CMS releases final Market Stabilization Rule

On April 13, 2017, the Centers for Medicare and Medicaid Services (CMS) released the final Patient Protection and Affordable Care Act; Market Stabilization Rule. The final rule is aimed at stabilizing the individual and small group markets by tightening enrollment standards and providing increased flexibility related to standards for Qualified Health Plans (QHPs), as outlined in detail below. The final rule also seeks to provide greater deference to state regulation of health insurance. [More]

Update on House v Burwell case

On December 5, 2016, the District of Columbia Circuit Court of Appeals accepted a Congressional request to postpone further proceedings in House v Burwell pending motions due February 21, 2017, turning the continued proceedings in this case over to the next administration and Congress.

In November 2014, the House of Representatives filed suit against the current administration claiming the cost-sharing reduction payments made to issuers for silver level Marketplace enrollees, with incomes of less than 250% of the Federal poverty level, are not lawful because Congress has not appropriated the funds. [More]

Insights from the annual National Academy of State Health Policy Conference - #NASHPCONF16

From October 17th to 19th, members of PCG’s Health Policy team attended the annual National Academy of State Health Policy (NASHP) Conference in Pittsburg, PA. The theme for this year’s event was “Where Ideas and Action Converge,” with particular focus on Delivery System Reform Incentive Payment (DSRIP) waivers, Medicaid expansion and payment and delivery system reform innovation. In addition to presentations highlighting the innovative efforts in states under waiver and grant programs, discussions led by state and national policy makers on health care’s more headline grabbing topics (e.g., opiate abuse, ever-growing prescription drug costs, etc.). were weaved through the three-day agenda. [More]

Consumer assistance for open enrollment 2017

This year, for the first time since the health insurance marketplace began, states will not have the support of consumer assistance funding from the Centers for Medicare and Medicaid Services (CMS) to educate the public about marketplace plan offerings. Without federal funding, many states are scrambling to find ways to assist consumers in the upcoming open enrollment period. [More]

Alabama’s Regional Care Organization 1115 waiver approval

In May 2013, Act-2013-261, Ala. Code §§ 22-6-150 was passed, advancing the move from a fee-for-service (FFS) system to a managed care program. According to the Alabama Medicaid Advisory Board report issued in January 2013, based on 2011 data, 22 percent of Alabama’s population was Medicaid eligible for a portion of the year. Additionally, Alabama’s Medicaid program covered 53 percent of births, 47 percent of children, and two-thirds of nursing home residents. In 2009, Medicaid accounted for 16.3 percent of all health care expenditures in Alabama. In order to contain costs associated with the substantial Medicaid population, managed care in the form of regional care organizations (“RCOs”) were established with little guidance other than the Act 2013-261 itself. [More]

CMS announces the release of $22 Million in Health Insurance Enforcement and Consumer Protections grant funding

On June 15, 2016, the Centers for Medicare and Medicaid (CMS) announced the release of $22 million in grant funding for State planning and implementing of the health insurance market reform provisions of the Affordable Care Act (ACA). The grants are aimed at helping States ensure their laws, regulations and procedures are in line with Federal requirements and that the States are able to effectively monitor and enforce health insurance market reforms and consumer protections under the ACA. States must submit a letter of intent by July 6th. Grant applications are due August 15th at 3:00 pm. [More]

CMS announces extension of SHOP direct enrollment transition

On April 18, 2016, CMS released guidance entitled “Extension of state-based SHOP Direct Enrollment Transition,” which extends the option of direct enrollment until the end of 2018 giving state based SHOPs more time to make online enrollment available. In order to allow facilitation of enrollment without SHOP portal functionality, CMS has allowed states to direct enroll employers and their employees, while also extending the small business tax credits to those eligible small employers offering coverage on a state-based SHOP utilizing direct enrollment. This most recent guidance includes three options for states regarding enrolling SHOP eligible employers in 2019. States should begin planning now, because significant time is needed to not only give CMS notice but also to implement the option of choice. [More]

Current state of CMS quality rating programs

For Marketplace plans, quality is coming to the forefront as Quality Rating System (QRS) and Quality Improvement Strategy (QIS) requirements are rolled out for Qualified Health Plans (QHPs) starting in 2017. In short, pending the approval of proposed regulations, the following changes are coming for 2017:
• CMS will be publicly displaying QHP quality rating information on HealthCare.gov;
• QHP issuers will be allowed to include 2016 QRS and QHP Enrollee Survey results in marketing materials;
• QHP issuers must adhere to guidelines, including the QRS Technical Guidance and User Guide for the 2017 Coverage Year, established by Federal Department of Health and Human Services in consultation with health care quality experts and stakeholders.
[More]

Supreme Court hears oral arguments on major health care case

Members of PCG Health’s Health Innovation Policy Information Technology (HIPIT) center of excellence have been keeping a close eye on Gobeille vs Liberty Mutual Insurance Company. Gobeille has the potential to seriously undermine state All-Payer Claims Databases (APCD) that many of PCG’s state clients rely on for data collection. These systems allow states to gather data that is necessary to analyze health care services and impact rising health care costs. [More]