OPEN ENROLLMENT IS OVER.
FOCUS ON SEPs, APPEALS & EXEMPTIONS!
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LUNCH & LEARN CONFERENCE CALL
April 27th, 2018
is
CANCELLED!
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Congress gave final approval at 1AM on 3/23/18 to a giant $1.3 trillion spending bill that ends the budget battles for now, but only after late scuffles and conservatives objections to big outlays on Democratic priorities at a time when Republicans control the House, Senate and White House. Senate passage shortly after midnight averted a third federal shutdown this year, an outcome both parties wanted to avoid. But in crafting a sweeping deal that busts budget caps, they've stirred conservative opposition and set the contours for the next funding fight ahead of the midterm elections.
Associated Press
President Trump made his first visit to New Hampshire since the 2016 campaign, unveiling a plan to combat the opioid epidemic that includes a push for the death penalty for drug dealers and a crackdown on illegal immigrants. Mr. Trump spoke in a state with the nation's third-highest rate of deaths from overdoses and where opioids are a potent political issue. In a speech at a community college here, he offered up more tough talk than he did specifics about his plan, or how he would pay for it.
New York Times
A leading AIDS researcher and proponent of medication-assisted therapy for addiction was appointed Wednesday to oversee the Centers for Disease Control and Prevention. Alex M. Azar II, secretary of the Health and Human Services Department, announced that the agency's new director would be Dr. Robert R. Redfield, a professor at the University of Maryland School of Medicine in Baltimore and co-founder of the Institute for Human Virology. New York Times
A judge dismissed the state of Tennessee's lawsuit accusing the U.S. government of unconstitutionally coercing it into subsidizing the federal refugee resettlement program. Tennessee accused the government of invading its sovereignty by requiring it to provide Medicaid benefits to refugees, or else risk losing nearly $7 billion of Medicaid funds annually, equal to about 20 percent of its state budget, if it refused. Reuters
Virginia is among 18 states that have not expanded Medicaid under the Affordable Care Act. But this year, the state legislature is closer to enacting expansion than it has been in the past, and the issue will be the sticking point as the legislature goes into a special session next month to hash out its budget. Republican Del. Barry Knight from the Virginia Beach area calls it "the 800-pound gorilla in the room." He's one of more than a dozen Republicans who voted to include Medicaid expansion in the House budget - along with a work requirement - this year. Kaiser Health News
Information about LGBT health was removed from a Department of Health and Human Services (HHS) website last fall, according to new reports from a watchdog group. The HHS Office of Women's Health (OWH) removed a webpage with extensive information about lesbian and bisexual health, and links that correspond to that webpage, according to reports the Sunlight Foundation released Wednesday. The Hill
The Commerce Department is reinstating a citizenship question to the 2020 Census for the first time in decades, a move that some argue will lead to an undercount of minorities living in the United States. The U.S. Census Bureau counts the total number of people in the country - not the total number of citizens - every 10 years. Though it usually doesn't ask about a person's citizenship status, the Justice Department asked the agency late last year to include the question. It is the first time the government has done that in 70 years.The Census count is used to redraw congressional districts, so it can affect the makeup of Congress, and to determine where federal, state and local funds will be used to build new schools, roads, health care facilities, child-care centers and senior centers. It also forms the basis of countless government and academic studies that drive public policy decisions and legislation from Washington, D.C., to statehouses and city halls.
USA Today
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AHCA Seeks Public Comment
AHCA has announced a 30-day public notice and comment period (3/9/2018-4/7/2018) regarding their request to CMS to amend Florida Medicaid's 1115 Managed Medical Assistance Waiver (Project Number 11-W-00206/4) to operate a Statewide Medicaid prepaid dental health program (PDHP). The Agency intends to operate the PDHP as an "Additional Program" under Section XIII of the Special Terms and Conditions in order to provide Florida Medicaid State Plan dental services to recipients through dental managed care organizations. The PDHP is expected to be implemented by January 1, 2019. Click here to view the proposed amendment.
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There's much left to be done in Puerto Rico
To reach the Martinez home in Puerto Rico's central mountains, social worker Eileen Calderon steers around piles of dirt, treacherous potholes and power company trucks that block the road. Finally, she pulls up to a sagging, cement home, its roof done in by Hurricane Maria. Laundry hangs under a tarp, and a cat is tied to a leash outside the door. Calderon, who is based in San Juan, and works for VarMed, a company that handles complex medical cases in Puerto Rico, has brought two colleagues - a nurse, Anamelia Velazquez, and a primary care physician, Dr. Carla Rossotti - to check in on Osvaldo Martinez and his son, Osvaldo Daniel Martinez. KHN
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Check out this report on the value of enrollment assisters (incl. CACs and NAVs)!
Obamacare is no longer busting the bank for insurers. After three years of financial bloodletting under the law - and despite constant repeal threats and efforts by the Trump administration to dismantle it - many of the remaining insurers made money on individual health plans for the first time last year, according to a POLITICO analysis of financial filings for 29 regional Blue Cross Blue Shield plans, often the dominant player in their markets. Politico
Democrats are gearing up to blame Republicans for ObamaCare premium increases after the likely failure of an effort to stabilize the law in this month's government funding package. The premium hikes for ObamaCare will likely be announced in October, just a month before a midterm election where Democrats are hoping to win back the House and Senate. The Hill
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Health Center Quality
As part of HRSA's commitment to recognize health centers as quality leaders, we recently delivered Health Center Quality certificates to the 47 National Quality Leaders and 393 Health Center Quality Leaders. This effort follows the August 2017 Quality Improvement Awards of nearly $105 million to 1,333 health centers to recognize the highest performing health centers nationwide, as well as those health centers that have made significant quality improvement gains.
2017 National Quality Leader:
BORINQUEN MEDICAL CENTERS, INC.
2017 Health Center Quality Leadership Award:
BANYAN COMMUNITY HEALTH CENTER, INC.
BREVARD HEALTH ALLIANCE, INC.
CAMILLUS HEALTH CONCERN, INC.
CITRUS HEALTH NETWORK, INC.
COMMUNITY AIDS RESOURCE
COMMUNITY HEALTH CENTERS OF PINELLAS, INC.
COMMUNITY HEALTH SOUTH FLORIDA, INC.
EMPOWER U, INC.
FOUNDCARE, INC.
HEALTH CARE DISTRICT OF PALM BEACH COUNTY
JESSIE TRICE COMMUNITY HEALTH CENTER, INC.
MIAMI BEACH COMMUNITY HEALTH CENTER, INC.
NEIGHBORHOOD MEDICAL CENTER, INC.
NORTH BROWARD HOSPITAL DISTRICT
PINELLAS, COUNTY OF
SUNCOAST COMMUNITY HEALTH CENTERS, INC.
TAMPA FAMILY HEALTH CENTERS, INC.
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If you have any questions about Special Enrollment Periods (SEPs), take a look at CBPP's informative webinar that was presented on March 14th.
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Certified Community Health Workers (CCHWs) continue to be a hot-topic among federally qualified health centers (FQHCs). Centers receive annual funding allocations funding based on the utilization and staffing they report on the Uniform Data System (UDS). While UDS does not currently require certification for this position, Florida has created a certification process through the Florida Certification Board. Furthermore, many CCHWs are hired to fill other positions and are never "counted" appropriately in UDS. It is important to ensure that "counting" is done correctly and CCHW tasks are reflected in job descriptions. See the following NACHC presentation on CHW activities nationwide.
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With most employees seeing withholding changes in their paychecks, the IRS recommends taxpayers use the Withholding Calculator to do a "paycheck checkup." This will help taxpayers check that they are having the correct amount of income tax withheld from their paychecks.
Doing a checkup can help protect against having too little tax withheld and facing an unexpected tax bill or penalty at tax time in 2019. Some taxpayers might prefer to have less tax withheld up front and receive more in their paychecks, which would reduce their tax refund next year.
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 PRETTY PLEASE!
Use the correct & complete CAC & NAV # on all applications!
***13 characters (FLCAC or FLNAV + A/B/C/D + 2 digit contract # + 5 digit CAC or NAV # ***
*** CAC or NAV # is issued by your employer***
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All Plan Year 2018 Florida Enrollment Assistance Personnel
PLEASE REGISTER NOW!
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My consumer enrolled in Dec 2017 with a new insurer but forgot that her former insurer had already pre-enrolled her. We appealed the pre-enrollment but the insurer is now invoicing the consumer for 3 months' of the full premium. What if she cancels her coverage altogether?
They are invoicing her because they are no longer receiving the APTC on her behalf. Please remember that an appeal is a legal procedure. Once invoked, I can do nothing to help resolve the situation. There are only a few things that the Marketplace Appeals Center can redress and, unless expedited, a final determination can take up to 90 days. Canceling coverage does not make your consumer eligible for a loss-of-coverage SEP and she will default on her appeal. See
Appeals for more information.
My enrolled consumer returned outside of the Open Enrollment period. We reported a "Life Change" because she changed jobs and income. This has now become a nightmare!
All consumers are required to promptly
report changes to employment and income But these do not always make them eligible for an
SEP. Changes in income may make the consumer newly eligible as long as there is a Marketplace application on file. However, it is also likely that a change of expected annual income changes the amount of Advance Premium Tax Credit to which the consumer may be eligible. There are also some
SEPs for Complex Cases.
I have a consumer who has contacted the Marketplace unsuccessfully several times about getting a revised Form 1095-A in order to do her income tax return. She is repeatedly told that the form was posted to her Marketplace account and/or mailed. What do I do?
My recommendation is to first follow these
instructions to check her Marketplace account. Remember that when viewing her applications, you should make sure to look at the one for 2017 because it is easily confused with others. If this does not work, send me the application ID # and the policy ID # (
No personally identifiable information, please!) and I will try to get this resolved.
Is the federal CAC training website no longer available? We can't get in!
Federal CAC training for PY 2018 is supposed to remain available until the training for PY 2019 is launched. But this inquiry has been made by others too! I will see if I can find out anything.
Does the Call Center give you a headache?
Got a question and need a reliable answer FAST?
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