January

ACA Subsidies Could Expand, but Public Option Is Unlikely

January 15, 2021

With the new Congress largely in place, and the new presidential administration set to take power on Jan. 20, health care insiders are beginning to make sense of what legislation and rulemaking the Biden administration and Democrats intend to develop that could affect health insurers. Experts say that large, structural changes like a public option are unlikely, given Democrats’ narrow Senate majority, but smaller reforms including expanded subsidies in the Affordable Care Act (ACA) exchanges are up for discussion, along with pandemic-related coverage protections.

The Biden transition team included increased ACA subsidies and temporary COBRA subsidies for laid-off workers as part of the pandemic relief package that President-elect Joe Biden announced on Jan. 14, as AIS Health went to press. But that policy does face some hurdles.

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Payers Stop Funding Reps Who Didn’t Certify Election Results

With Chart: Historically, BCBSA Political Contributions Have Favored Republicans

January 15, 2021

Insurers and other health care organizations are halting or reconsidering donations to federal lawmakers who voted against certifying the results of the presidential election, in moves they say are designed to counter the extremism that led to the Jan. 6 insurrection at the Capitol.

In some cases, these decisions could have a noticeable impact, as many of the organizations announcing changes to their policies gave to members of Congress who voted against certifying election results. But in other cases, the decisions may not have a substantial result since the organization in question hadn’t made many donations in the past or was announcing a review, rather than a change in policy.

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Tennessee’s ‘Aggregate Cap’ Medicaid Waiver Gets CMS OK

January 15, 2021

Continuing its spree of approving ambitious waivers before the end of the Trump administration, CMS on Jan. 8 gave Tennessee its blessing to become the first state in the nation to cap its Medicaid funding in exchange for a range of operating flexibilities. Industry insiders tell AIS Health that while the future of Tennessee’s demonstration is uncertain, its approval could still be a point of concern for Medicaid managed care organizations.

“Similar to medical loss ratio (MLR) requirements in the Medicaid managed care final rule, the waiver would give Tennessee more oversight over their Medicaid plans, from flexibility in managed care contracting to rate setting,” explains Abner Mason, founder and CEO of ConsejoSano, a health tech startup specializing in linguistically and culturally aligned Medicaid and Medicare health plan member outreach.

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Executive Compensation Data for Presidents and/or CEOs of Blue Cross and Blue Shield Affiliates, 2019

January 15, 2021

Click here for a pdf of the full issue

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News Briefs

January 15, 2021

On Jan. 15, CMS finalized a rule that compels Medicaid, CHIP and Affordable Care Act (ACA) exchange plans to streamline their prior authorization processes. The regulation, which the administration proposed in December (HPW 12/18/20, p. 1), would also require the affected plans to add new capabilities to the Patient Access APIs that they had to build in order to comply with a previously finalized data interoperability rule. Read more at https://go.cms.gov/2LDw8eL.

CMS on Jan. 14 finalized several provisions in the 2022 Notice of Benefit and Payment Parameters (NBPP), cementing controversial new regulations for the ACA exchanges. Payer trade groups criticized the draft rule on various points, particularly an unusually short comment period and a provision that would allow states to abandon a centralized health insurance exchange in favor of relying on brokers, agents and insurers (HPW 1/8/21, p. 5). While that provision was among those finalized, CMS said it “anticipates continuing to review comments and finalizing other proposed policies in a second final rule to be published at a later date.” Read more at http://go.cms.gov/3sku3Vs.

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On Jan. 15, CMS finalized a rule that compels Medicaid, CHIP and Affordable Care Act (ACA) exchange plans to streamline their prior authorization processes. The regulation, which the administration proposed in December (HPW 12/18/20, p. 1), would also require the affected plans to add new capabilities to the Patient Access APIs that they had to build in order to comply with a previously finalized data interoperability rule. Read more at https://go.cms.gov/2LDw8eL. ✦ CMS on Jan. 14 finalized several provisions in the 2022 Notice of Benefit and Payment Parameters (NBPP), cementing controversial new regulations for the ACA exchanges. Payer trade groups criticized the draft rule on various points, particularly an unusually short comment period and a provision that would allow states to abandon a centralized health insurance exchange in favor of relying on brokers, agents and insurers (HPW 1/8/21, p. 5). While that provision was among those finalized, CMS said it “anticipates continuing to review comments and finalizing other proposed policies in a second final rule to be published at a later date.” Read more at http://go.cms.gov/3sku3Vs.
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2021 Outlook: Chaotic Transition Complicates Regulatory Landscape for PBMs

January 14, 2021

In the year ahead, Trump administration drug pricing policies are likely to be changed or revoked by the incoming Biden administration and court challenges, although which policies will be affected — and to what extent — is still unclear, policy experts tell AIS Health. Meanwhile, the violent attack on the Capitol by supporters of President Donald Trump may have poisoned bipartisan efforts to reform drug pricing before Congress had a chance to take them up.

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