In This Week’s Update:
- New Proposed ACA Rules for 2023
- State Health Coverage for Pregnant Immigrants & Children
- Census Data Quality Challenges in 2020
- Budget Neutrality and Section 1115 Waivers
- Enrollment Figures for Medicare, Medicaid, and CHIP
- State Updates: AR, CA, CO, GA, MA, ME, MD, NJ, NV, PA & WA
New Proposed ACA Rules for 2023
The Centers for Medicare and Medicaid Services (CMS) released its proposed Notice of Benefit & Payment Parameters for plan year 2023 on December 28, 2021. This annual regulation governs core provisions of the ACA, including operation of the health insurance marketplaces, standards for insurers, and the risk adjustment program. State Health and Value Strategies published an expert perspective focused on provisions of the proposed rule that are of particular import to the state-based marketplaces and state insurance regulators. Comments on the proposed NBPP are due January 27.
State Health Coverage for Pregnant Immigrants & Children
Also, SHVS published the second issue brief in its series Supporting Health Equity and Affordable Health Coverage for Immigrant Populations. The new issue brief, CHIP Coverage Option for Pregnant Immigrants and their Children reviews how states may provide pregnancy-related care through the Children’s Health Insurance Program (CHIP) to targeted low-income children from conception to birth (the so called “unborn child” option). This option enables states to provide prenatal, labor and delivery, and postpartum services to pregnant individuals, regardless of immigration status. To provide an overview of the series, SHVS also published an expert perspective this week that highlights upcoming programming. Updates follow.
An Annual Conversation with the U.S. Census Bureau: Addressing Data Quality Challenges in the 2020 ACS Data
Impacts of the COVID-19 pandemic have been demonstrably far reaching and, by now, fairly well documented. One facet of the COVID-related disruption that has recently come to light is the interruption to data collection processes and response patterns for yearly federal surveys, such as the U.S. Census Bureau’s American Community Survey (ACS), that provide estimates of health insurance coverage for the United States population. On January 19, SHADAC will host a webinar with U.S. Census Bureau experts for a discussion regarding the unique challenges the Census Bureau faced in both data collection and production efforts for the 2020 ACS, which resulted in a more limited set of “experimental” estimates being released this year. Registration to attend the webinar is available here.
Section 1115 Budget Neutrality
The Medicaid and CHIP Payment and Access Commission (MACPAC) recently published an issue brief on Section 1115 waiver spending. The brief outlines the share of Section 1115 demonstration costs not otherwise matchable (CNOM) spending by waiver type; MACPAC found that 82 percent of CNOM spending is attributable to supplemental payments, 8 percent of CNOM spending is attributable to coverage expansion, and 5 percent CNOM spending is attributable to designated state health programs. The brief also documents policy concerns surrounding budget neutrality including rebasing, limiting CNOM expenditures, and classifying hypothetical expenditures for the ACA expansion population.
Latest Enrollment Figures for Medicare, Medicaid, and CHIP
CMS released the latest enrollment figures for Medicare, Medicaid, and CHIP on December 21, 2021. The June 2021 Medicaid/CHIP enrollment snapshot shows more than an estimated 83 million individuals now have access to coverage through Medicaid and CHIP. This represents an increase of 433,963 compared to figures for May 2021. Since February 2020, enrollment in Medicaid and CHIP has increased by 12,507,181 individuals or 17.7 percent. The COVID-19 Public Health Emergency continues to play a significant role in Medicaid/CHIP enrollment.
- Arkansas – The Arkansas Department of Human Services announced an expansion of pharmacy benefits for adult Medicaid clients. Previously, Arkansas Medicaid paid for up to three prescriptions for adult clients per month. Adult Medicaid clients are now eligible to have six prescriptions paid for by Medicaid per month. Also, multiple classes of routine medication will not count toward that limit, such that clients will be able to have these types of prescriptions covered in addition to having Medicaid cover up to six other prescriptions.
- California – CMS approved the California Department of Health Care Services’ request for a five-year extension of its Medicaid section 1115 demonstration and a five-year extension of its Medicaid managed care section 1915(b) waiver. Both were scheduled to expire on December 31, 2021. The demonstration and managed care 1915(b) combination, re-named “California Advancing and Innovating Medi-Cal” (CalAIM), includes important provisions to advance health equity, fund key services, like home and community-based services for underserved communities, and improve access to care. For more information about California’s Medi-Cal transformation, see here.
- Colorado – The state’s Section 1332 waiver was deemed complete earlier this week by CMS, starting the public comment period. Comments are due by February 2, 2022. As a reminder, SHVS tracks Section 1332 state activity via a map.
- Georgia – CMS announced that it notified Georgia in a letter to the state that it will no longer have authority to require work activities as a condition of Medicaid eligibility, or charge premiums beyond those allowed under the Medicaid statute, in its Georgia Pathways to Coverage demonstration.
- Governor Janet Mills celebrated the third anniversary of her signing of an Executive Order expanding voter-approved Medicaid in Maine. While 89,421 people are currently covered through the expansion, it has helped over 120,000 residents of Maine in the three years since its launch.
- Governor Mills announced a plan to increase MaineCare (Medicaid) payment rates for 225 nursing and residential care facilities across Maine beginning January 1, 2022. The improved rates will allow these facilities to increase pay for direct care workers to at least 125 percent of the state’s minimum wage. They also come as the Maine Department of Health and Human Services implements MaineCare payment increases for other direct care workers across a range of services, including home- and community-based care, behavioral health, and long-term residential care settings.
- Maryland – The Department of Health released a request for applications for a contractor to provide technical assistance for best practices for social needs screening and patient demographic data collection for primary care practices. The primary goal of the project is to assist practices with the implementation of social needs screenings so that they will be well-equipped to provide adequate screenings for all patients and follow up with a referral to address any unmet needs.
- The state submitted a request to extend its MassHealth section 1115 demonstration for five years on December 22, 2021. The Commonwealth’s application proposes to continue, refine, and introduce new value based care initiatives, including activities that may target disproportionately affected populations and advance health equity. The Commonwealth is also seeking to maintain the safety net care pool, expand behavioral health services, and expand coverage initiatives under the demonstration. The federal public comment period will be open through February 3, 2022.
- To support development of the Plan Year 2023 Seal of Approval strategy, Massachusetts Health Connector, the state’s official health insurance marketplace, is seeking feedback on a range of policy considerations through a request for information (RFI). The RFI is designed to seek feedback on a range of questions related to health coverage priorities, health insurance product design, and health equity, intended to help inform strategy for the Health Connector’s 2023 Seal of Approval process.
- New Jersey
- Governor Phil Murphy signed an Executive Order launching the New Jersey Health Care Cost Growth Benchmark Program, an initiative that aims to mitigate the rate of health care cost growth in the state. Over time, the benchmark program aims to decrease how much healthcare costs grow each year. The program is bolstered by a stakeholder compact organized by the Murphy Administration consisting of advocacy groups, hospitals and healthcare providers, leading insurers, a union, employers and other stakeholders across New Jersey.
- The governor signed legislation that extends for the next two years the requirement adopted at the outset of the COVID-19 pandemic that health benefits plans reimburse healthcare providers for telehealth and telemedicine services at the same rate as in-person services, with limited exceptions. At the same time, the legislation charges the Department of Health with conducting an in-depth study of the utilization of telehealth and telemedicine and its effects on patient outcomes, quality and satisfaction, and access to care in order to inform future decisions on payment structure for these services.
- Nevada – Governor Steve Sisolak issued an executive order to address the growth in cost of healthcare in Nevada. The executive order sets a benchmark for how much the cost of healthcare services should grow in a year. It also charges healthcare payers, namely insurance companies, and healthcare providers to work together to meet these goals.
- Pennsylvania – Governor Tom Wolf announced that the state is organizing, in coordination with the Federal Emergency Management Agency, regional support sites for both hospitals and long-term care facilities, as well as strike teams to support hospitals facing staffing shortages. The Pennsylvania Department of Health and Pennsylvania Emergency Management Agency are coordinating the effort.
- Washington – A rule to solidify access to gender-affirming health care in Washington state took effect January 1, 2022. The rule clarifies several aspects of the existing Gender Affirming Treatment Act (SB 5313), passed by the Washington state Legislature in 2021. The rule clarifies several aspects of the existing law to ensure medically necessary gender-affirming treatments are covered by health insurers.