Welcome to our new AAAB members! In the August issue of AAAB Insights, check out the most recent regulatory updates out of Washington D.C. and across the country in Regulatory Updates.
Please make a note of the upcoming May meetings that are listed in the Members' Spot. If you would like to join a committee, please reach out to get involved.
We welcome any questions or feedback you may have regarding AAAB, so please feel free to contact our leadership board via email at gfeng@aaab.net.
Brandon Wood
AAAB President
From DC:
ACA:
- ACA Plans Have Better Psych Coverage: Medicare Advantage (MA) beneficiaries have less choice when it comes to finding a psychiatrist than Medicaid enrollees or those who buy coverage on the Affordable Care Act (ACA) marketplace do, according to a study published in Health Affairs. That’s because the networks through which MA beneficiaries might find a psychiatrist are narrower, the researchers said.
- ACA Success in LGBTQ+ Community: The percentage of LGBTQ+ adults with health care coverage increased from 76% in 2013 to 91% in 2019, due to the Affordable Care Act and the 2015 Supreme Court ruling on same-sex marriage equality, according to a new Health Affairs study. An analysis of Health Reform Monitoring Survey data showed that, historically, LGBTQ+ adults were less likely to access health care coverage. Yet the disparities between LGBTQ+ and non-LGBTQ+ adults began to decline in 2014 when the main coverage provisions of ACA went into effect. By 2019, coverage rates for LGBTQ+ people (91.2%) were comparable to those of non-LGBTQ+ adults (90.6%).
- Biden Takes Aim at Short Term Plans: The Biden administration announced plans recently to tamp down on short-term health plans and surprise medical fees as part of an ongoing effort to lower healthcare costs. The White House proposal would reverse a controversial Trump-era rule that expanded the duration of short-term health plans, or what critics refer to as "junk" plans.
- ACA Promoted for Redeterminations: According to Kaiser Family Foundation’s (KFF) Medicaid enrollment and unwinding tracker, more than two million people have lost Medicaid coverage since redeterminations started. KFF data shows that about 75 percent of those disenrolled have been disenrolled for procedural reasons. To combat this, the Center for Medicare and Medicaid Services (CMS) plans to increase efforts to connect those disenrolled to the exchange marketplace with an Affordable Care Act (ACA) plan. Currently, CMS is working on conducting outreach to those who have lost Medicaid coverage to outline available options.
Medicare/Medicaid:
- Medicare cutting Home Health: The Biden administration issued a proposal Friday to cut reimbursements to home health providers by 2.2% next year, or an estimated $375 million less than 2023 payment levels.
- Georgia Medicaid Expansion: Georgia on July 1 implemented its partial Medicaid expansion — which also comes with a work requirement. The program, Pathways to Coverage, allows uninsured able-bodied adults living at or below the federal poverty line to become eligible for Medicaid benefits if they participate in 80 or more hours per month of work, volunteering, school or another qualifying activity. The Trump administration approved the program in October 2020, and Georgia is now the only state in the country to tie a work requirement to Medicaid coverage. Georgia currently serves 2,887,544 Medicaid beneficiaries, with 77.0% enrolled in managed care plans. The state estimates about 100,000 additional lives would enroll in Medicaid under Pathways to Coverage, according to the Associated Press.
- Molina to Bright’s Remaining MA Assets: After two months of shopping around its Medicare Advantage business, Bright Health Group, Inc. recently unveiled plans to sell its remaining insurance assets to Molina Healthcare, Inc. in a deal worth approximately $600 million. The transaction will allow the “insurtech” to focus on its consumer care delivery business, which serves fee-for-service Medicare, Medicaid, and Affordable Care Act marketplace customers, while enabling Molina to continue its strategic growth in the niche low-income MA space.
- C-SNP Expansion:Scottsdale, AZ-based Gold Kidney Health Plan will expand its offerings to nine Florida counties for the 2024 plan year, pending regulatory approval from CMS. The specialty Medicare Advantage insurer offers chronic special needs plans (C-SNPs) focused on integrated, patient-centered benefits for Medicare eligibles with chronic conditions that cause kidney disease. "By coming to Florida — one of the Top 3 most populous states for U.S. residents aged 65 and older, we plan to help make a difference in the lives of more seniors…by designing plans tailored to their specific care needs," Gregg Kunemund, COO at Gold Kidney Health Plan, said in a statement. The insurer currently serves 230 members in Arizona.
- Proposed Episode Payment Model:The Center for Medicare and Medicaid Innovation has released a request for information to design a future episode-based payment model. The center is looking for feedback on questions related to care delivery, incentive structure alignment, clinical episodes, participants, health equity, quality measures and multipayer alignment, payment methodology and structure, and model overlap, according to the request.
- Medication Management in Maryland:CareFirst BlueCross BlueShield is partnering with Baltimore-based medication engagement company Scene Health to boost medication adherence among its Medicaid members, according to a recent press release. CareFirst’s Medicaid members in Maryland will have free access to Scene’s digital medication support program, which offers individual coaching and video-based personal engagement. “Scene Health…shares CareFirst’s vision of patient-centered care while encouraging individuals to take an active role in their health,” the insurer wrote in a statement. CareFirst currently serves 83,865 Medicaid members in Maryland, about 6% of the state’s managed care beneficiaries.
Federal Activity:
Federal Register: In the month of July, there were 14 new Federal Register entries in the Healthcare Reform section. Those entries break down as follows:
- Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Payment for Intensive Outpatient Services in Rural Health Clinics, Federally Qualified Health Centers, and Opioid Treatment Programs; Hospital Price Transparency; Changes to Community Mental Health Centers Conditions of Participation, Proposed Changes to the Inpatient Prospective Payment System Medicare Code Editor; Rural Emergency Hospital Conditions of Participation Technical Correction (CMS): This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for calendar year 2024 based on our continuing experience with these systems. In this proposed rule, we describe the changes to the amounts and factors used to determine the payment...(click for more info)
- Anniversary of the Americans with Disabilities Act, 2023 (EOPOTUS): (click for more info)
- Advisory Committee on Immunization Practices (CMS):In accordance with regulatory provisions, the Centers for Disease Control and Prevention (CDC) announces the following meeting of the Advisory Committee on Immunization Practices (ACIP). This meeting is open to the public. Time will be available for public comment. (click for more info)
- Catastrophic Health Emergency Fund (IHS): The Indian Health Service (IHS or Service) administers the Catastrophic Health Emergency Fund (CHEF) pursuant to section 202 of the Indian Health Care Improvement Act (IHCIA). The purpose of the CHEF is to meet the extraordinary medical costs associated with the treatment of victims of disasters or catastrophic illnesses who are within the... (click for more info)
- Privacy Act of 1974; Matching Program (CMS): In accordance with subsection (e)(12) of the Privacy Act of 1974, as amended, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) is providing notice of the re-establishment of a matching program between CMS and the Social Security Administration (SSA), "Determining Enrollment or Eligibility for... (click for more info)
- Announcing the Intent To Award a Single-Source Supplement for the National Center for Benefits Outreach and Enrollment (Community Living Administration): The Administration for Community Living (ACL) announces the intent to award a single-source supplemental to the current cooperative agreement held by the National Council on Aging (NCOA) for the National Center for Benefits Outreach and Enrollment (NCBOE). The purpose of the NCBOE is to provide technical assistance to states, Area Agencies on... (click for more info)
- Health and Human Services Grants Regulation (HHS): This is a notice of proposed rulemaking (NPRM) to repromulgate and revise certain regulatory provisions of the HHS, Uniform Administrative Rule Requirements, Cost Principles, and Audit Requirements for HHS Awards, previously set forth in a final rule published in the Federal Register.
- Request for Information Regarding Medical Payment Products (CFPB, CMS, TREAS): The CFPB, an independent agency, HHS, and the Treasury (collectively, the agencies), are soliciting comments from the public and interested parties on medical credit cards, loans, and other financial products used to pay for health care. The agencies seek to understand the prevalence, nature, and impact of these products, including disparities... (click for more info)
- Short-Term, Limited-Duration Insurance; Independent, Noncoordinated Excepted Benefits Coverage; Level-Funded Plan Arrangements; and Tax Treatment of Certain Accident and Health Insurance (IRS, EBSA, HHS): This document sets forth proposed rules that would amend the definition of short-term, limited-duration insurance, which is excluded from the definition of individual health insurance coverage under the Public Health Service Act. This document also sets forth proposed amendments to the requirements for hospital indemnity or other fixed indemnity... (click for more info)
- Medicare Program; Hospital Outpatient Prospective Payment System: Remedy for the 340B-Acquired Drug Payment Policy for Calendar Years 2018-2022 (CMS): This proposed rule describes the agency's proposed actions to comply with the remand from the district court to craft a remedy in light of the United States Supreme Court's decision in American Hospital Association v. Becerra, 142 S. Ct. 1896 (2022), relating to the adjustment of Medicare payment rates for drugs acquired under the 340B Program... (click for more info)
- Medicare Program; Calendar Year (CY) 2024 Home Health (HH) Prospective Payment System Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin Items and Services; Hospice Informal Dispute Resolution and Special Focus Program Requirements, Certain Requirements for Durable Medical Equipment Prosthetics and Orthotics Supplies; and Provider and Supplier Enrollment Requirements (CMS): This proposed rule would set forth routine updates to the Medicare home health payment rates for calendar year (CY) 2024 in accordance with existing statutory and regulatory requirements. This rule would--provide information on home health utilization trends and solicits comments regarding access to home health aide services; implement home... (click for more info)
- Improving Income Driven Repayment for the William D. Ford Federal Direct Loan Program and the Federal Family Education Loan (FFEL) Program (ED): The U.S. Department of Education issues final regulations governing income-contingent repayment plans by amending the Revised Pay as You Earn (REPAYE) repayment plan and restructuring and renaming the repayment plan regulations under the William D. Ford Federal Direct Loan (Direct Loan) Program, including combining the Income Contingent... (click for more info)
- Agency Information Collection Activities: Submission for OMB Review; Comment Request (CMS): The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), Federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including... (click for more info)
- National Committee on Vital and Health Statistics; Meeting (HHS): Pursuant to the Federal Advisory Committee Act, the Department of Health and Human Services (HHS) announces the following advisory committee meeting. This meeting is open to the public. The public is welcome to attend in person or virtually by following the instructions posted on the website: https://ncvhs.hhs.gov/meetings/full-committee.
Bills Introduced in Key Health Committees:
- House Energy & Commerce: 152 bills filed in July (1,108 total introduced so far this Congress)–NOTABLE: None.
- House Ways & Means: 102 bills filed in July (861 total introduced so far this Congress)–NOTABLE: None.
- Senate Finance: 54 bills filed in July (372 so far this Congress)–NOTABLE: None.
- Senate HELP: 92 bills filed in June (429 total introduced so far this Congress)–NOTABLE: None.
Salient Congressional Bills:
- H.R.711 — To amend title XXVII of the Public Health Service Act to eliminate the short-term limited duration insurance exemption with respect to individual health insurance coverage. NO ACTION since 02/10/2023 when referred to the Subcommittee on Health of the Energy & Commerce Committee.
- H.R.1610/S.799 — To amend title XVIII of the Social Security Act to provide Medicare coverage for all physicians' services furnished by doctors of chiropractic within the scope of their license, and for other purposes. NO ACTION since 03/24/2023 when referred to the Subcommittee on Health of the Energy & Commerce Committee in the House. Same in the Senate since 03/14/2023 when referred to the Committee on Finance.
- H.R.824 — Telehealth Benefit Expansion For Workers Act. RECENT ACTION on 07/19/2023 when amended by the Yeas and Nays: 29 - 20 in the Committee on Energy and Commerce.
- H.R.3133 — To amend title XVIII of the Social Security Act to provide coverage for acupuncturist services under the Medicare program. NO ACTION since 05/12/2023 when referred to the Subcommittee on Health of the Committee on Energy and Commerce.
Around the Country:
- Bon Secours and Anthem in Dispute: Another contentious payer-provider contract dispute has gone public. Bon Secours Mercy Health will no longer accept Anthem Medicaid patients beginning July 1 as it pushes for higher reimbursement rates.
- Chemotherapy Drug Shortage: Cancer patients and their healthcare providers are facing record shortages of effective treatments. A recent survey found that over 90% of large U.S. cancer centers reported shortages. This nationwide shortage is due to expanded demand, supply chain challenges, limited labor and manufacturing capacity, and low profit margins for generic therapies. The Society of Gynecologic Oncology recently released a statement recommending short-term solutions such as minimizing ordering drugs under shortage if others have similar efficacy, as well as using the lowest dose and the longest interval possible between doses. Providers are calling for increased transparency around the timing for additional drug shipments, as well as requesting the U.S. government set up a strategic reserve for cancer drugs. In response to the shortage, the FDA has authorized Qilu Pharmaceutical, a drug manufacturer in China, to import an injectable version of a widely used drug. Apotex, a Canadian pharmaceutical company, will distribute the medication on a temporary basis.
- Higher Healthcare Costs: Humana echoed comments made recently by top brass at UnitedHealth Group, warning in a new filing that it's expecting higher care use this year. The Medicare Advantage insurer said in a filing with the Securities and Exchange Commission that is expecting its benefit expense ratio to land at the higher end of its guidance for the year, which was between 86.3% and 87.3%. The insurer said this trend is driven by "higher than expected" utilization in outpatient services, including emergency care, surgeries, and dental services. Humana added that it has also continued to see high enrollment in its MA plans, including more age-ins than expected. These members "tend to run a higher benefit expense ratio than the average new member," according to the filing.
- Centene Continues Divestiture: Centene Corp. recently finalized its sale of Apixio, its artificial intelligence value-based care platform, to New Mountain Capital. "We are confident this transaction will best position Apixio to expand its impact as a leading artificial intelligence platform that enables value-based care programs across the country," Centene CEO Sarah London said in a statement. The company has been working to divest its “non-core assets” since 2021. Centene’s insurance units currently enroll 21,669,643 people nationwide, with 69.2% enrolled in managed Medicaid, and 9.6% enrolled in Affordable Care Act marketplace products.
- Prior Auth Push: A bipartisan group of legislators from both chambers of Congress is urging the Biden administration to finalize updates to prior authorization. Nearly 300 members of Congress submitted letters to the Department of Health and Human Services backing rules proposed in December 2022 that aim to modernize prior auth. In these regulations, the Centers for Medicare & Medicaid Services proposed requiring government payers to switch to electronic prior authorization by 2026.
