An unprecedented number of individuals are now enrolled in Patient Protection and Affordable Care Act (PPACA) Marketplace health insurance plans – and federal officials this week signaled that the trend can likely be expected to continue.
The Centers for Medicare & Medicaid Services (CMS) recently announced the availability of half a billion dollars in grants over the next five years to increase the number of organizations that help people enroll on HealthCare.gov, marking the single largest funding allocation the agency has made available for so-called “Navigator” entities to date.
Along with making available the additional funding, CMS is encouraging eligible entities and individuals to apply for it – especially those that focus on “education, outreach, and enrollment efforts to underserved and diverse communities.”
Officials rolled out a six-question FAQ chart assembled by the CMS Office of Minority Health to address potential inquiries from providers. They noted that the primary intent of the aforementioned grant rollout was to promote “increased participation of smaller, community-based organizations as part of CMS efforts to reach people where they are.” This includes longer periods of multi-year grant funding and what they described as a shorter and easier-to-digest application process.
Organizations eligible for the grants may include but are not limited to a dizzyingly broad array of types: community and consumer-focused nonprofit groups; trade, industry, and professional associations; commercial fishing industry organizations; ranching and farming organizations; chambers of commerce; unions; resource partners of the Small Business Administration; non-healthcare licensed insurance agents and brokers; Native American tribes, tribal organizations, or urban Indian organizations; and state or local human service agencies.
CMS said it also arranged to hold two technical assistance sessions for potential applicants; the first took place on Thursday, June 13, while the second has been scheduled to run from 2-3 p.m. EST on Tuesday, July 2 on Zoom (2024 Navigator NOFO Technical Assistance Session No. 2, Meeting ID: 161 815 5550, Password: 829693). Applicants are encouraged to submit questions in advance of each session to Navigatorgrants@cms.hhs.gov.
Applications must then be received by Monday, July 8 through Grants.gov; for instructions on how to submit, see their “Quick Start Guide for Applicants.”
Not only is the $500 million total sum an all-time high devoted to Navigator grants, but the awards mark the first time such grants are being offered for more than three years of funding, “allowing grantees to better retain and add more staff who are trained to help consumers find affordable, comprehensive health coverage,” the Office of Minority Health said in its announcement. It also marks a drastic increase up to $100 million in annual Navigator grant availability, an all-time high and up tenfold from the $10 million that was allocated in 2018, 2019, and 2020.
However Navigator work has been funded, enrollment in PPACA insurance plans continues to grow; in January, the U.S. Department of Health and Human Services (HHS) issued a news release noting that a record 21.3 million Americans selected such a plan for the 2024 Open Enrollment Period. That included more than 5 million people new to the Marketplace coverage and 16 million who renewed their coverage.
“For decades, when it came to federal programs we could depend on to keep Americans covered, three were always top of mind – Medicare, Medicaid, and Social Security – but now it’s crystal clear that we need to add a fourth: the Affordable Care Act,” HHS Secretary Xavier Becerra said at the time. “Once again, a record-breaking number of Americans have signed up for affordable health care coverage through the Affordable Care Act’s Marketplace, and now they and their families have the peace of mind that comes with coverage. The ACA continues to be a successful, popular, and important federal program to millions of people and their families. As we celebrate the success of this most recent enrollment effort, HHS will double down on the Biden-Harris Administration’s efforts to increase access to quality care and lower costs.”
Earlier this month, HHS issued five new reports specifically illustrating increases in coverage among minority communities since the implementation of the PPACA.
“President Biden firmly believes that health care is a right, not a privilege, and is committed to making sure that everyone one of us has the peace of mind that health insurance brings,” White House Domestic Policy Advisor Neera Tanden said in a statement. “These reports show that by making health insurance more affordable, more accessible, and easier to sign up for, millions of Americans in underserved communities are now able to access the health care they need and deserve.”
“Behind the historic health equity gains championed by the Biden-Harris Administration are the countless communities we are connecting to health care coverage, often for the first time,” CMS Administrator Chiquita Brooks-LaSure added. “The combination of asking the right questions and unprecedented investments in Marketplace outreach will help us better understand the communities we serve, making coverage more attainable than ever for people who are our neighbors, friends, and loved ones.”
Specifically, officials noted, and largely attributable to gains in PPACA enrollment, the uninsurance rate for the following populations declined thusly from 2010-2022, based on available census data:
To learn more about the newly unveiled Navigator grants, go online to: https://www.grants.gov/search-results-detail/349642?linkId=460945059
The Centers for Medicare & Medicaid Services (CMS) issued the review copy of the Fee Schedule, Friday, Nov. 1. Usually, the final copy appears about
Some of you may have noticed that I am not always very nice to some insurance companies. And deservedly so. But I also point out
Please log in to your account to comment on this article.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
This webcast, presented by Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, a recognized expert with over 30 years of experience, offers essential strategies to improve outpatient clinical documentation integrity. You will learn how to enhance the accuracy and completeness of patient records by adopting best practices in coding and incorporating Social Determinants of Health (SDOH). The session also highlights the role of technology, such as EHRs and CDI software, in improving documentation quality. By attending, you will gain practical insights into ensuring precise and compliant documentation, supporting patient care, and optimizing reimbursement. This webcast is crucial for those looking to address documentation gaps and elevate their coding practices.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 RACmonitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
👻Spooky Sale is Back!👻 Get 31% off all three Medlearn brands, using code SPOOKY24.
