by Art Kelly
1. Health and Human Services (HHS) Secretary Kathleen Sebelius claims that Obamacare provides health insurance for nearly 50,000 persons with high-risk pre-existing conditions.
HHS has released a new report to show that Obamacare is helping to fill a void in the insurance market for consumers with pre-existing conditions who are denied insurance coverage and are ineligible for Medicare or Medicaid coverage.
Sebelius said that, thanks to Obamacare, which she called the Affordable Care Act, "Our most vulnerable Americans across the country have the care they need."
In a news release, HHS states that, under this law, persons with serious medical problems "are not charged a higher premium. Program participants pay comparable premium rates to healthy people."
Information, including eligibility, plan benefits, and rates, as well as information on how to apply, is available online at https://www.pcip.gov/ Information is also available by phone at 1-866-717-5826 (TTY 1-866-561-1604) from 8 AM to 11 PM Eastern Time.
However, in order for pre-existing conditions to be covered, it is necessary to require all persons, especially young adults in good health, to purchase health insurance. The constitutionality of this provision in Obamacare is currently being challenged in the U.S. Supreme Court.
A previous issue of this newsletter reported that the U.S. Department of Justice has filed a brief with the Supreme Court stating that, if the individual mandate is found to be unconstitutional, then the parts of the law requiring people with pre-existing conditions to be covered without higher premiums cannot stand either.
2. The Centers for Medicare & Medicaid Services (CMS) announced a new initiative to reduce errors and save money for Medicare.
New audits of Medicare Advantage (MA) contracts will reduce the payment error rate for the Medicare Advantage program and will recover an estimated $370 million in overpayments for the first year.
In a news release, CMS Acting Administrator Marilyn Tavenner said, "CMS will use a new method of auditing Medicare Advantage plans that improves program integrity and reflects public input."
CMS is required to adjust payments to MA organizations based on the health status of their plan enrollees. The new initiative launched will improve these audits.
A fact sheet on this initiative is available online at http://tinyurl.com/87folpu and additional details are at http://www.cms.gov/Plan-Payment/02_PaymentValidation.asp
3. The Inspector General's Office of the Social Security Administration (SSA) issued a report regarding an outside audit of the agency performed by KPMG LLP to determine the level of service it provided to the public.
A survey of persons who contacted SSA or visited one of its offices found that 78.2% rated the agency operations as either excellent, very good, or good.
SSA's goal had been to obtain an 83.5% rating of good to excellent.
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