August 31 Update: Impact of eliminating ACA’s preexisting condition protections; Connecting people with complex needs to community resources; Model legislation for PBM transparency

In addition to the recent federal activity we covered in previous updates, see this Health Affairs blog post for a brief synopsis of federal guidance for health insurers you might have missed these last few months. Updates follow.

  • California – The California Department of Insurance issued a press release announcing action its taking to stop an out-of-state insurance agent from conducting deceptive marketing and sales practices to health insurance consumers.
  • District of Columbia – Mayor Muriel Bowser announced that the District will hold its first Maternal and Infant Health Summit on September 12. The summit will be an opportunity for stakeholders to have a focused conversation regarding perinatal health and racial disparities in birth outcomes. The event is open to the public and will feature panel discussions geared towards articulating and sharing best infant and maternal health practices.
  • Illinois
    • Governor Bruce Rauner announced he signed legislation requiring medical professionals to take three hours of existing continuing education on how to safely prescribe opioid medications.
    • Governor Rauner vetoed legislation that would have limited short-term, limited duration products to six months rather than up to 364 days under the new federal rules.
  • Louisiana – Insurance Commissioner James Donelon issued an advisory letter to health insurance issuers that describes the interplay between existing federal and state regulations of association health plans (AHPs). The letter provides an overview of the provisions of the federal final rule and outlines the options that exist for the formation of AHPs as well as non-AHP multiple employer welfare arrangements under both state and federal law.
  • New Jersey—Governor Phil Murphy signed into a law a bill that requires certain schools to maintain a supply of opioid antidotes and permits emergency administration of an opioid antidote by a school nurse or trained employee. The law will require governing bodies of public and private schools to develop policies to obtain a standing order to maintain the supply of opioid antidotes for schools with grades 9-12.
  • New York
    • Governor Andrew Cuomo signed into a law a bill that prohibits smoking in any facility that provides child care services in New York State, including private homes.
    • The New York Department of Health held a webinar detailing the state’s draft 1915(c) Children’s Waiver amendment to implement the Children’s Medicaid Redesign program. The webinar provides an overview of the state’s draft waiver application and includes a timeline for submission. The state is collecting stakeholder comments until September 23, 2018.
  • Utah – The Utah Department of Health announced the launch of a study, Utah SOARS (Study of Associated Risk of Stillbirth), to help health officials learn why stillbirths occur. The one-year study seeks to collect data typically not included in medical records or on fetal death certificates.
  • Washington – Insurance Commissioner Mike Kreidler announced a proposed rule to restrict the sale of short-term limited duration medical plans to three months, prohibit renewal, and require enhanced disclosure to consumers about the limitations of coverage. The state is collecting stakeholder comments on the proposed rule until September 24, 2018.
  • Minnesota and New York – The Centers for Medicare and Medicaid Services released an administrative order announcing that the federal government will pay Minnesota and New York for the first three quarters of 2018 for their Basic Health Programs.

Upcoming Webinar – Save the Date!

Using Hospital Admission, Discharge, and Transfer Data to Coordinate Care: Lessons from Tennessee and Washington

Thursday, September 6, 2018 1:00 to 2:00 p.m. ET

SHVS will host a webinar featuring the use of admissions, discharge, and transfer (ADT) data feeds by two states, Tennessee and Washington, and how they use the data to coordinate care for patients with behavioral health and other complex care issues. Presenters will provide an overview of their respective state programs, including operational and financing strategies, linkages to quality metrics and outcomes, and alignment with other statewide payment and delivery system efforts.

Registration (required) at the following link:

Impact of Eliminating the Affordable Care Act’s Preexisting Condition Protections Will Depend on Where You Live

Our friend and colleague, Sabrina Corlette of Georgetown University, co-authored a blog post describing state activity in enacting and enforcing laws related to the Affordable Care Act’s provisions of guaranteed issue, preexisting condition exclusion, and community rating standards. The blog post summarizes a 50-state scan of insurance statutes and explains how the result of the current lawsuit filed by Texas and 20 other states may impact consumers.

Addressing Social Determinants of Health: Connecting People with Complex Needs to Community Resources

Our friends at the Center for Health Care Strategies will be hosting a webinar on September 10 from 2:00pm- 3:30pm ET that focuses on how providers that serve individuals with complex health and social needs are addressing the social determinants of health (SDOH). The webinar will feature speakers from South Carolina and California, who will share strategies for addressing SDOH through screening approaches, innovative technologies that track social service referrals, and development of strong connections with community partners.

Model Legislation to Bring Transparency to Pharmacy Benefit Managers

The National Academy for State Health Policy announced model legislation to help states shed light on the business practices of pharmacy benefit managers (PBMs). States can use the model bill to require the licensing of PBMs, ban gag clauses that prevent pharmacists from sharing lower-price drug options with consumers, and require more transparency into who profits from rebates.