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HHS Secretary Kathleen Sebelius announced on Monday the award of $1 million to California to help crack down on health insurance premium increases.
California will use this Affordable Care Act funding to help improve the oversight of proposed health insurance premium increases, take action against insurers seeking unreasonable rate hikes, and ensure Californians receive value for their premium dollars.
“The Affordable Care Act puts in place critical market reforms to improve quality and reduce the cost of health care for employers and individuals. Increased competition, lower insurance overhead, and better risk pooling in health insurance Exchanges in 2014 are expected to reduce premiums in the individual market by anywhere from 14-20 percent according to the Congressional Budget Office,” said HHS Secretary Kathleen Sebelius.
“Between now and then, we will continue to work with States to ensure consumers are receiving value for their premium dollars and to avoid the kind of double digit premium increases seen recently,” Sebelius said. “The state proposals approved today demonstrate the need and desire for new resources and tools to help them protect against unjustifiable premium increases.”
The Affordable Care Act provides states with $250 million in Health Insurance Premium Review Grants over five years to help create a more level playing field by improving how states review proposed health insurance premium increases and holding insurance companies accountable for unjustified premium increases. Applications for the first round of Health Insurance Premium Review Grants were made available on June 7.
The grants build on the Obama Administration’s work with states to implement the Affordable Care Act. Earlier this year, Secretary Sebelius called on certain insurance companies to justify large premium increases and encouraged State and local officials to obtain stronger health insurance premium review authorities under State laws.
This increased scrutiny by the administration and by several states has led to the withdrawal or reduction of several proposed health insurance premium increases that in some cases turned out to be based on faulty assumptions and data.
This grant will be used for the purposes detailed in the approved application. The following is a general summary of how California intends to use its funding:
Pursue additional legislative authority: The governor will present legislation that synchronizes review activities across the Department of Managed Health Care and Department of Insurance offices. California’s Department of Managed Health Care conducts limited review of small group and guaranteed issue rates for HMO and other managed care plans. The California Department of Insurance reviews health insurance premium increases in the non-HMO market prospectively. An actuary reviews rates for compliance with California’s 70 percent medical loss ratio rule and also assesses actuarial assumptions and trends. Insurers are contacted regarding most filings and approximately two thirds resubmit lower rates. For small group, plans must demonstrate compliance with rate factors requirements. There is no large group review by either entity.
Expand the scope of the review process: California will expand the authority of the Department of Managed Health Care to collect and review all submitted individual and small group health insurance premium increases.
Improve the review process: The Department of Managed Health Care currently has limited review authority. Both the Department of Managed Health Care and the Department of Insurance will improve the collection of health insurance premium information, enhance the depth and breadth of current rate review activities, and make IT system improvements. The Department of Managed Health Care will initiate actuarial review of filings and the Department of Insurance will enhance its existing actuarial review capacity.
Increase transparency and accessibility: Currently only the Department of Insurance posts filings by insurance companies. The Department of Managed Health Care will also begin to post filings and both agencies will educate consumers on influential underlying factors of cost data so consumers are able to understand the cost of health care choices.
Develop and upgrade technology: California will build the infrastructure necessary to scrutinize a significantly greater number of rate proposals.
“States will use these grant dollars in the way that makes the most sense for their insurance consumers,” said Jay Angoff, director of the Office of Consumer Information and Insurance Oversight. “As we continue to implement the new health insurance reform law, we will continue to work with States to ensure they have the tools they need to ensure the stability of the marketplace, keep costs low and provide consumers with increased transparency, choice and quality they need to make the best health care decisions for their businesses and families.”
The Health Insurance Premium Review Grants are one element of a broad effort under the Affordable Care Act to reduce the unreasonable premium increases proposed by some insurers today. Additional resources from this $250 million program will be available in subsequent years to further strengthen State health insurance premium review procedures.
Other statutory provisions designed to improve affordability include:
In 2011, the Affordable Care Act allows the Secretary of the U.S. Department of Health and Human Services to review justifications for unreasonable increases in premiums and make them public;
In 2011, insurers will generally be required to spend at least 80 percent of premium dollars on medical care services and quality-improvement activities and limit their spending on overhead, marketing, CEO salaries, and profits; and
In 2014, the Affordable Care Act empowers States to exclude health plans that show a pattern of excessive or unjustified premium increases from the new health insurance Exchanges.
The Affordable Care Act includes a wide variety of provisions designed to promote a high-quality, high-value, health care system for all Americans and to make the health insurance market more consumer-friendly and transparent.
Some of the provisions that take effect by the end of next year, or are already in effect, include prohibitions on pre-existing condition exclusions for children; prohibition on lifetime dollar limits in all health plans; extended access to insurance for many young adults; and an unprecedented level of transparency about health insurance through www.HealthCare.gov.
To read more about how each state will use its grant funding, visit www.healthcare.gov/center/grants/index.html. For a national fact sheet visit www.healthcare.gov/news/factsheets/rates.html.
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KELSEYVILLE, Calif. – Narcotics Anonymous is holding their fifth annual Unity Weekend Campout Friday, Aug. 27, through Sunday, Aug. 29, at Clearlake State Park, 5300 Soda Bay Road, Kelseyville.
Due to limited space, a $20 preregistration fee is recommended for camping.
There is no cost for day use but a $6 parking fee may apply, obtainable at the park entrance.
For the Saturday night barbecue a $5 donation is suggested.
For more information contact Tony C. at 707-631-2182.
To preregister visit www.lakecountyna.org. PayPal is accepted.
For more information about Narcotics Anonymous in Lake County, visit the Web site or call the helpline at 707-262-0132.
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LAKE COUNTY, Calif. – Ten hospitals affiliated with the not-for-profit Sutter Health network earned the July 2010 “Certificate of Excellence” from the California Hospital Assessment and Reporting Task Force (CHART).
The honor recognizes exceptional performance in health care quality in 50 categories. Only 40 hospitals across California received the award – and Sutter Health facilities comprise 25 percent of those honored.
Recognized Sutter Health hospitals include:
Eden Medical Center (Castro Valley);
Memorial Medical Center (Modesto);
Mills-Peninsula Health Services (Burlingame);
Novato Community Hospital (Novato);
Sutter Amador Hospital (Amador);
Sutter Auburn Faith Hospital (Auburn);
Sutter Davis Hospital (Davis);
Sutter Lakeside Hospital (Lakeport);
Sutter Medical Center of Santa Rosa (Santa Rosa);
Sutter Roseville Medical Center (Roseville).
Twice a year, CHART, a third-party consumer-reporting agency, presents the certificates of excellence to hospitals that achieve “above average” or “superior scores” in five of the eight CHART measurement areas; receive no “below average” or “poor” score on any measure; and report data for all measurements for which they qualify.
These measures include patient satisfaction and experience among common reasons for admissions such as cardiac care, maternity services and treatment for pneumonia.
Participating hospitals voluntarily submit data, and more than 200 California hospitals take part. The not-for-profit Sutter Health network has participated in the CHART process since its inception in 2004.
For complete performance information on the hospitals participating in CHART, see www.CalHospitalCompare.org.
Published by the California HealthCare Foundation, the online report card helps consumers easily search for quality information about hospitals by location, name or medical condition.
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On Tuesday U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced that the third round of one-time, tax-free $250 rebate checks have been mailed to eligible Medicare beneficiaries whose drug costs are so high they have reached the Medicare Part D prescription drug coverage gap known as the “donut hole.”
Experts estimate that more than a quarter of Part D enrollees hit the donut hole and often stop following their drug regimen as a result of the added cost burden.
The $250 rebates will go a long way in preventing seniors from having to make such difficult and almost certainly harmful health decisions.
In California, 76,970 seniors and persons with disabilities who rely on Medicare for access to health care have received new help with their prescription drug costs to date, thanks to the Affordable Care Act.
Across the country, more than 750,000 Medicare beneficiaries have already received checks this year, and more beneficiaries will be receiving checks in the coming months as they enter the coverage gap.
“High prescription drugs costs are a problem for many seniors and other Medicare enrollees with limited incomes,” said Secretary Sebelius. “These checks are an important first step in helping them afford the medications they need – and are evidence of how Americans are already seeing the very real benefits of the Affordable Care Act. From strengthening the long-term future of Medicare as evidenced by the recent Medicare Trustees report, to saving seniors and the disabled money on everything from prescription drug costs to preventive services, the Affordable Care Act is helping to preserve and protect Medicare.”
The rebate checks will partly close the donut hole this year, with the $250 one-time checks for beneficiaries who enter the gap. In 2011, the Affordable Care Act takes an additional step for Medicare beneficiaries in the donut hole by providing them with a 50 percent discount on their brand name medications. Every year from 2011 to 2020, the Affordable Care Act will take progressive steps to close the donut hole.
In addition to savings on prescription drugs, the new law takes a series of steps to strengthen Medicare. Under the Affordable Care Act:
Medicare beneficiaries will receive free preventive care services like mammograms and certain colon cancer tests and a free annual physical starting in 2011;
By 2018, seniors can expect to save on average almost $200 per year in premiums compared to what they would have paid without the new law, and most beneficiaries will also see a significant reduction in their Medicare coinsurance as a result of the Affordable Care Act; and
The life of the Medicare Trust Fund is extended by 12 years.
“These checks represent just one way that Medicare is going to work better for seniors and persons with disabilities under the Affordable Care Act,” said Don Berwick, administrator for the Centers for Medicare & Medicaid Services. “Seniors will see lower prescription drug costs when they are in the donut hole, preventive services and annual wellness visits without cost-sharing, and higher quality care. And our efforts to crack down on fraud and waste are making beneficiaries safer and Medicare stronger financially, adding years to the Medicare trust funds.”
“Often, seniors reach the donut hole because they are on costly medications to help them manage chronic conditions such as high blood pressure or diabetes,” said Kathy Greenlee, assistant secretary for aging. “These checks will help America’s seniors afford the medications they need to manage those illnesses, keeping them healthy and improving their quality of life.”
Medicare beneficiaries who do not already receive Medicare’s Extra Help receive these checks automatically in the mail when they reach the donut hole; there is no requirement to sign up.
Seniors should never give out personal information to anyone who is not a trusted source.
Seniors are encouraged to contact 1-800-MEDICARE to report any solicitations of personal information, or go to www.stopmedicarefraud.gov to learn about how the Affordable Care Act helps to protect seniors from scams and safeguard taxpayer dollars.
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