CMS releases 2018 enrollment data for the federal health insurance marketplace

At the agencies

The Centers for Medicare and Medicaid Services (CMS) announced that over 8.7 million individuals enrolled in 2018 insurance plans on HealthCare.gov as of Dec. 23. While the number of people who signed up for new policies increased since CMS last provided statistics, the number of those who renewed policies decreased from 6.4 million to 6.3, indicating individuals who were auto-enrolled elected to drop their coverage.

The Department of Veterans Affairs (VA) announced that it will take steps to improve the timeliness of payments to private sector provider partners. These steps include publishing a list of providers with large amounts of unpaid claims during the week of Jan. 8 and creating rapid response teams to work with these identified providers to reach settlements within a 90 day window. The VA will also increase the number of claims processed by vendors by 300 percent in January and 600 percent in April. The department will also provide multiple entry points where providers can review the status of their claims. The VA will also streamline the claims submission and payment process by implementing software improvements and award four contracts this year to establish a new Community Care Network in 2019.

The Federal Communications Commission (FCC) submitted a notice of proposed rulemaking on potential changes to the Rural Health Care Program. The notice considers changes such as redefining the term “rural health care,” reducing the percentage of rural providers that are needed to qualify for subsidies and reducing waste and fraud. In December the FCC voted to spend unused money on the program, thereby enabling the commission to temporarily spend more than the $400 million annual cap to subsidize broadband use by healthcare providers.

The Substance Abuse and Mental Health Services Administration (SAMHSA) released a final rule that allows for easier sharing of patients’ substance abuse records for the purpose of billing and operations. Industry experts question why the rule would not allow records sharing for the purposes of treatment. Experts also agree that the behavioral health privacy rules will continue to be limited until they are aligned with the Health Insurance Portability and Accountability Act (HIPAA), which could not happen without action from Congress. Legislation by Senators Joe Manchin (D-VW) and Shelley Moore Capito (R-WV) and Representative Markwayne Mullin (R-OK) is currently pending in both chambers to do so.

On the Hill

Senator Susan Collins (R-ME) announced her aim for Congress to pass Affordable Care Act (ACA) stabilization legislation before premiums rise in 2019 due to the recent repeal of the individual mandate. Senator Collins has proposed legislation that would fund a reinsurance program for states in order to help stabilize the individual insurance market, and a Congressional Budget Office (CBO) score of the reinsurance legislation is expected soon.

The Senate unanimously passed S. 925, the Veterans E-Health and Telemedicine Support (VETS) Act of 2017, which allows providers working with the Veterans Health Administration to provide telemedicine services to veterans in any state, regardless of where the professional or patient is located. The accompanying House legislation passed unanimously in November 2017. As the Senate bill contains a provision not included in the House bill that prevents states from denying or revoking physicians’ licenses for using telemedicine across state lines, the legislation will have to go through a conference committee before it reaches the president’s desk.

Senator Orrin Hatch (R-UT) announced he will retire after the conclusion of his seventh term in January 2019. During his time in Congress, he has championed several healthcare measures, including the Children’s Health Insurance Program (CHIP); Medicaid Part D; the Drug Price Competition and Patent Term Restoration, or Hatch-Waxman, Act; and orphan drug reform. Before he leaves Congress, Hatch may try to finish passing the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act. Hatch has worked on chronic care reform since he assumed the chairmanship of the Senate Finance Committee and may seek to cement his healthcare legacy by fighting for its passage in his final year.

From the administration

President Trump dismissed all sixteen remaining members of the Presidential Advisory Council on HIV/AIDS (PACHA), which provides guidance to federal government on its response to the HIV/AIDS epidemic. The administration posted a notice in early December seeking recommendations for new members. The council’s executive director stated that firing the Obama-appointed members is standard procedure and that the White House will nominate a new panel. Six members had already quit last summer, citing concerns about the administration’s goals and proposed prevention funding cuts.

At the courts

U.S. District Court Judge Rudolph Contreras rejected a request by the American Hospital Association and allies for an injunction to block 340B drug program discounts as the cuts had not yet gone into effect. The judge allowed the Trump administration’s $1.6 billion cuts to 340B to proceed; hospitals will be able to resubmit their lawsuit once the cuts begin. The American Hospital Association, the Association of American Medical Colleges and America’s Essential Hospitals pledged to continue pursuing the case against the Medicare rule that would reduce certain drug payments by 28.5 percent to providers who serve predominately low-income patients. The associations argued that the Department of Health and Human Services ignored congressional intent in promulgating the cuts. A legislative fix through Congress has been discussed and continues to be advanced by industry lobbyists.


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