Update on the Early Retiree Reinsurance Program

Assemble your Early Retiree Reinsurance claims!  The U.S. Department of Health and Human Services (HHS) will hold an event on August 31 to release the list of 1,300 employers that have qualified for the Early Retiree Reinsurance Program under Section 1102 of the Patient Protection and Affordable Care Act.  Under the program, these entities, comprising both public and private employers, will be certified to file for reimbursement of early retiree health care expenses.  HHS has already begun sending formal notification today to the employers approved for the program.

  • The notice includes a description of the electronic certifications the plan sponsor will have to make.
  • The notice states that a notice to plan participants will be required, however form notices will be provided by the government in September.
  • Reimbursement will only be made for claims that are Medicare eligible (guidance as to this will be released in September).
  • Payments from the government are anticipated to begin in October.

Guidance on Claims and Appeals Rules

Recently issued rules clarify internal claims and appeals procedures and external review processes, and provide details on external review requirements under the Patient Protection and Affordable Care Act.

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Centers for Medicare and Medicaid Services Issues Proposed Changes to Medicare Graduate Medical Education Payments

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) has released proposed changes to the Medicare Outpatient Hospital Prospective Payment System (OPPS), including several proposed changes to Medicare Graduate Medical Education (GME) payments.  Hospitals with existing GME programs, those that are contemplating new or expanded GME programs, and those considering closure of programs or sale or acquisition of a hospital should carefully review the proposed regulations to evaluate the effect of the proposed changes and consider submitting comments to CMS before August 31, 2010. 

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