2012 Activities to Watch

What to watch in 2012:

Month
Section
Description
January
1102
MA benchmarks: reduces Medicare Advantage (MA) benchmarks relative to current levels. Benchmarks will vary from 95% of Medicare spending in high-cost areas to 115% of Medicare spending in low-cost areas, with benchmarks increased by five percentage points in all areas for high-quality plans, starting January 1.
 
March
1001
Summary of benefits and coverage: requires group health plans, employers, and health insurers to provide a uniform summary of benefits and coverage explanation prior to enrollment or re-enrollment by March 23.
 
March
1506/ 10106; 2001
U.S. Supreme Court hears arguments on ACA to include:
  • March 26: whether Anti-Injunction Act (AIA) bars individuals from suing over ACA’s minimum coverage provision. Under the AIA, a taxpayer may not challenge a tax before personal liability is determined by the IRS.
  • March 27: whether the individual mandate per ACA Section 1501/10106 (which requires individuals to have essential health insurance coverage starting January 1, 2014) is Constitutional under the Commerce Clause.
  • March 28: whether the law is severable from the individual mandate and whether the Medicaid coverage expansion per ACA Section 2001 is “unconstitutionally coercive.”
April
3022
ACOs become operational under the Shared Savings Program: first set of ACOs become operational under the Medicare Shared Savings Program on April 1. ACOs can also opt for a July 1, 2012 start date. All ACOs that start in 2012 will have agreement periods ending at the end of 2015.
 
June
NA
Supreme Court ruling on ACA expected.
 
July
2702
Medicaid payments prohibited for provider-preventable conditions: Medicaid will no longer pay providers for preventable conditions. This provision was effective July 1, 2011, but CMS will delay enforcement until July 1, 2012.
 
August
1001
MLR rebates: plans that do not meet MLR requirements will have to pay consumers rebates by August 1 each year.
 
October
3001
Hospital VBP program effective: Medicare will start tying Medicare payments for inpatient hospitals to performance on quality measures for hospital discharges on or after October 1, 2012 (FY 2013).
 
October
3025
Medicare reduces payments for hospital readmissions: CMS will reduce Medicare payments for inpatient hospitals for preventable hospital readmissions starting October 1, 2012. CMS plans to release requirements in the future regulations.

 

 
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