The Department of Health and Human Services (HHS) released several proposed rules today dealing with insurance reforms, including the proposed rule "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation." The proposed rule provides guidance to states on the essential health benefits (EHBs) that must be offered in most nongrandfathered qualified health plans (QHPs) that are offered in each state's affordable Health Insurance Exchanges ("Exchanges") as directed under the Affordable Care Act (ACA). The Exchanges are expected to create competitive
marketplaces making health insurance plans more affordable for individuals. EHB applicability to Medicaid will be defined in a separate regulation. The Exchanges must become operational by January 1, 2014. (See related articles titled "Proposed Rule Protects Patients From Discriminatory Policies" and "HHS Proposes Incentives for Nondiscriminatory Wellness Programs in Group Health Plan.")
The proposed rule outlines Exchange and issuer standards related to coverage of EHBs and actuarial value. The proposed rule reiterates the 10 mandatory EHB categories of (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services, including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services (under age 19), including oral and vision care. States must create EHB benchmark plans from their default benchmark state health plans by adding any mandatory categories that are not in their default plans. These nongrandfathered health plans must offer balanced benefits not unduly weighted toward any one category.
The proposed rule includes that:
Finally, the Affordable Care Act describes the levels of coverage that of the EHB packages offered in the Exchanges: actuarial values of 60% for a bronze plan, 70% for a silver plan, 80% for a gold plan, and 90% for a platinum plan.
APTA will be commenting on this proposed rule. Comments are due on or around December 20.
APTA's Regulatory Affairs department will provide full summaries of the 3 proposed rules shortly.
The Department of Health and Human Services (HHS) today released a proposed regulation that would implement the policies in the Affordable Care Act that make it illegal for insurance companies to discriminate against people with preexisting conditions. The provisions in the proposed rule are related to fair health insurance premiums, guaranteed availability, guaranteed renewability, risk pools, and catastrophic plans. Notably, the proposed rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are nonfederal governmental plans. Additionally, this proposed rule would amend the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the Public Health Service Act, which established a process for reviewing unreasonable increases in premiums for health insurance coverage. The rule also revises the timeline for states to propose state-specific thresholds for rate review and approval by the Centers for Medicare and Medicaid Services.
Comments on this proposed rule are due on or around December 26.
See related articles titled "HHS Releases Essential Health Benefits Proposed Rule" and "HHS Proposes Incentives for Nondiscriminatory Wellness Programs in Group Health Plans."
third proposed regulation issued today by the Department of Health and Human Services (HHS) offers amendments to regulations, consistent with the Affordable Care
Act, regarding nondiscriminatory wellness programs in group health
coverage. Nondiscriminatory wellness programs generally allow premium
discounts, rebates, or modification to otherwise applicable cost sharing
(including copayments and deductibles) in return for adherence to certain
programs of health promotion and disease prevention.
these proposed regulations would increase the maximum permissible reward under
a health-contingent wellness program offered in connection with a group health
plan (and any related health insurance coverage) from 20% to 30% of the cost of
coverage. In addition, the proposed regulations would further increase the
maximum permissible reward to 50% for wellness programs designed to prevent or
reduce tobacco use. These regulations also include other proposed
clarifications regarding the reasonable design of health-contingent wellness
programs and the reasonable alternatives they must offer in order to avoid
Comments on this proposed rule are due on or around January 26, 2013.
related articles titled "HHS Releases Essential Health Benefits Proposed Rule" and "Proposed Rule Protects Patients From Discriminatory Policies."
Regulatory Affairs department will provide full summaries of the 3 proposed rules
November 19 article in American Medical News, a publication of the American Medical
Association (AMA), highlights APTA's statement on the recent legal settlement
prohibiting Medicare contractors from denying coverage based on a patient's
potential for improved health status.
Heard on the Hill podcast provides a comprehensive update
on APTA's Veterans Affairs (VA) and Armed Services initiatives, including a
traumatic brain injury briefing held on Capitol Hill in
September and discussions with the Federal Physical Therapy Section on recent
developments in the Joining Forces Initiative. The podcast also addresses
recruitment and retention efforts aimed at physical therapists in the VA.
National Council on Aging's (NCOA) new State Policy Toolkit aims to organize and maximize
community falls prevention assets and resources, and establish innovative
policies and practices within states, communities, and organizations. The
toolkit offers a compendium of suggested policy changes to advance falls
prevention, categorized under 8 major goals. It outlines the opportunities,
strategies, and examples of what is possible through education and engagement
of key stakeholders.
toolkit can be used as a guide for promoting discussion and potential action on
policy changes that are appropriate for the population, geographic location,
partnerships, and culture of your community. Users can adapt a limited,
manageable set of strategies from the toolkit to put into action; include a set
of indicators to measure progress of select recommendations; and review the
resource compendium to find materials to promote strategic partnerships with
a member of NCOA's Falls Free Coalition.
additional patient care and consumer education resources on this topic, visit
APTA's Balance and Falls webpage.
exercise can be regarded as beneficial for individuals with cancer-related fatigue
during and postcancer therapy, specifically those with solid tumors, say
authors of an updated version of an original Cochrane
review published in The Cochrane Library in 2008.
For this update, the authors searched the Cochrane
Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, British Nursing
Index, AMED, SIGLE, Dissertation Abstracts International, and reference lists
of all studies identified for inclusion and relevant reviews. In addition, they
hand-searched relevant journals and contacted experts in the field of
They identified a total of 56 studies (4,068
participants) for inclusion (28 from the original search and 28 from the
updated search), with the majority carried out in participants with breast
cancer (28 studies). A meta-analysis of all fatigue data, incorporating 38
comparisons, provided data for 1,461 participants who received an exercise
intervention and 1,187 control participants. At the end of the intervention
period exercise was seen to be statistically more effective than the control
intervention. Benefits of exercise on fatigue were observed for interventions
delivered during or postadjuvant cancer therapy. In relation to diagnosis, the
authors identified benefits of exercise on fatigue for breast and prostate
cancer but not for those with hematological malignancies. Aerobic exercise
significantly reduced fatigue, but resistance training and alternative forms of
exercise failed to reach significance.
"We're not expecting people to go out and be running a mile the next
day," Fiona Cramp, who worked on the analysis at the University of the
West of England in Bristol, told Reuters News. "Some people will
be well enough that they're able to go for a jog or go for a bike ride, and if they
can, that's great. But we would encourage people to start with a low
Centers for Disease Control and Prevention (CDC) has introduced a new online
tool, Diabetes Interactive Atlases, which provides data for
diagnosed diabetes, obesity, and leisure-time physical inactivity at the
national, state, and county levels. The new tool also includes interactive
motion charts showing trends in the growth of diabetes and obesity throughout
the United States and within states.
The tool was launched with the release of CDC's November 15 Morbidity and Mortality Weekly Report,
which highlights a study that found that the prevalence of diagnosed diabetes
increased in all US states, the District of Columbia, and Puerto Rico between
1995 and 2010. During that time, the prevalence of diagnosed diabetes increased
by 50% or more in 42 states, and by 100% or more in 18 states.
The states with the largest increases are Oklahoma (226%), Kentucky (158%),
Georgia (145%), Alabama (140%), and Washington (135%).
Wood Johnson Foundation (RWJF) and the American Heart Association (AHA) have joined in an ambitious collaboration to reverse
the nation's childhood obesity epidemic by 2015. RWJF will provide AHA with $8
million in initial funding to create and manage an advocacy initiative focused
on changing local, state, and federal policies to help children and adolescents
be more active and eat healthier foods.
Under the new initiative, RWJF and AHA will focus on policy interventions to
advance 6 priorities that research shows are likely to have the greatest impact
on childhood obesity. AHA will develop the overarching strategy that connects
efforts across all 6 priorities and will fund efforts in underserved
communities for the last 3 of them:
RWJF and AHA will focus on reaching communities hardest hit by the epidemic,
including communities of color and lower-income communities.
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