ACA Round-Up: Hospital Nonprofit Status, ACA Nondiscrimination Litigation, And More
American non-profit hospitals have long qualified for tax exempt status under federal law as “charitable” organizations. They are often afforded exempt status from state and local property, sales, and income tax under similar requirements. The Affordable Care Act imposed additional requirements that hospitals must meet if they wish to retain federal tax exempt status. These include: Establishing written financial assistance and emergency medical care policies, Limiting amounts charged for emergency or other medically necessary care to individuals eligible for assistance, Making reasonable efforts to determine whether ...
Source: Health Affairs Blog - August 18, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Hospitals Insurance and Coverage ACA section 1557 cost-sharing reduction payments nonprofit hospitals Source Type: blogs

Health Affairs Briefing: Understanding The Value Of Innovations In Medicine
“Value” is at the center of discussions of payment and policy, but value has different definitions and meanings reflecting the diversity of stakeholders in the healthcare system. As part of our ongoing efforts to foster discussion about this important concept in health policy, on September 13 Health Affairs will sponsor a forum for policymakers to examine various frameworks for formally defining and measuring value and discuss the public policy issues and strategies attendant to their use. National Press Club 529 14th Street NW, Washington, DC (Metro Center) Wednesday, September 13, 2017 RSVP Today! Follow the conver...
Source: Health Affairs Blog - August 18, 2017 Category: Health Management Authors: Health Affairs Tags: Elsewhere@ Health Affairs Source Type: blogs

Teenage Pregnancy Prevention Is The Latest Front In The War On Science
A few weeks ago, the Trump Administration suddenly killed a modest federal program, the Teenage Pregnancy Prevention program. The Department of Health and Human Services (HHS) summarily ended grants to hospitals, schools, and community groups after only three years of work, leaving service delivery and evaluation efforts in limbo. While first appearing to be just another skirmish in the culture wars, ending the program fits within the Administration’s larger efforts to devalue science, data, and evidence. Aside from causing harm by ending effective services, the Administration is quashing any faint hope that the Federal ...
Source: Health Affairs Blog - August 18, 2017 Category: Health Management Authors: Charles Homer Tags: Featured Public Health Quality teenage pregnancy Source Type: blogs

Managed Care Companies Should Publish Lessons Learned From Studying Their Own Big Data
In this era of big data, managed care companies have comprehensive data sets from which to extrapolate and report precise and meaningful findings about health services. With pay-for-performance models championed by the Affordable Care Act and pursued by the Centers for Medicare and Medicaid Services, the value and relevance of these data in improving health is likely greater than ever. That is why we agree that managed care companies have an imperative to participate in quality improvement initiatives, conduct rigorous, transparent research with our data, and widely share and disseminate those findings so that others may l...
Source: Health Affairs Blog - August 18, 2017 Category: Health Management Authors: Stuart L. Lustig and Liana D. Castel Tags: Diffusion of Innovation Featured Insurance and Coverage Population Health Quality big data health services research managed care companies peer-reviewed studies quality improvement initiatives Source Type: blogs

The United States Can Reduce Socioeconomic Disparities By Focusing On Chronic Diseases
“It is natural to ask whether rising gaps in income might be associated with widening gaps in health and longevity between rich and poor Americans,” Jacob Bor and colleagues noted in an article in The Lancet this spring. This association is bidirectional: If someone is poor, they have a greater likelihood of having chronic illnesses such as diabetes and cardiovascular disease and associated complications. Illness also restricts financial security, especially within communities of color. The June issue of Health Affairs, Pursuing Health Equity, draws much needed attention to the need to pursue solutions that address the...
Source: Health Affairs Blog - August 17, 2017 Category: Health Management Authors: Kenneth Thorpe, Kathy Ko Chin, Yanira Cruz, Marjorie A. Innocent and Lillian Singh Tags: Health Equity Population Health chronic disease socioeconomic disparities Source Type: blogs

Questions About The FDA ’s New Framework For Digital Health
In June 2017, the new Food and Drug Administration (FDA) commissioner Scott Gottlieb pre-announced his agency’s Digital Health Innovation Action Plan that indicates notable shifts in the agency’s approach to digital health technologies. This plan is an important step in FDA regulation of this area, a process that began in 2011 with a draft guidance, followed by significant congressional actions. The new changes should not be surprising, given critiques published by Gottlieb prior to re-joining the FDA. In 2014, he wrote that smartphones are “purposely dumbed down” due to the “risk of unwieldy FDA regulation,” a...
Source: Health Affairs Blog - August 16, 2017 Category: Health Management Authors: Nathan G. Cortez, Nicolas Terry and I. Glenn Cohen Tags: Featured Health IT 21st Century Cures Act digital health Food and Drug Administration medical devices mHealth mobile health Scott Gottlieb Source Type: blogs

Terminating CSR Payments Would Increase Deficits, CBO Finds
On the afternoon of August 15, 2017, the Congressional Budget Office and the Joint Committee on Taxation released an analysis of the potential effects of an administration or congressional decision to terminate the Affordable Care Act’s cost-sharing reduction (CSR) payments to insurers. The CBO examined the effects on the federal budget, health insurance coverage, market stability, and premiums. The CBO projects that the primary negative effect of CSR payment termination would be an increase in the federal budget deficit, but if the CBO’s assumptions prove unwarranted, CSR payment termination could be more damaging tha...
Source: Health Affairs Blog - August 15, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage ACA premium tax credits cost-sharing reduction payments Source Type: blogs

The ‘Tanning Tax’ Is A Public Health Success Story
Among the lesser known provisions in the now-rejected Republican House and Senate health care bills was a plan to eliminate an excise tax on tanning bed use. Tanning first became fashionable when Coco Chanel popularized the practice in the 1920s, making lounging outside in the sun a symbol of leisure, relaxation, and health. In the late 1970s, pioneering businesses began to offer ultraviolet (UV) radiation beds as a shortcut to fashionable tanned skin; by the 1990s, indoor UV tanning services were ubiquitous staples of the American beauty industry. Despite its popularity, research has shown that exposure to UV radiation is...
Source: Health Affairs Blog - August 15, 2017 Category: Health Management Authors: Elisabeth Ryan Tags: Costs and Spending Public Health tanning tax Source Type: blogs

If The Trump Administration Terminates Cost-Sharing Reduction Payments, States Can Use 1332 Waivers To Fund Their Own
One of the main causes of instability in the Affordable Care Act (ACA) health exchanges, aside from the constant stream of repeal-and-replace efforts, is the uncertainty over the future of the cost-sharing reduction (CSR) payments. CSR and the advanced premium tax credits (APTC) are subsidies created by the ACA to enhance the affordability of the qualified health plans sold on the health exchanges. Whereas the APTC reduces the cost of premiums to beneficiaries with incomes between 100 and 400 percent of the federal poverty level, CSR lowers the out-of-pocket expenses of beneficiaries with incomes between 100 and 250 percen...
Source: Health Affairs Blog - August 15, 2017 Category: Health Management Authors: Steven Chen Tags: Costs and Spending Following the ACA cost-sharing reduction payments CSRs Section 1332 waivers States Source Type: blogs

What Should We Conclude From ‘ Mixed ’ Results In Payment Reform Evaluations?
Now that the Affordable Care Act (ACA) repeal-and-replace process is coming to an end, perhaps it’s a good time to turn to an area of health policy where there is considerably more bipartisan consensus: payment reform. Even here, however, challenges remain. A recent spate of evaluations, reviews, and published perspectives have cast doubt on the promise and spending-reduction potential of care coordination initiatives, shared savings accountable care organizations (ACOs), patient-centered medical homes, and bundled payments in particular. As the Trump administration, members of Congress, states, and other health care sta...
Source: Health Affairs Blog - August 14, 2017 Category: Health Management Authors: Len Nichols, Alison E. Cuellar, Lorens Helmchen, Gilbert Gimm and Jay Want Tags: Costs and Spending Featured Payment Policy Accountable Care Organizations Patient-Centered Medical Home Payment Reform Source Type: blogs

Fighting HIV/AIDS: Human-Rights Focused Advocacy Is More Critical Than Ever
We are at an interesting and uncertain time in global health. The political climate is, to put it mildly, dynamic. One need only look at the United States, historically the largest donor to the global AIDS response, to see how precarious progress is at the moment. The Trump administration outlined devastating budget cuts that, if enacted, could erode progress, lay the groundwork for further inequities, and hurt those who are already most vulnerable to the HIV/AIDS epidemic. Source: FCAA (Funders Concerned About AIDS) Data Spotlight: HIV Philanthropy for Advocacy & Human Rights, April 2017 While the United States is no...
Source: Health Affairs Blog - August 11, 2017 Category: Health Management Authors: John Barnes Tags: GrantWatch advocacy Chronic Care Funders Concerned About AIDS Global Health Health Philanthropy HIV/AIDS human rights Policy Robert Wood Johnson Foundation Source Type: blogs

The Future Of Value-Based Payment — Time To Reexamine And Refocus Our Efforts
Great strides have been made over the years in the care of Medicare beneficiaries by focusing on and implementing quality performance measurement and hospital value-based payment systems. However, the laws and regulations that drive these efforts have not been revisited since their inception, and it is time for reexamination. Changes and adjustments should be made to ensure that the programs continue to advance better and more efficient care across the health care delivery system. Examining The Goals Of Value-Based Payment There remains a broad-based understanding that quality improvement, transparency, and accountability ...
Source: Health Affairs Blog - August 11, 2017 Category: Health Management Authors: Charles Kahn Tags: Costs and Spending Medicare Payment Policy Quality meaningful reporting value payment value-based payment Source Type: blogs

New Guidance On CSR Payments And Risk Adjustment: Answers … And More Questions
The ongoing saga of the cost-sharing reductions just got stranger. On August 10, 2017, the Centers for Medicare and Medicaid Services released at their REGTAP.info website a guidance on risk adjustment methodology and rate filing deadlines. The guidance states “At this time, there have been no changes regarding HHS’s ability to make cost-sharing reduction payments to issuers.” But “[m]any state departments of insurance (DOIs) have permitted issuers to increase rates for their silver metal level plans for the 2018 benefit year in order to account for uncompensated liability that issuers may face for cost-sharing red...
Source: Health Affairs Blog - August 11, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage cost-sharing reduction payments risk adjustment Source Type: blogs

Making America Healthy Again: Analyzing Trump ’s Take On The Social Determinants Of Health
Access to health care is critical for the health of individuals and for the well-being of the community, but health depends on more than medical care. Studies show that the social determinants of health, including education, socioeconomic status, poverty, the physical and social environment, employment, and discrimination, among others, are at least as important for health as is medical care. It is worth considering where the new administration stands with respect to the social determinants of health. President Trump’s budget, perhaps the best indication we have of his administration’s priorities, unfortunately appears...
Source: Health Affairs Blog - August 11, 2017 Category: Health Management Authors: Patricia Illingworth Tags: Health Equity Population Health Public Health 2018 budget asthma Social Determinants of Health Source Type: blogs

Policy Primers: Public Coverage And Prescription Drug Pricing
Health Affairs has released the next set in a series of peer-reviewed health policy briefs on key issues currently shaping the prescription drug market. Each brief offers a short, accessible overview of the issue and a close examination of how it affects pricing. This second set of briefs tell the story of different prescription drug coverage mechanisms (who pays whom and how much), how they interact with other pricing measures, and what future reforms might look like. They are: MEDICARE PART B The Medicare Part B “buy and bill” payment structure for physician-administered drugs also influences private-sector prices. M...
Source: Health Affairs Blog - August 10, 2017 Category: Health Management Authors: Health Affairs Tags: Elsewhere@ Health Affairs Featured Health Policy Briefs Source Type: blogs