July 27 Update: CMS issues final rule for 2017 risk adjustment payments; Balancing health care’s checkbook

This week, the Centers for Medicare and Medicaid Services (CMS) issued a final rule to readopt the risk adjustment methodology for the 2017 plan year. With this new rule, CMS will resume the risk adjustment program and begin collecting and paying out about $10.4 billion in risk adjustment transfers for 2017. For a summary of the final rule, check out this Health Affairs blog post.

In case you missed it, the Kaiser Family Foundation (KFF) updated its resource tracking proposed 2019 marketplace premiums to include new state premium rate filings since June. KFF first published the resource last month and will continue to update it as more data becomes publically available for additional states. Updates follow.

  • Arizona – Arizona Health Care Cost Containment System (AHCCCS) announced that American Indians who are enrolled in Medicaid coverage will have new integrated health plan choices when AHCCCS Complete Care begins October 1, 2018. Under AHCCCS Complete Care, the American Indian Health Program and AHCCCS managed care health plans will provide integrated care for all physical and behavioral health care services.
  • Delaware – As part of the State Innovation Model initiative, the Delaware Health Care Commission announced it is seeking applications from providers for one-time, value-based payment reform mini-grants to grow their capacity to integrate data, improve the coordination of patient care or increase their readiness to integrate into a total cost of care or Alternative Payment Model.
  • Maryland – This week Maryland’s official health insurance marketplace, Maryland Health Connection, has a blog post up explaining short-term health plans for consumers and what is and is not covered under this type of insurance.
  • New Jersey – The Department of Human Services Commissioner, Carole Johnson, penned an opinion piece this week on how the new state budget updates and modernizes the state’s Medicaid program and will make New Jersey a healthier state.
  • Pennsylvania – Insurance Commissioner Jessica Altman released the 2019 requested rate filings for individual and small group health insurance plans under the ACA this week, highlighting minimal rate increases and increased choices for many Pennsylvania consumers, including a new insurer in the individual market.
  • Virginia – Governor Ralph Northam announced a three-year, $900,000 federal grant awarded to the Virginia Department for Aging and Rehabilitative Services to enhance access to services and supports for Virginians with traumatic brain injury.
  • Massachusetts and New York – The New York and Massachusetts attorneys general filed a complaint in U.S. District Court on behalf of 11 states and D.C. against the U.S. Department of Labor, alleging that the administration’s association health plan rule violates ERISA, the Administrative Procedure Act, and the Affordable Care Act (ACA). The plaintiffs cite significant harm to states, including reduced tax revenue and the necessity to devote additional resources to police a “flood of inadequate or fraudulent plans” offered by associations.

Balancing Health Care’s Checkbook: New Strategies For Providers And States

Our friend and colleague Michael Bailit recently co-authored a Health Affairs blog post describing the various budgeting mechanisms states and providers are using to better manage health care cost growth. The authors provide a brief overview of payment models in general and highlight specific provider-, service-, and state-level budgeting strategies for consideration. State examples include those from California, Delaware, Maryland, Massachusetts, New York, Pennsylvania, Rhode Island, and Vermont.

Advancing A Health System Transformation Agenda Focused On Achieving Health Equity

Families USA recently published a report focused on addressing health equity within health system transformation efforts. The report, developed by Families USA’s Health Equity Task Force for Payment and Delivery System Transformation, lays out a rubric for assessing the potential impact of new initiatives on equity, a conceptual framework to organize the broad topics of delivery and payment reform and health equity, and a menu of policy options to consider by advocates and policymakers. For a brief summary of the report, see this article.

State Activity in the Individual Health Insurance Markets

In a new publication for The Commonwealth Fund, our friend and colleague Sabrina Corlette at Georgetown University’s Center on Health Insurance Reforms co-authored a post describing the policy actions states are taking to promote access to affordable and comprehensive health insurance coverage in the individual market. This work also marks the launch of an interactive map that will continuously track state policy choices likely to affect state individual markets.