- Health Care Sabotage: Association Health Plans Are Here
- New Jimmo Resources from the Center for Medicare Advocacy and The John A. Hartford Foundation
Thanks to a final rule issued by the Administration, Association Health Plans (AHPs) will be available starting this month. Expanding AHPs will make it easier for certain small employers to offer plans that don’t have Affordable Care Act (ACA) coverage protections. In previous Alerts, we highlighted how these inadequate plans would draw younger healthier people from the ACA Marketplace while raising costs for older people. These plans could also weaken essential health benefits for people who need coverage the most and cause a spike in premiums for others. Consumers who choose these “junk plans” would find themselves without comprehensive coverage when they need care the most. The expansion of these plans through regulation is yet another action taken by the Administration to undermine the ACA.
The Attorneys General of the states of New York, Massachusetts, California, Delaware, Kentucky, Maryland, New Jersey, Oregon, Pennsylvania, Virginia, Washington, and the District of Columbia have filed a lawsuit to roll back this regulation. The suit argues that the AHP regulation will exempt “a significant portion of the health insurance market from the Affordable Care Act’s consumer protections.” The Attorneys General also agree that issuing this regulation is part of a “continued effort to sabotage our health care system.”
Interestingly, Politico reported that the National Federation of Independent Business, a long-time advocate of AHPs now says it “won’t set one up, describing the new Trump rules as unworkable.” The report also states that many of the groups that supported the rules are now “still trying to figure out how to take advantage of them and whether the effort is even worth it.”
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With support from The John A. Hartford Foundation, the Center for Medicare Advocacy has produced two new Checklists to help Medicare beneficiaries and their families respond to unfair Medicare denials based on an erroneous “Improvement Standard.” Per the Jimmo Settlement, CMS revised the Medicare Benefit Policy Manual to clearly disavow any notion that residents of a skilled nursing facility must improve in order for their care to be covered by Medicare.
Medicare Home Health Coverage Requirements Checklist
The following Checklist provides Medicare beneficiaries and their families with an overview of the home health coverage criteria, providing an emphasis on the Jimmo Settlement. As the Checklist illustrates, beneficiaries who meet the coverage criteria cannot be denied care solely because of an erroneous “Improvement Standard.”
- Download the Home Health Coverage Checklist at: https://www.medicareadvocacy.org/wp-content/uploads/2018/09/Home-Health-Jimmo-Checklist.pdf
Skilled Nursing Facility Expedited Appeals Checklist
The following Checklist provides readers with an overview of the expedited appeals process in traditional Medicare, focusing on the termination of skilled care solely based on an erroneous “Improvement Standard.” The Center hopes this Checklist will help beneficiaries and their families as they appeal improper terminations and denials.
- Download the Expedited Appeal Checklist at: https://www.medicareadvocacy.org/wp-content/uploads/2018/09/Expedited-Appeals-Fact-Sheet.pdf
SNF Coverage Checklist
The Two Checklists above are in addition to our previously published Checklist to help Medicare beneficiaries and their families respond to unfair Medicare denials for nursing home care based on an erroneous “Improvement Standard.” The Checklist outlines the coverage criteria for care at a skilled nursing facility and emphasizes language from the Jimmo Settlement Agreement. Per the Settlement, the Centers for Medicare & Medicaid Services (CMS) revised the Medicare Benefit Policy Manual to clearly disavow any notion that residents of a skilled nursing facility must improve in order for their care to be covered by Medicare.
- Download the SNF Coverage Checklist at: https://www.medicareadvocacy.org/wp-content/uploads/2018/08/Checklist.pdf
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