Health Policy News December 2016

With the end of 2016 and the change in administration fast approaching, it is no surprise we are seeing a flurry of activity and discussion across the health policy landscape. As state regulators and policy-makers, current and future Federal health care policy reforms directly affect your day to-day-operations and we hope to assist you by helping to monitor and understand the impact of these changes.

Much like the proposed 2018 Notice of Benefit and Payment Parameters (NBPP), the Centers for Medicare and Medicaid Services (CMS) released its draft 2018 Letter to Issuers in the Federally-facilitated Marketplaces (Letter) earlier than in previous years. Our first article below highlights PCG’s recent summary and webinar exploring the Letter. This edition of Health Policy News also includes a post-election debrief, which provides a high-level overview of potential changes to health policy, and shares insights into the timing, mechanisms and limitations of large scale reforms.

Rounding out this edition are updates on the recent stay of proceedings in House v Burwell, as well as the passage of the “21st Century Cures” bill by the US House of Representatives.

We here at Health Policy News wish you all a restful holiday season and happy new year — we will be back in 2017!  As always, please contact us at for more information on any of these topics.

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CMS releases 2018 draft Letter to Issuers in the Federally-Facilitated Marketplaces (FFM) early

CMS released a draft of its 2018 Letter to Issuers in the FFM (Letter) on November 10, 2016. The Letter – updated annually – provides operational and technical guidance for issuers seeking to offer Qualified Health Plans (QHPs) and Standalone Dental Plans (SADPs) on FFMs and State-Based Marketplaces on the Federal Platform (SBM-FPs). This year’s Letter was released following an election that raises significant questions regarding the future of the Marketplaces and the Affordable Care Act (ACA). However, until changes are enacted, issuers must begin working on plans that they will file in the Spring for certification to be included on the Marketplaces in 2018.

Overall, relatively few changes were made to the Letter as we enter the fifth year of QHP certification. Many of the changes were more to clarify and provide greater detail, rather than depart from prior policy. PCG subject matter experts hosted a webinar on the Letter on November 22nd and those interested in a recording can email Bobby Riso at

We anticipate CMS will release the final NBPP regulations this month, followed soon after by the final Letter (given the short comment period), so be on the lookout for PCG’s upcoming summary highlighting changes made to the final NBPP regulations and Letter. Our subject matter experts will also host a webinar exploring these changes. Stay tuned for more information!

Click here to read more about the Letter, and a summary of it prepared by PCG.

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Looking ahead: Key considerations for the future of health policy

There has been much discussion on the future of the ACA and health policy in general since the election. While it is tempting to try to predict the future of health policy, in reality it is still too early to know how policy will change, via which vehicles, and according to what timeline. There are, however, some key considerations to be mindful of as we approach inauguration day:

  • Repeal and replace will take time;
  • Other vehicles may be used to stop ACA implementation; and
  • There are common themes among “replace” packages.

Click here to read more about the future of health policy.

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Update on House v Burwell case

On December 5, 2016, the District of Columbia Circuit Court of Appeals accepted a Congressional request to postpone further proceedings in House v Burwell pending motions due February 21, 2017, turning the continued proceedings in this case over to the next administration and Congress.

In July 2014, the House of Representatives filed suit against the current administration claiming the cost-sharing reduction payments made to issuers for silver level Marketplace enrollees with incomes of less than 250% of the Federal poverty level are not lawful because Congress has not appropriated the funds. Cost-sharing reductions, together with advance premium tax credits, are significant affordability measures included in the ACA: they were established to ensure that individuals in moderate income brackets could purchase Marketplace coverage. As such, the impact of the ruling in this case has far-reaching repercussions for consumers, states and insurance issuers. It is estimated that 8.8 million individuals are currently receiving financial assistance for plans purchased through the Marketplace…Read More

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House passes 21st Century Cures bill

On November 30, 2016, the U.S. House of Representatives passed an amended “21st Century Cures” bill by a 392-26 vote.  The bill covers a diverse range of topics, such as: medical research, development of drugs and medical devices, interoperability of electronic health record systems, and mental health/substance use disorder (MH/SUD) programs.

MH/SUD provisions in the House bill (H.R. 34, as amended) seek to ensure that such programs keep pace with science and technology, encourage innovation and evidence-based practices, and improve access to state-based prevention initiatives.  The bill seeks to integrate MH/SUD services with primary care in community-based settings, support state efforts to reduce opioid abuse, strengthen early intervention and mental health crisis response systems, prevent suicides, and address the needs of high-risk populations such as veterans and homeless persons…Read More

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