Legislative/Judicial/Regulatory Updates
 The Colorado Legislature passed a bill on May 5 that would have the state seek a waiver from HHS to establish a reinsurance program aimed at reducing claims costs according to geographic variations in health insurance premiums across the state. The bill is now under consideration by Gov. Jared Polis.
A bill passed by the Tennessee Legislature on May 2, now under consideration by Gov. Bill Lee, would require the state to request a waiver from the Centers for Medicare & Medicaid Services (CMS) to receive funding for its Medicaid program in the form of a block grant.
The Congressional Budget Office (CBO) released a report, Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2029, on May 2. The report contains projections of federal subsidies, taxes, and penalties associated with health insurance coverage for Americans under age 65 over the next decade. According to CBO, the net subsidy from the federal government for such coverage will be $737 billion in 2019, and $1.3 trillion in 2029. In addition, CBO found that the number of people without health insurance is projected to rise from 30 million in 2019 to 35 million in 2029.
Analysis released by CBO on May 2 estimates that a rule proposed by the Trump administration to address prescription drug costs would increase federal spending for Medicare by about $170 billion and spending for Medicaid by about $7 billion over the next decade. The rule, which was proposed in January, would eliminate the existing safe harbor for rebates paid by pharmaceutical manufacturers to health plans and pharmacy benefit managers in Medicare Part D and Medicaid managed care.
CBO released a report, Key Design Components and Considerations for Establishing a Single-Payer Health Care System, on May 1 providing an overview of key features of single-payer health insurance systems. The report discusses the design considerations and choices facing policymakers who seek to establish a single-payer system in the U.S. as a means of achieving universal health insurance coverage. Read the Academy alert.
Senators in the Kansas Legislature voted to block a bill that would expand Medicaid eligibility from reaching debate in that chamber following its passage in the House. The legislation, which was supported by Kansas Gov. Laura Kelly, would have extended eligibility for the state’s Medicaid program to working-age adults with incomes below 133 percent of the federal poverty level.
CMS issued a request for information (RFI) on May 1, seeking input on new programs and concepts that states could use when developing Section 1332 waivers. The RFI follows guidance released by CMS in November 2018 allowing states greater flexibility in designing and managing their individual insurance markets. Comments on the RFI are due July 2.
The U.S. House Committee on Rules held a hearing on H.R. 1384, the Medicare for All Act of 2019, on April 30. The legislation would establish a single-payer health insurance system based on the current Medicare program and implement measures to reduce health care costs and prescription drug costs.
The U.S. Department of Labor (DOL) issued a statement on April 29 regarding a March ruling that vacated key provisions of a DOL rule intended to broaden the scope and availability of association health plans (AHPs). Noting that it filed an appeal of the ruling on April 26, DOL announced in its statement that parties that established an AHP in accordance with the recently vacated rule will be allowed to maintain coverage through the end of the plan year. In addition, DOL will not pursue enforcement action against parties that are in violation of the ruling as long as those parties meet their obligations to association members, participants, and beneficiaries.
A bill passed by the Washington Legislature on April 28 and now under consideration by Gov. Jay Inslee would create a public health insurance option that would be available to residents through the state’s individual market. If the bill is signed into law, Washington would become the first state to establish a public health insurance option.
CMS sent a letter to the directors of state Medicaid programs on April 24 inviting states to work with CMS in testing new approaches to serve individuals who are dually eligible for Medicare and Medicaid. These approaches included a capitated financial alignment model and a managed fee-for-service model. In addition, states are invited to develop and propose their own state-specific models for consideration by CMS.
CMS announced a new “Primary Care First” initiative on April 22 that is aimed at strengthening primary care and providing better value to patients. The initiative consists of five value-based payment models intended to test the effects of financial risk and performance-based payments, as well as allowing health care providers to take greater control of managing the costs of care. CMS is seeking public comment on one of the models, the geographic population-based payment model, with comments due May 23.
In conjunction with its announcement, CMS released the first annual evaluation report for the Comprehensive Primary Care Plus (CPC+) Model, providing an overview of the impact on beneficiary outcomes over the first year for practices that started participating in the CPC+ model in January 2017.
CMS issued the final Notice of Benefit and Payment Parameters for 2020 on April 18. Read the Academy alert.
|
