HealthCheck, Fall/Winter 2021

Fall/Winter 2021
VOL 12 | NO 4

HEWG Issues Request for Information

Comments Due Jan. 14

The Health Equity Work Group (HEWG) issued a request for information (RFI) to solicit input for its work assessing whether and how health actuarial practices and methods affect health disparities. Health actuaries often partner with other professionals in many different aspects of the health care, including those related to administration, financing, and care management.

The HEWG has identified four areas in which health actuaries are involved that may affect health disparities, either by contributing to or mitigating them, including: health insurance benefit design, provider contracting and network development, premium pricing, and managing population risk. The work group is also exploring data collection issues.

The HEWG is seeking articles, links, and other input, information, and existing or ongoing research in these areas from anyone with relevant information or perspectives, including, but not limited to health economists and health services researchers, actuaries, health plans and other payers, health care providers, health care consumers, policymakers, and other health policy experts or stakeholders.

The HEWG will use what it learns from this RFI to inform future papers on this topic, actuarial practices on health equity, and research proposal requests to further explore areas of interest. Respondents will be recognized as contributors to this work. In addition, the HEWG plans to hold a health equity symposium and respondents may be invited to attend and/or to present their work or perspectives.

Learn more about the RFI here. Comments are due by Jan. 14 and should be sent via email to healthequityRFI@actuary.org. Please include the phrase “HEWG Request for Information” in the subject line and do not password-protect any attachments. Comments may be sent via conventional mail to: Health Equity Work Group, American Academy of Actuaries, 1850 M Street NW Suite 300, Washington, DC 20036. Please contact Senior Health Policy Analyst Matthew Williams with any questions—williams@actuary.org.

Annual Meeting Looks at Health Issues Including COVID-19, Health Equity, Insurance, and Medicare

Boston University’s Andrew Stokes speaks at the COVID-19 plenary session

The Academy’s Annual Meeting and Public Policy Forum, held Nov. 4–5 in the nation’s capital as a hybrid event, covered multiple health topics, in both breakout and plenary sessions. It included plenary sessions that looked at COVID-19 and health equity, and breakout sessions with health-specific programming, including the outlook for regulating the Affordable Care Act (ACA) that featured representatives of the Centers for Medicare & Medicaid Services’ Center for Consumer Information and Insurance Oversight (CCIIO), addressing the risk of Medicare insolvency, and expanding access to health insurance coverage. A property/casualty session also looked at telehealth issues. For a complete recap of this outstanding event, be sure to check out the Annual Meeting and Public Policy supplement, published alongside the November Actuarial Update.

HEWG Releases Discussion Briefs on Population Health, Provider Contracting & Network Development

The HEWG released discussion briefs on population health and provider contracting and network development—both developed by the work group to provide more context on issues raised in the initial discussion brief, Health Equity from an Actuarial Perspective: Questions to Explore.

Health Equity from an Actuarial Perspective: Provider Contracting and Network Development addresses questions including:

How do overall health plan spending or other outcome goals and considerations affect network development and provider contracting, and do these have effects on access to care and health disparities?
How do alternative payment models (APMs) and cost targets for risk-bearing provider contracts affect provider incentives and disparities in health care access and outcomes?
Are quality provisions and outcome measures in APM contracts aligned with achieving equitable health outcomes?
How do the risk adjustment methods used in provider contracting and network development affect access to care and health outcomes?

Health Equity from an Actuarial Perspective: Managing Population Health, the final in the HEWG discussion-papers series, looks at questions such as:

How do algorithms that are designed to identify enrollees for disease management, care management, or wellness programs—and the proxy data underlying the algorithms—affect disparities?
When designing care management programs for specific populations, how are factors other than those directly related to health care considered, and how does applying the same rules and methods to different populations and markets affect health disparities?
Does the focus on a one-year time horizon for program costs and benefits perpetuate disparities?
Are financial metrics, such as return on investment, aligned with the goal of improved health outcomes in under-served or under-resourced groups, and do they widen or narrow health disparities?

The discussion paper series was undertaken by the HEWG to lay the groundwork for future exploration and research into health disparities. See more on the Academy’s Diversity, Equity & Inclusion webpage.

Academy Hosts Successful In-Person LHQ Seminar

Past President D. Joeff Williams leads an LHQ Seminar session

The Academy’s annual Life and Health Qualifications Seminar returned as an in-person event this year. Held Nov. 15–18 in Arlington, Va., the highly regarded and well-attended LHQ Seminar featured sessions on topics including professionalism, actuarial opinions, and cash flow, and interactive case-study breakout sessions that have long been highly valued by attendees—many return every few years to brush up on skills.

Attendees gained required basic education and continuing education to be qualified to sign NAIC Life and Health annual statements of actuarial opinion, and a range of topics were discussed, including principle-based reserving, risk adjustment data validation, and risk-based capital. David Dillon was a new member of the LHQ Seminar faculty, and Actuarial Standards Board Chairperson Darrell Knapp chaired the subcommittee that organized this year’s seminar.

Medicaid Committee Releases COVID-19 Issue Paper

The Medicaid Committee released an issue paper, Considerations for Reflecting the Impact of COVID-19 in Medicaid Managed Care Plan Rate Setting, that explores key components of rate setting during or shortly after the COVID-19 pandemic, including data, assumptions and adjustments, risk mitigation, and communication.

Public Policy Outreach

JamesHEWG Chairperson Annette James participated in a panel, “The Cost of Health Inequity: Dollars and Sense,” as part of The Alliance for Health Policy’s Health Equity Summit, held Sept. 15–16. Panelists discussed health disparities and health care financing from various standpoints, including the cost implications of inaction to address health inequities in terms of additional national health expenditures and lost productivity, and in context of the COVID-19 pandemic. James became a regular director on the Academy’s Board of Directors and was awarded an Outstanding Volunteerism Award at the Academy’s Annual Meeting and Public Policy Forum in November for her work leading the efforts of the HEWG.

LTC Reform Subcommittee Comments to NAIC

The Long-Term Care Reform Subcommittee sent a comment letter to the NAIC’s Long-Term Care Insurance (EX) Task Force regarding the exposure drafts of the operational and actuarial sections of the Long-Term Care Insurance Multi-State Rate Review Framework released in mid-September.

Risk Sharing Subcommittee Comments to CCIIO

The Risk Sharing Subcommittee sent a comment letter to CCIIO on the HHS-Operated Risk Adjustment Technical Paper on Possible Model Changes, which was exposed for comment in late October.

Health Practice Council Presents to HATF

Health Practice Council (HPC) volunteers presented to the NAIC’s Health Actuarial (B) Task Force (HATF) in early December.

HPC Vice Chairperson Barb Klever provided an update on the HPC’s 2021 activities, including the COVID-19 pandemic’s implications for health care utilization and spending, health insurance coverage and the ACA, health equity, long-term care, and Medicare sustainability.
The Long-Term Care (LTC) Valuation Work Group presented results of the LTC Insurance Mortality and Lapse Study. The work group released a major report, Long-Term Care Insurance Mortality and Lapse Study, resulting from a 2016 request from the NAIC’s Health Actuarial (B) Task Force regarding replacing the mortality and lapse bases for statutory minimum reserves. The study was completed jointly by the Academy and the Society of Actuaries Research Institute.

Public Employment Opportunity

The Utah Insurance Department is seeking a Health Insurance Actuary to direct and enforce actuarial functions related to health insurance. The person in the position will apply advanced actuarial science, mathematical, and statistical methods for the review and approval of reports, financial statements, and rate filings, among other tasks. For more information and to apply, click here.

The Academy has long supported government employers that are seeking to hire qualified actuaries. For more information, see our Public Employment Opportunity Posting Policy.

In This Issue

HEWG Issues Request for Information
Annual Meeting Looks at Health Issues Including COVID-19, Health Equity, Insurance, and Medicare
HEWG Releases Discussion Briefs on Population Health, Provider Contracting & Network Development
Academy Hosts Successful In-Person LHQ Seminar
Medicaid Committee Releases COVID-19 Issue Paper
Public Policy Outreach
LTC Reform Subcommittee Comments to NAIC
Risk Sharing Subcommittee Comments to CCIIO
Health Practice Council Presents to HATF
Public Employment Opportunity
Legislative/Regulatory Activity
In the News

Legislative/Regulatory Activity

Following is a roundup of recent state and federal health-related legislative and regulatory activity.

Federal Activity

The U.S. departments of Health and Human Services (HHS), Labor (DOL), and the Treasury, and the Office of Personnel Management (OPM) announced proposed rules that would require air ambulance plans, issuers, and providers of services to submit detailed data regarding air ambulance services specified in the reporting requirements of the No Surprises Act, a law addressing out-of-network billing that was enacted through the Consolidated Appropriations Act of 2021 (H.R. 133, Division BB—Private Health Insurance and Public Health Provisions). The federal departments also issued an interim final rule with a comment period to further implement the No Surprises Act. The latter rule provides a process to settle out-of-network rates between providers and payers and outlines requirements for health care cost estimates for uninsured or self-pay individuals. It also provides for a payment dispute resolution process for uninsured or self-pay individuals and expands the scope of ACA protections pertaining to the external review process for those claims.

The Centers for Medicare & Medicaid Services (CMS) released a frequently asked questions (FAQ) sheet on implementation of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the ACA. The FAQs address questions on HIPAA wellness programs and COVID-19-related premium penalties and rewards. Agency guidance in the FAQ clarifies that employer group health plans cannot deny benefits to customers who have not received the COVID-19 vaccine but can offer premium discounts to customers who decide to get the shot.

Deliberations continue in the Senate over the Build Back Better Act, after the House passed the roughly $2 trillion social and economic spending package on Nov. 19. Notable health items include plans to expand Medicare to include hearing benefits, and create a new Medicaid-like program administered by the federal government for the twelve states that chose not to expand Medicaid under the ACA. Debate continues over the size, scope, and potential terms of these new health programs. Decisions on the programs that are to be included in the package and their funding levels are underway. Read the Academy alert.

State Activity

Oregon Gov. Kate Brown signed Senate Bill 844 relating to prescription drug prices. The law establishes the Prescription Drug Affordability Board within the state’s Department of Consumer and Business Services to review prices for prescription drug products meeting specified cost criteria. Each calendar quarter the department is required to provide the board with a list of prescription drugs marketed in the state during the previous calendar year. From that list the board is required to identify nine drugs and at least one insulin product that it determines may create affordability challenges for health care systems or high out-of-pocket costs for patients. The department and board must confer and adopt annual fees to be paid by manufacturers based on their share of gross revenue from the sale of prescription drugs in the state, with the proceeds of these fees being used to offer assistance for purchasers of the drug designated on the aforementioned list.

Brown also signed House Bill 2046, which requires insurers to provide specified notice to individuals insured in short-term health insurance policies. It prohibits insurers from imposing due dates for the payment of health plan premiums earlier than 15 days after coverage begins. Subject to certain conditions, the law also authorizes the Oregon Department of Consumer and Business Services to access and disclose data in all claims payer databases.

Brown also signed House Bill 3352. The law expands Medicaid eligibility to adults who would be eligible for Medicaid if not for their immigration status, including Deferred Action for Childhood Arrivals (DACA) recipients. A program called Cover All Kids only covered children younger than 19 regardless of immigration status.

Illinois Gov. J.B. Pritzker signed SB 1682 related to prescription drug price disclosures. The law removes a provision of the state’s Pharmacy Practice Act that limited consumers to a maximum of 10 requests for the disclosure of current prescription drug and medical device prices. The law also requires pharmacies to post a notice informing customers that they may request the current retail price of any prescription drug or medical device.

California Gov. Gavin Newsom signed Assembly Bill No. 457. Existing law mandates that a contract issued, amended, or renewed on or after Jan. 1 between a carrier and a health care provider requires the carrier to reimburse the provider for the diagnosis, consultation, or treatment of an enrollee delivered through telehealth services on the same basis and as similar service through in-person diagnosis, consultation, or treatment.

North Carolina Gov. Roy Cooper signed Senate Bill 257 related to prescription drug pricing. The law permits pharmacists to disclose prescription drug cost information with patients and sell patients a lower-cost drug if one is available. The law also requires pharmacists to disclose any shipping and handling fees that will be charged to patients for mailed and delivered prescriptions. It also requires pharmacy benefit managers operating in the state to be licensed by the state of North Carolina.

Delaware Gov. John Carney signed Senate Bill No. 109. The law requires that home health care services for Medicaid long-term care services and support providers be reimbursed for services by Medicaid-contracted organizations at a rate equal to or more than the rate set by the state’s Division of Medicaid and Medical Assistance. This rate floor system is currently used for reimbursement rates for home health care nursing services paid for by Medicaid-contracted organizations.

In the News

Advisor Magazine, California Broker Magazine, Fierce Healthcare, Modern Healthcare, Richmond Times-Dispatch, and BenefitsPro reported on the Academy’s recent issue brief, Drivers of 2022 Health Insurance Premium Changes. AIS Health quoted Senior Health Fellow Cori Uccello on the uncertainty of COVID-19’s impact on 2022 premium rates while citing the issue brief.

Advisor Magazine reported on the updated Essential Elements papers on “Medicare’s Long-Term Sustainability Challenge” and “Securing Social Security.”

The Academy was mentioned in a Think Advisor article on NAIC’s work on a system for multistate long-term care insurance rate review.

Employee Benefit News referenced the Health Equity Work Group in a story about health inequities.