of the 2010 health care reform law have entered one of their last steps, according to an online notice. The Office of Management and Budget began its review of the final rule for the ACO program, also known as the Medicare Shared Savings Program, on Oct. 5. Such OMB reviews are usually the last or one of the last steps that regulations take before they are publicly issued. Officials at the CMS would not comment on whether the highly anticipated rule to implement the ACO section of the Patient Protection and Affordable Care Act would come within days or weeks (Daly, 10/10).

Politico Pro: Three Things To Watch In The Final ACO Rule
The Obama administration's most ambitious hope for reining in health costs will live or die by its nuts and bolts. Providers are demanding substantial changes to draft rules issued in March to create Medicare accountable care organizations, networks of doctors and hospitals that are rewarded for delivering more efficient care. The final rules are now at the last stage before being publicly issued: They're being reviewed by the Office of Management and Budget. The health care sector will be watching three major factors in the final rule that will determine whether providers will want to sign up. If ACOs don't get enough traction, the administration may lose its best chance to remove the economic incentives largely responsible for driving up health spending (Feder, 10/11).

The Hill: Patient Advocacy Group Ramp Up Public Campaign For Coverage Mandate
Patient advocacy groups across the country are ramping up their requests to have their priorities included in mandatory coverage guidelines under the federal health care law. The public campaign is expected to heat up over the next several months as federal regulators get closer to deciding the level of coverage private health plans will have to provide if they want access to federally subsidized insurance exchanges in 2014. The Institute of Medicine issued recommendations late last week that spell out a methodology rather than specific requirements for the law's "Essential Health Benefits," setting up a showdown between patient advocates concerned with quality of coverage and business groups that are worried about spiraling health care costs (Pecquet, 10/10).

Politico Pro: Insurers' Rate Hikes Close To Review Threshold
The Affordable Care Act requires a review of insurance premium rate hikes more than 10 percent starting this year, prompting some to wonder whether insurers may try to come in just under that figure to avoid the extra scrutiny. But from the first batch of rate hike explanations HHS posted for review last week, it appears that at least some insurers aren't afraid of the oversight. Everence Association in Montana is asking for 10 percent on the nose, for instance, while a 9.9 percent request would have slipped in below the federal radar. And Coventry in Missouri is asking for a 10.9 percent hike. The CCIIO is contracting with auditors to review proposed hikes of 10 percent or more in eight states that don't have full-fledged rate review programs of their own. For now, the site only includes requests from those eight states, but it will include such requests from all states, and next year will add information on the medical loss ratio (Norman, 10/10).

Meanwhile, consumer advocates are criticizing Indiana's request for a permanent waiver from the health law's medical loss ratio requirement —  

The Hill: Group Rips Indiana Request For Permanent Health Law Waiver
The state of Indiana is under fire from consumer advocates for requesting a perpetual waiver from a key provision of the health care reform law. The law allows waivers for health plans to phase in the law's medical loss ratio requirement, which requires the plans to spend at least 80 percent of premiums on medical care or give consumers a rebate. Indiana is the only state so far to request that high-deductible health plans be exempted forever (Pecquet, 10/10).

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