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On January 20th, the Department of Health and Human Services released an overview of its regulatory priorities for fiscal year 2012 and some of the regulations that will advance these priorities. According to the document, the Centers for Medicare & Medicaid Services (CMS) will finalize the following three rules related to the expansion of and information about health insurance:

• A rule to establish Exchanges.
• A rule related to risk adjustment and reinsurance. Under risk adjustment, HHS, in consultation with the states, plans to establish criteria and methods to be used by states in determining the actuarial risk of plans within a state to minimize the negative effects of adverse selection. Under reinsurance, all health insurance issuers, and third-party administrators on behalf of self-insured group health plans, will contribute to a nonprofit reinsurance entity to support reinsurance payments to individual market issuers that cover high risk individuals.
• A rule regarding the expansion of Medicaid coverage to adults under the age of 65 earning up to 133 percent of the Federal poverty level and those who earn above that level may be eligible for tax credits through the Exchanges. CMS states it will simplify eligibility rules to make it easier for eligible individuals and families to obtain Medicaid coverage, including ensuring that Medicaid uses the same eligibility standards as other insurance affordability programs available through the Exchange. CMS states the rule will further outline how Medicaid and CHIP will coordinate with the Exchange, including sharing data to ensure that individuals are determined eligible for the appropriate program regardless of where an applicant submits the application.

CMS also plans to issues several regulations advance its quality and patient safety goals including the following:

• CMS is implementing value-based purchasing programs throughout its payment structure in order to reward hospitals and other health care providers for delivering high-quality care, rather than just a high volume of services. The payment rules scheduled for publication this year will reflect a mix of standards, processes, outcomes, and patient experience of care measures, including measures of care transition and changes in patient functional status.
• HHS will continue to encourage health care providers to become meaningful users of health information technology (IT) by accelerating health IT adoption and promoting electronic health records to help improve the quality of health care, reduce costs, and ultimately, improve health outcomes.

Source: NAMD

The regulatory statement is posted at: http://www.reginfo.gov/public/jsp/eAgenda/StaticContent/201110/Statement_0900.html