Legislative/Judicial/Regulatory Updates
 The 5th Circuit Court of Appeals began hearing oral arguments for Texas v. Azar on July 9. The court is considering whether to uphold a December 2018 ruling by the U.S. District Court for the Northern District of Texas, which found the ACA’s individual mandate for health insurance coverage to be unconstitutional and, further, inseverable from the rest of the ACA, thus declaring the entire law invalid. The decision in question has been stayed until the appeals court issues its ruling.
President Trump issued an executive order June 25 with the stated intention of increasing the transparency of health care costs and quality in the U.S. The order directs the U.S. Department of Health and Human Services (HHS) to take steps to increase price transparency, including implementing price disclosure requirements for providers and insurers. Read the Academy alert.
The U.S. District Court for the District of Columbia issued an opinion and order on July 8 vacating an HHS rule, finalized in May, which would have required pharmaceutical companies to include price disclosures for products featured in television advertisements. In the ruling, U.S. District Court Judge Amit P. Mehta determined that HHS does not possess sufficient statutory authority to require drug manufacturers to disclose list prices.
The Centers for Medicare & Medicaid Services (CMS) issued guidance to state Medicaid agencies on June 20 detailing steps that states should take to reduce improper payments and to ensure that all beneficiaries meet the program’s eligibility criteria.
HHS, along with the U.S. departments of Labor and the Treasury, issued final rules on June 14 that are intended to expand access to health insurance coverage through health reimbursement arrangements (HRAs). The rules were issued in response to an October 2017 executive order from President Trump, which directed the agencies to expand access to HRAs, as well as association health plans and short-term limited duration insurance (STLDI) plans. Read the Academy alert.
U.S. Reps. Frank Pallone, Richard Neal, and Bobby Scott sent a letter to HHS on June 13 in response to an August 2018 internal memo issued by CMS analyzing several proposed changes to the ACA, which the agency estimated could reduce enrollment in the federal health insurance exchange by 1.1 million. In their letter, the representatives called upon HHS not to finalize the proposed policies and requested that HHS and CMS provide them with further information regarding the analyses conducted by both agencies on each of the proposed policies.
New Hampshire Gov. Chris Sununu signed a bill into law July 8 delaying the implementation of the state’s requirements for work or community engagement as a condition of eligibility for Medicaid. The requirements, which were originally scheduled to take effect in June, will now be delayed through September. In addition, the new law allows the state’s insurance commissioner to waive requirements until July 2021 for enrollees affected by certain circumstances, including: the inability of the state to provide direct notification that such requirements are mandatory, an inability to achieve sufficient hours of qualifying activities despite a good faith effort, and the unavailability of transportation and other supports.
Florida Gov. Ron DeSantis signed a bill into law June 25 requiring insurers to make at least one health plan available to individuals with pre-existing conditions in the event that the ACA is repealed or vacated. In addition, the legislation allows individuals to obtain health insurance through short-term, limited duration insurance (STLDI) plans for up to one year, and allows STLDI plans to be renewed for an additional two years. Finally, the legislation expands the availability of association health plans (AHPs) by allowing small employers in the same industry or geographic region to form a plan, and removing a requirement limiting membership in AHPs to members of trade or professional associations.
Maine Gov. Janet Mills signed a bill into law June 24 directing the state to request permission from HHS to establish a program for the wholesale importation of prescription drugs from Canada. Similar legislation was approved by Florida Gov. Ron DeSantis on June 11.
Texas Gov. Greg Abbott signed two bills into law on June 14. H.B. 2536 requires prescription drug manufacturers, pharmacy benefit managers (PBMs), and insurers to share information with the state on drug price increases of more than 10 percent in a year, or 40 percent over three years, for drugs costing at least $100 for a 30-day supply. Such information would be disclosed by the state on a public website. S.B. 1264 prohibits health care providers from sending surprise bills to patients for out-of-network emergency services and establishes an arbitration process for insurers and providers to resolve disputed claims.
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