VOL 13 | NO 1
Date:04/01/2022
HPC Holds Annual ‘Hill Visits’ With Federal Health Policy Stakeholders
Schmitz
Health Practice Council (HPC) volunteers and Academy staff virtually visited the offices of federal policymakers and regulators March 10–11 during their annual health “Hill Visits.” A number of key issues for both the HPC and policymakers were discussed, including health equity, COVID-19 and the implications for health care utilization and spending, insurance coverage, long-term care, Medicare sustainability, payment and delivery reform, and climate change implications for health.
Over two dozen volunteers took part in about 20 meetings with majority and minority U.S. House and Senate leadership and committee staff members, and with representatives from the Biden administration and key agencies including the U.S. Treasury Department, Labor Department, the Congressional Budget Office, Congressional Research Service, the Centers for Medicare & Medicaid Services, and the Government Accountability Office.
Academy volunteers offered perspectives on a variety of health insurance issues and heard from stakeholders about their priorities for 2022 and into next year.
“It was clear from our visits that the Academy is held in very high regard by the various congressional agencies, committees, and the Biden administration,” said Al Schmitz, the Academy’s health vice president. “Those we met with were very appreciative of our perspective and willingness to meet with them, and we engaged on a wide variety of the Health Practice Council’s key 2022 priorities including health equity, Medicare sustainability, payment and delivery reform, and long-term care.”
Meetings also included those with Senate Finance Committee, House Ways & Means Committee and with health policy staff members of House Speaker Nancy Pelosi and Minority Leader Kevin McCarthy.
“It’s always good to hear from the Academy—we really value your high-quality work,” one congressional staff member said; another staffer opined that “the actuarial perspective is critically important.”
Hospital Price Issue Brief Released
In conjunction with the Hill Visits, the HPC’s Health Care Delivery Committee released a new issue brief, Implications of Hospital Price Transparency on Hospital Prices and Price Variation, which examines factors contributing to hospital pricing and price variation and the impacts on consumers and insurance payers, that was discussed during the visits.
Key points include:
- Price transparency may be a necessary but not sufficient mechanism to lower hospital prices and health care spending;
- Whether price transparency leads to increased competition, lower hospital prices, and lower variation in prices depends on several factors;
- Consumers might not have an incentive to seek lower-priced care unless their out-of-pocket costs are tied to prices and referring providers also have an incentive to refer patients to lower-priced providers; and
- It is not yet understood how price transparency will impact health care expenditures overall and consumer affordability.
James
James Participates in Health Policy Forum
Health Equity Work Group (HEWG) Chairperson and Academy Board member Annette James took part in “Health Policy Roundup: Recent Trends in Coverage Enrollment and Affordability,” an online forum hosted Jan. 21 by the Alliance for Health Policy, in which she focused on what health actuaries do, including premium development, current trends in the health “ecosystem,” and the considerable work of the HEWG.
Academy Engages on New Colorado Insurance Discrimination Law
Academy President Maryellen Coggins sent a letter to Colorado Insurance Commissioner Michael Conway on that state’s law to protect consumers from unfair discrimination in insurance enacted last year.
The statute prohibits unfair discrimination based on certain personal characteristics—race, color, national or ethnic origin, religion, sex, sexual orientation, disability, gender identity, or gender expression—in any insurer practice. The law is intended to regulate insurers that use external consumer data and information sources, algorithms, and predictive models.
“It is our belief that we can continue to provide useful professional input as you work on the implementation of [the regulations],” Coggins wrote. The letter addressed general considerations, across practice areas, on implementing the law as well as particular issues involving health insurance.
Stakeholder Engagement Session
During the implementation process, the Colorado Division of Insurance (DOI) intends to hold stakeholder engagement meetings The DOI has held its first session, chaired by Conway, on life underwriting considerations in which Academy Life Underwriting and Risk Classification Work Group chairperson, Sue Bartholf presented.
HPC Groups Comment on Proposed 2023 NBPP
The HPC’s Individual and Small Group Markets Committee, Risk Sharing Subcommittee, and Health Equity Work Group submitted a comment letter to the Centers for Medicare & Medicaid Services (CMS) on CMS’ proposed rule for the 2023 Notice of Benefit and Payment Parameters (NBPP). The letter addresses network adequacy, standardized plan options, several provisions on health equity, updating quality improvement strategy, and other topics.
Still Time to Order—Life and Health Law Manual
Make sure you have the latest requirements at your fingertips with the Academy’s Life and Health Valuation Law Manual, which contains information to help appointed actuaries and others, including:
- A current topics section outlining key valuation developments and specific state guidance;
- Current NAIC model laws and regulations that have an effect on reserve calculations;
- A discussion of generally distributed interpretations; and
- Current actuarial guidelines from the NAIC Financial Examiners Handbook.
Academy Submits Statement to Senate Committee on Medicare’s Financial Condition
Medicare Committee Chairperson Rina Vertes and Academy Senior Health Fellow Cori Uccello submitted a statement for the record to the Senate Committee on Finance Subcommittee on Fiscal Responsibility and Economic Growth regarding its Feb. 2 hearing, “The Hospital Insurance Trust Fund and the Future of Medicare Financing.”
Committee Comments to CCIIO on Draft AV Calculator
The Individual and Small Group Markets Committee submitted comments to CMS’ Center for Consumer Information & Insurance Oversight (CCIIO) on the Draft 2023 Actuarial Value (AV) Calculator Methodology.
Health Solvency Committee Presents to NAIC
Health Solvency Subcommittee Chairperson Derek Skoog presented on recommendations from the Health Solvency Committee based on the Academy’s H2 Underwriting Risk and Managed Care Credit report to the NAIC’s Health Risk-Based Capital (E) Working Group at its virtual Spring National Meeting March 18.
Big Data Webinar Set for March 22
Mark your calendar for next week’s “Big Data and Algorithms in Actuarial Modeling and Consumer Impacts: Six Questions and Answers for Actuaries,” a webinar that will discuss the use of big data and algorithms in actuarial modeling, a topic of increased interest. Panelists will draw from and expand on the findings of the cross-practice area monograph, Big Data and Algorithms in Actuarial Modeling and Consumer Impacts. Attendees can count this toward the new U.S. Qualification Standards (USQS) requirement of annual bias education. The webinar will be held on Tuesday, March 22, from 11 a.m. to 12:30 p.m. EDT. Register today.
In This Issue
Legislative/Regulatory Activity
Following is a roundup of recent health practice-related legislative and regulatory activity.
Federal Activity
The Centers for Medicare & Medicaid Services (CMS) released new guidelines to state health officials for promoting continuity of coverage and distributing eligibility and enrollment workload in Medicaid. The guidelines aim to ensure states are prepared to initiate eligibility renewals for individuals enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). Goals include restoring routine eligibility and enrollment operations after the COVID-19 public health emergency ends, promoting continuity of coverage, and facilitating transitions between Medicaid, CHIP, and health insurance marketplaces.
CMS issued a proposed rule that would revise Medicare Advantage (MA) (Part C) program and Medicare Prescription Drug Benefit (Part D) program regulations. The proposed changes pertain to marketing, past performances, medical loss ratio (MLR) reporting, special requirements during public emergencies, and pharmacy price concessions. It would also revise regulations with dual eligible special needs plans and cost contract plans.
The Biden administration released the National COVID-19 Preparedness Plan, which has four stated goals: protecting against and treating COVID-19, preparing for new variants, preventing economic and educational shutdowns, and continuing global vaccination efforts.
State Activity
New York Gov. Kathy Hochul signed Senate Bill 612B, which directs the commissioner of health to promulgate rules and regulations that would establish policies and procedures for reporting—by the staff or volunteers of the long-term care (LTC) ombudsman office—issues concerning the health, safety, and welfare of residents at long-term care facilities licensed or certified by the state and requires the LTC Ombudsman Program to establish an awareness program to advertise and promote that program.
Hochul also signed Senate Bill 7767 relating to prescription drug formulary changes during a plan year. It prohibits health care plans from making changes during the contract year and expands the timeframe of notifying policyholders of changes to their plan from 30 days to 90 days before the start of the plan year. She also signed the similar Senate Bill 4111, which conforms other sections of state law with language prohibiting prescription drug formulary changes.
Arkansas Gov. Asa Hutchinson signed Senate Bill 88, invoking an emergency clause for the funding of the State and Public School Life and Health Insurance Program, eliminating the per participant dollar limit used for calculating contributions by participating entities into the program’s fund.
Hutchinson also signed Senate Bill 86, which establishes a funding mechanism with procedures to ensure the State and Public School Life and Health Insurance Program has adequate funding, including working toward achieving an optimal reserve balance of 14%.
Illinois Gov. J.B. Pritzker signed House Bill 3666, amending the Nursing Home Care Act. The law allows a nursing home facility to initiate an involuntary transfer if the resident or resident’s legal representation does not submit a payment within 75 days after the initial bill was presented.
A STATstory about Medicare’s premium increase quoted Academy Senior Health Fellow Cori Uccello on the effect one drug can have on total health spending.
MedPage Today reported on Health Equity Work Group Chairperson and Academy Board member Annette James’ presentation at an Alliance for Health Policy virtual event.