Health Policy News August 2016

As states across the country prepare for another year of open enrollment for the health insurance marketplace, they must assess the past three years of operation while adjusting to the changes brought on by evolving federal regulations. This issue of Health Policy News touches upon efforts being made at both the state and federal level to prepare for 2017 marketplace operations. First, we share findings from a recently issued report from the Centers for Medicare and Medicaid Services (CMS) on enrollee costs from 2014-2015. We also highlight federal and state efforts to assist consumers with understanding their options for 2017. PCG has worked with many state insurance departments and health marketplaces to create tools to assist consumers; leveraging this experience, we share specific examples to help those states struggling to find ways to answer consumers’ questions about their options. Rounding out our open enrollment coverage is a look at the pilot network breadth program introduced by CMS in the 2017 HHS Notice of Benefit and Payment Parameters.
Our final article summarizes a recent PCG policy brief on the expanded scope of the Health Information for Economic and Clinical Health Act (HITECH) 90/10 funding available that seeks to encourage the adoption and promote the use of electronic health record (EHR) technology and health information exchange (HIE).

CMS releases report on Affordable Care Act (ACA) health insurers’ payment trends

CMS released a report on August 11, 2016 entitled, “Changes in ACA Individual Market Costs from 2014 to 2015: Near-Zero Growth Suggests an Improving Risk Pool.”  The report states that per member per month (PMPM) paid claims for health insurers in the individual market under the ACA fell 0.1 percent on average from 2014 to 2015, perhaps due to a broader, healthier ACA risk pool in 2015 than in 2014.  As evidence to support that hypothesis, CMS provides data showing that PMPM paid claims for health insurers in the ACA individual market fell 5 percent on average from 2014 to 2015 in the 10 states with…Read more

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Consumer assistance for open enrollment 2017

This year, for the first time since the health insurance marketplace began, states will not have the support of consumer assistance funding from CMS to educate the public about marketplace plan offerings. Without federal funding, many states are scrambling to find ways to assist consumers in the upcoming open enrollment period.

CMS has started promoting consumer assistance tools available to states and consumers for 2017, including FAQ’s, fact sheets and useful blogs:

  • blog to help consumers find out if they qualify for a Special Enrollment Period (SEP) for Marketplace health insurance coverage or if they qualify for Medicaid or Children’s Health Insurance Program (CHIP) coverage after experiencing certain major life changes.
  • A list of the types of health insurance losses that may qualify consumers for an SEP along with additional information.
  • Some of the most common Marketplace health insurance questions with detailed answers for consumers.
  • New fact sheets that outline the action that needs to be taken by a consumer who is turning 26 this year and has health insurance under a parent’s plan, and three reasons why young adults need health coverage.

States like New Hampshire and Arkansas have also started creating open enrollment assistance documents and fact sheets…Read More

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Network breadth classifications: 2017 pilot for Qualified Health Plans

On August 19, CMS released a bulletin outlining the details of the 2017 pilot program of the network breadth classification. The bulletin indicates that for 2017 open enrollment, consumers will be able to see the breadth of a plan’s provider network and compare networks across three provider types. This new pilot program will be limited to six states and will only highlight plans in the individual market. The states being considered are those that offer a sample of plans in geographic areas with a range of networks. CMS will consider both Federally-Facilitated Marketplace (FFM) and partnership states for the pilot. For more details on the network breadth classifications, including the methodology used to calculate breadth, please consult the final 2017 HHS Notice of Benefit and Payment Parameters and the Final 2017 Annual Letter to Issuers in the Federally-facilitated Marketplaces.

The proposed Notice of Benefit and Payment Parameters regulations for 2018 were released this week, so be on the lookout for summaries and webinar information from PCG’s team!

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Bridging the electronic health information highway and promoting interoperability for Medicaid providers 

The following summary highlights a recent news brief developed by Janice Paterson, a member of PCG’s Health team and former Acting Medicaid Director and Bureau Chief, Medicaid Policy for the State of New Hampshire.

CMS recently expanded the scope of the HITECH 90/10 funding available to encourage the adoption and meaningful use (MU) of EHR technology and HIE. The enhanced HITECH 90/10 funding provides a way for Medicaid agencies to continue to close the gap of providers who can communicate electronically with each other. This new funding source provides agencies’ the ability to gather important clinical and administrative data elements for robust program planning, improvements in quality of care; and managing costs.

While CMS initially limited matching funds to support for HIE for eligible professionals (EPs) and eligible hospitals, this new funding source allows Medicaid agencies to facilitate HIE between Medicaid providers even if the provider does not meet the definition of an EP – an important step to encourage MU of EHRs across the Medicaid provider continuum. Medicaid HITECH funds can now support HIE architecture and on-boarding for Medicaid providers who are not incentive-eligible, such as: post-acute providers, substance abuse treatment providers, home health providers, correctional health providers, other health care providers, pharmacies and laboratories.
Many states have been challenged with developing a truly robust HIE that connects Medicaid providers across all clinicians and healthcare related providers.

Read the complete news brief to learn more about this strategic funding opportunity that CMS has placed squarely with Medicaid agencies, including the kinds of innovative solutions CMS seeks to fund.

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