October 28 Update

In This Week’s Update:

  • Public Charge Final Rule FAQ
  • CMS Announces Average Premium Drop
  • State Updates: AZ, CT, MA, NE, NJ, NY, OK, OR, PA & WA
  • Webinar: Standardizing Health Plan Benefit Design
  • County-level Look at Volatility of the Individual Market
  • Provider Consolidation and Health Care Costs


Public Charge Final Rule FAQ

Last month, State Health and Value Strategies (SHVS) held a webinar on the final public charge rule issued by the Department of Homeland Security. Technical experts at Manatt Health have authored a Public Charge Final Rule: Frequently Asked Questions, which provides answers to questions about whom the rule will impact, what benefits are implicated by the rule, and how the rule might be administered. The rule was to go into effect as of October 15, but multiple federal courts have issued nationwide preliminary injunctions temporarily blocking the Administration’s implementation of the rule.


CMS Announces Average Premium Drop

Also last week, the Centers for Medicare & Medicaid Services (CMS) announced that the average premium for the second lowest cost silver plan on HealthCare.gov will drop by four percent for the 2020 coverage year. Three of the six states—Delaware (-20%), North Dakota (-15%), and Montana (-14%)—that experienced double-digit percentage declines in plan premiums are states that submitted successful Section 1332 waiver applications to implement reinsurance programs. Katie Keith has a blog post up on Health Affairs that goes through the numbers.


State Updates: AZ, CT, MA, NE, NJ, NY, OK, OR, PA & WA

  • Arizona—The Arizona Health Care Cost Containment System sent a letter to CMS saying that they will suspend implementation of the state’s Medicaid work requirement and other proposed changes. The state cited the evolving national landscape and ongoing lawsuits in other states’ work requirements.
  • Massachusetts
    • The Baker-Polite administration introduced health care legislation to improve outcomes for patients, increase access to care and bring down costs. The reforms will promote access to behavioral health and primary care services and establishes a spending target. Providers and insurers, including MassHealth, will be required to increase spending on behavioral health and primary care by 30 percent over three years within the construct of the state’s health care benchmark.
    • In addition to the legislation, Governor Charlie Baker signed an executive order forming a commission tasked with conducting a comprehensive study of the individual and small group insurance market to examine the underlying trends that are contributing to growing costs for individuals and small and mid-size employers.
  • Nebraska – The Nebraska (NE) Department of Health and Human Services (DHHS) is accepting public comments on two draft state plan amendments (SPAs) related to its proposed Medicaid expansion. The two SPAs are for the Nebraska Basic Alternative Benefit Plan (ABP) and the Nebraska Prime ABP. All newly enrolled individuals and individuals who do not meet wellness initiatives and personal responsibility activities defined under the Nebraska Prime ABP would receive services under the Nebraska Basic ABP. Beginning in waiver demonstration year two, individuals not participating in community engagement activities would also receive services under the Nebraska Basic ABP.
  • Oklahoma – The Oklahoma Health Care Authority is expanding its virtual pharmacist pilot program statewide to improve the health of SoonerCare (Oklahoma Medicaid) members with chronic conditions by optimizing their medication. Enrollees will receive personalized medication counseling, access improvement and treatment optimization services from clinical pharmacists using the Virtual Pharmacist platform developed by health care technology company Arine.
  • Oregon
    • Governor Kate Brown announced the membership of a committee to control the cost of health care for Oregonians. The committee will set an annual target for health care spending growth and recommend enforcement tools to hold the health care system accountable for meeting the target.
    • Last week, Governor Brown also convened the Behavioral Health Advisory Council formed by executive order earlier this month. The council will make recommendations to the Governor and the legislature on care for adolescents and adults with serious mental illnesses, including those with co-occurring substance use disorders. The council’s recommendations must include a focus on how to advance health equity within the state’s behavioral health system.
  • Washington—The Washington Health Benefit Exchange, the state-based marketplace, announced 2020 health plans are available for preview starting this week. Washington Healthplanfinder customers will have access to preview plans prior to the 2020 open enrollment and may signup to receive a reminder email when plans are available to purchase from November 1 through December 15. The plan preview is available until Washington Healthplanfinder begins final open enrollment system readiness on October 31 beginning at 1:00 p.m. P.T.
  • Connecticut, Pennsylvania, New Jersey, New York – New York Governor Andrew M. Cuomo, Connecticut Governor Ned Lamont, New Jersey Governor Phil Murphy, and Pennsylvania Governor Tom Wolf co-hosted the Regional Cannabis Regulation and Vaping Summit. The Governors, joined by legislative leaders and officials from each of the four states, discussed a collaborative joint regional approach to cannabis and vaping legislation and policies. Following the Summit, the Governors reached a set of core principles on issues related to market regulation and empowerment; public health; public safety and enforcement; and vaping best practices.


Standardizing Health Plan Benefit Design in the Individual Market: Opportunities and Implications

Wednesday, November 6, 1:00 to 2:00 p.m. ET

State Health and Value Strategies will host a webinar on the opportunities for states to implement standardized benefit designs, either through their health insurance marketplace or as part of a public option plan. The webinar will explore issues to consider in developing standardized options, communicating with stakeholders, and leveraging standardized designs to improve affordability for enrollees and encourage maintenance of coverage. The webinar will also review the development of standardized designs through state-based marketplaces, their connection to public option proposals, operational requirements to improve the end-user experience, and data collection and analysis needs.

Registration (required) at the following link: https://rwjfevents.webex.com/rwjfevents/onstage/g.php?MTID=e3cade0aaf60b554a6a16870264d01a07


Volatility in the Individual Market

A new blog post authored by Kathy Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, examines each county’s level of carrier change between 2015 and 2020. Almost all counties had at least some change. About half had fewer than five carrier changes, and about three-quarters had less than seven. The top 10 percent of counties had nine or more carrier changes, and a very small number of counties (54, or about 2%) had more than 10 carrier exits and entries. The blog post delves into some of the reasons for the flux and is accompanied by a map that visualizes the volatility in the individual market at the county level.


How are Private Insurance and Employer-Purchasers Faring in their Efforts to Contain Cost?

Georgetown’s Center on Health Insurance Reforms released a new report which examines strategies that private insurance companies and employer-purchasers in highly concentrated health care markets use to constrain health care cost growth and how these strategies are affected by increased provider consolidation. The researchers at Georgetown conducted six market-level, qualitative case studies of mid-sized health care markets in which there had been recent provider consolidation activity. The report shares key findings from the six case studies to address the increased market clout of hospitals and health systems which are driving higher commercial market prices and higher premiums and cost-sharing for consumers.