An Update for Consumers about Corrected 1095-As

By Kevin Counihan, Marketplace, Chief Executive Officer, Centers for Medicare & Medicaid Services

If you had coverage through the Health Insurance Marketplace last year, you may have benefited from advance payments of a tax credit to help make health coverage more affordable. By now, you should have received a statement in the mail from the Marketplace called a Form 1095-A. This statement includes important information you need in order to complete and file your tax return.

One piece of information included in your Marketplace tax statement is the premium amount for the “second lowest cost Silver” or benchmark plan in your area. This premium amount represents the benchmark plan we use to determine the amount of premium tax credit you were eligible to receive. In February, we notified about 800,000 tax filers, less than one percent of total tax filers, to expect an updated Marketplace tax statement because the original version they were issued listed an incorrect benchmark premium amount. At that time, Treasury announced that if you filed your taxes before learning that your Form 1095-A was incorrect because of this error, you will not need to file an amended return and the IRS will not pursue the collection of any additional taxes based on updated information in the corrected forms. You may still choose to file an amended tax return with your corrected form.

The vast majority of Marketplace consumers who needed an updated Marketplace tax statement now have access to their corrected form. If your form was affected, you can log into your HealthCare.gov account and download your updated form. Updated statements are also in the mail and should be arriving shortly, if you haven’t received it already. We’ll also call and email you to let you know your form is ready. If you’re concerned about the status of your updated form, contact the Marketplace Call Center at 1-800-318-2596.

As with any extensive data generation process – especially one that is being conducted for the first time – there are going to be issues that are a part of the normal course of business or other problems that are identified. For example, a consumer could have received a form with wrong coverage dates. This could occur if, for example, the Marketplace received updated information from your insurer after your form was generated. In other cases, the Marketplace encountered administrative issues relating to the quality of data used to populate the 1095-A form and it could have been generated with incorrect information or a form was unable to be generated. We are also aware of similar 1095-A issues in some State-based Marketplaces.

Today, the Department of the Treasury is expanding the relief it announced previously on February 24, which will mitigate any harm to tax filers. If you enrolled in Marketplace coverage, received an incorrect Form 1095-A, and filed your return based on that form, you do not need to file an amended tax return. The IRS will not pursue the collection of any additional taxes from you based on updated information in the corrected forms. This relief applies to tax filers who enrolled through the Federally-facilitated marketplace or a state-based marketplace.

As before, you still may choose to file an amended return. Treasury intends to provide additional information to help tax filers determine whether they would benefit from filing amended returns. You also may want to consult with you tax preparers to determine if you would benefit from amending. For more information on the Treasury announcement, see Treasury’s statement and consumer FAQs.

While Treasury expects that in the vast majority of cases the impact on a consumer’s tax refund or bill, if any, will be very small, we know that we have a responsibility to identify these issues quickly, understand the impact and reach out to you with the information you need. Issues that negatively impact your experience are not acceptable and we are focused on providing a smoother consumer experience. If you have not received your original or corrected form or have any questions about the information on your form, reach out to the Marketplace call center or your state Marketplace.

Our focus is on helping you understand the steps you need to take this tax season and providing you with the resources and assistance you may need. We’ve conducted extra quality assurance and are reviewing forms to make sure that when you receive your corrected form, it includes accurate information. We’re committed to listening and learning along the way so that we can improve our practices and the support we provide.

If you have questions or want to learn more visit www.HealthCare.gov/taxes. Representatives at the Marketplace Call Center are also standing by to answer your questions. The call center is open 24/7 at 1-800-318-2596.

Building on the Success of the ACO Model

By Patrick Conway, M.D., Deputy Administrator for Innovation and Quality and Chief Medical Officer, Centers for Medicare & Medicaid Services  

On March 10, the U.S. Department of Health and Human Services launched a new Accountable Care Organization (ACO) initiative from the Centers for Medicare & Medicaid Services (CMS) Innovation Center known as the Next Generation ACO Model. This model builds on the successes of earlier ACO models, such as the Pioneer ACO Model, and further enables innovation by providers to improve care for patients. Made possible by the Affordable Care Act, ACOs encourage quality improvement and care coordination to help improve our health care system. ACOs are a critical part of achieving the Department’s goals of delivery system reform nationally – aimed at better care, smarter spending and healthier people.

The Next Generation ACO Model is one of many innovative payment and care delivery models developed by the CMS Innovation Center. These models are designed to set clear, measurable goals and a timeline to move the Medicare program — and the health care system at large — toward paying providers based on the quality, rather than the quantity of care they provide to patients.

Building upon experiences from the Pioneer ACO Model and the Medicare Shared Savings Program, the Next Generation ACO Model offers a new opportunity in accountable care — one that sets more predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality of care.

ACOs in the Next Generation ACO Model will take on greater financial risk than those in current Medicare ACO initiatives, while also potentially sharing in a greater portion of savings. To support increased risk, ACOs will have a stable, predictable benchmark and flexible payment options that support ACO investments in care improvement infrastructure to provide high quality care to patients. These changes are responsive to feedback from external stakeholders.

The Next Generation ACO Model encourages greater coordination and closer care relationships between ACO providers/suppliers and beneficiaries by enhancing services that beneficiaries can receive from participating ACOs. ACOs will have a number of tools available to enhance the management of care for their beneficiaries. These include additional coverage of telehealth and post-discharge home services, coverage of skilled nursing care without prior hospitalization, and reward payments to beneficiaries for receiving care from ACOs.

This ACO model provides for greater engagement of beneficiaries, a more predictable, prospective financial model, and more tools to coordinate care for beneficiaries.

For more information on the Next Generation ACO Model, please visit the Next Generation ACO Model web page.

CMS announces release of 2015 Impact Assessment of Quality Measures Report

By Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer

Today, CMS released the 2015 National Impact Assessment of Quality Measures Report (2015 Impact Report) (http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/National-Impact-Assessment-of-the-Centers-for-Medicare-and-Medicaid-Services-CMS-Quality-Measures-Reports.html.). The 2015 Impact Report demonstrates that the nation has made clear progress in improving the healthcare delivery system to achieve the three aims of better care, smarter spending, and healthier people.

This report is a comprehensive assessment of quality measures used by CMS. It examines the effectiveness and impact of measurement and demonstrates our commitment to achieving optimal results from our quality measurement programs. The report summarizes key findings from CMS quality measurement efforts and recommended next steps to improve on these efforts.

Specifically, the report outlines the performance on quality measures over time and improvements achieved. Findings from the report include research on 25 CMS quality programs and hundreds of quality measures from 2006 to 2013 and builds on the prior 2012 Impact Assessment Report. Many of these measures are also included in incentive programs that link payment to quality performance.

The key findings of the 2015 Impact Report indicate that CMS is making a difference for the patients we serve. Highlights include: 

• Quality measurement results demonstrate significant improvement. 95 percent of 119 publicly reported performance rates across seven quality reporting programs showed improvement during the study period (2006–2012). In addition, approximately 35 percent of the 119 measures were classified as high performing, meaning that performance rates exceeding 90 percent were achieved in each of the most recent three years for which data were available. 
• Race and ethnicity disparities present in 2006 were less evident in 2012. Measure rates for Hispanics, Blacks and Asians showed the most improvement, and American Indian/Native Alaskans and Native Hawaiian/Pacific Islanders the least improvement. Transparency and monitoring of measures rates by race and ethnicity for all publicly reported measures and ensuring that disparities across programs, setting and demographic groups are eliminated, remain top priorities consistent with our CMS Quality Strategy. 
• Provider performance on CMS measures related to heart and surgical care saved lives and averted infections. From 2006 to 2012, 7,000 to 10,000 lives were saved through improved performance on inpatient hospital heart failure process measures, and 4,000 to 7,000 infections were averted through improved performance on inpatient hospital surgical process measures. (A number of the measures are also included in the previously released patient safety results demonstrating from 2010 to 2013 a 17 percent reduction in patient harm, representing 1.3 million adverse events and infections avoided, approximately 50,000 lives saved, and an estimated $12 billion in cost savings.) 
• CMS quality measures impact patients beyond the Medicare population. Over 40 percent of the measures used in CMS quality reporting programs include individuals whose healthcare is supported by Medicaid, and over 30 percent include individuals whose healthcare is supported by other payer sources. This demonstrates the public-private collaboration that CMS facilitates and hopes to expand. 
• CMS quality measures support the aims of the National Quality Strategy (NQS) and CMS Quality Strategy. CMS quality measures reach a large majority of the top 20 high-impact Medicare conditions experienced by beneficiaries, with more measures directed at the six measure domains related to the NQS priorities, and better balance among those domains. Much of our data resulted from process measures; however, there is an increase in measures related to patient outcomes, patient experience of care, and cost and efficiency. CMS is moving increasingly toward these outcome measures across programs. 

Quality measurement is a key lever that CMS uses to drive the transformation of the health care system in partnership with hospitals, clinicians, and patients. We will use the results from the 2015 Impact Report to refine our CMS quality measurement strategies, better understand the measures that have worked well, and guide the development and application of measures going forward. Important messages from this comprehensive report include: 

1. Performance based on quality measures has improved, and the programs that include these measures support a healthier individual and a healthier nation; 
2. New themes and actions to consider have emerged, which provide new insights for informed measure and program-specific decisions in the months ahead.

 We hope providers, private payers, and patient communities will use this report to understand which measures have worked well and which have had less of an impact on quality. Everyone receiving healthcare in our nation can benefit from CMS progress on quality measurement and the programs associated with these measures. We strive to achieve better care for our patients and families, better health in our communities, and smarter spending through quality improvement.