Health Policy News June 2017

On May 4th, the House passed the American Health Care Act, H.R. 1628 (AHCA), proposing significant changes to the Affordable Care Act (ACA) as well as Medicaid and Children’s Health Insurance Program (CHIP) provisions. The bill is currently in the Senate, but the Senate has yet to release their version. Unlike the House, the Senate is able to utilize the Congressional Budget Office (CBO) report on the impact of AHCA that was released on May 24th to as they consider the bill.

As the Senate continues crafting an “ACA Repeal” package, the administration is taking more limited steps to influence implementation of the law. Highlighted below are two upcoming changes to Marketplace enrollment that were announced last month, along with an update on recent movement in the House v Price case.

Also, this month, we continue our discussion of Section 1332 Waivers, outlining recent movement at the state and federal level, including a new checklist from the Centers for Medicare and Medicaid Services (CMS) and the Department of Treasury designed to help states pursue ACA State Innovation Waivers. Additionally, we have updated our 1332 summary to include the 1332 Waiver application filed by Minnesota in May.

Finally, this month’s Health Policy News also includes a special feature focused on the 21st Century Cures Act, highlighting two elements of the act that are of particular importance to states, as well as the work we do at PCG.

As always, you can also contact us at for more information on any of these pieces.

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House passes the AHCA — Awaiting Senate action

The AHCA passed the House of Representatives on May 4, 2017. The original bill was a compilation of budget reconciliation packages from the House Energy & Commerce Committee and the House Ways & Means Committee, in follow-up to the budget resolution adopted in January. Following initial failure to pass the bill, several amendments were introduced, ultimately securing enough votes for passage.

The AHCA does not repeal the ACA in full, but rather proposes changes primarily focused on the ACA’s insurance affordability, Medicaid expansion, coverage requirements, and revenue provisions. It also proposes changes to Medicaid funding more generally.

The AHCA is now in the Senate, which is expected to propose significant changes. In addition to putting its stamp on the bill and addressing the concerns of its members, the Senate will need to grapple with the fact that certain provisions do not directly impact the Federal budget and, therefore, could run afoul of Senate rules for budget reconciliation. Unlike the House, the Senate can utilize the May 24th CBO and Joint Committee on Taxation (JCT) report on the impact of the bill.

Click here to continue reading about the AHCA, including details of the amendments made prior to the bill’s passage by the House, as well PCG’s comprehensive overview of the AHCA.

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CBO estimates that AHCA would severely increase the number of uninsured persons

On May 24, 2017, the CBO and the JCT released estimates on the impact of the proposed AHCA, as passed by the U.S. House of Representatives.

The CBO estimates that AHCA would severely increase the number of persons without health coverage, as compared to the ACA:

  • By 2018, 14 million more uninsured persons
  • By 2020, 19 million more uninsured persons
  • By 2026, 23 million more uninsured persons

A total of 51 million Americans would be uninsured by 2026, 23 million more than the 28 million who would be uninsured in 2026 under the ACA.

The CBO also estimates that AHCA would reduce the federal deficit.  AHCA would eliminate various federal revenue streams established under the ACA, but would still cut the federal deficit by a net $119 billion (about $12 billion per year) through 2026.

Click here to read the complete article, which takes a more detailed look into the recent CBO estimates

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New ACA-Related announcements from the Federal Administration

On May 15, CMS announced that it will be proposing a rule to have enrollment into Federally-facilitated Small Business Marketplace (known as Small Business Health Options Program or “SHOP”) health insurance plans go directly through insurers as of 2018. Two days later, on May 17, CMS released guidance enabling (but not requiring) full direct enrollment in individual market Federally-facilitated Marketplace (FFM) plans starting for open enrollment for plan year 2018.

Click here  to read the full article highlighting key information from each announcement.

Also last month, the administration joined the U.S. House of Representatives in, once again, requesting that the lawsuit challenging the payment of cost-sharing reductions (CSRs), House vs. Price, be held in abeyance, leaving open the question of ongoing payment of the CSRs as insurers develop rates for 2018. If granted, the case will be put on hold until August 20, 2017. At the same time, the court is considering a motion by the Attorney Generals in 15 states and the District of Columbia asking the court to lift the abeyance so they can intervene in the appeal. Both the House and the administration have filed motions opposing that request.  Our summary of the recent proceedings can be found here. We will release additional guidance on motion to intervene proceedings as it becomes available.

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Section 1332 State Innovation Waiters: Recent developments and the newly-released checklist

There continues to be more movement at the federal and state levels related to Section 1332 State Innovation Waivers. States are urged to consult the Section 1332 checklist released by CMS on May 16th follow-up to its letter to Governors regarding the Section 1332 Waiver opportunity. Designed to help states pursue ACA State Innovation Waivers, this new checklist specifically notes information that should be provided by states seeking pass-through funding to support reinsurance or high risk pool programs.

Also, last month Minnesota became the most recent state to submit a Section 1332 Waiver application. Similar to Alaska’s waiver, Minnesota is seeking pass-through federal funding to support a new state reinsurance program, the Minnesota Premium Security Plan (MPSP). The federal funding would come from savings to federal premium tax credits and payments to the state’s Basic Health Plan as a result of the MPSP. Minnesota is also seeking to waive the single risk pool requirement in the individual market to allow insurers to factor in reinsurance payments received in calculating rates.

Click here for a detailed look at recent 1332 Waiver developments; including more information about the CMS checklist as well as PCG’s updated overview of all waiver requests, opportunities, and actions by state, now reflecting Minnesota’s draft waiver.

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Special Feature: 21st Century Cures Act

Implementing the 21st Century Cures Act

On December 7, 2016 Congress passed the  21st Century Cures Act (the “Act”), which was signed into law on December 14, 2016. The Act is aimed at modernizing health care delivery, improving quality and targeted improvements in the area of cancer treatment, mental health care, opioid addiction, and other focused areas.

One such modernization effort requires states to implement Electronic Visit Verification (EVV) systems for personal care services and home health care services providers by 2019 and 2023, respectively. Additionally, the Act allocates over $1 billion in grant funding over the next two years for states to combat the opioid epidemic. Below we highlight one way PCG has identified to leverage existing claims data to implement reforms. Be sure to check out the complete special feature here for additional information about the Act.

Paving the way for EVV implementation across all states

Section 12006 of the Act requires states to implement EVV systems for Medicaid-reimbursed personal care services and home health care services providers by 2019 and 2023, respectively. Failure of a state to adhere with the timelines outlined in the Act will result in the gradual decrease of a state’s Federal Medical Assistance Percentage.

The growing Home and Community Based Services (HCBS) population and the recent reports highlighting fraud amongst personal care service providers has ignited conversation on the necessity for real-time, mobile oversight technologies. PCG is an active participant in this dialogue as we seek to better understand states’ needs in order to refine our flexible and scalable EVV product line.

Utilizing Medicaid claims data to target opioid abuse

In April 2007, the U.S. Department of Health and Human Services (HHS) announced the first round of state targeted opioid prevention and treatment grant approvals, with $485 million to be administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). The grant funding sets forth stipulations around the use of the opioid abuse prevention and treatment. The funds are to be used for treatment, recovery and preventative services with an administrative costs cap for costs associated with grant implementation.

PCG receives and utilizes Medicaid claims data in certain states as part of our longstanding program integrity efforts. This work has centered around ensuring programmatic and provider compliance, as well as audit services. This data could provide states with the opportunity to run timely data analytics regarding opioid utilization across the state to pursue a variety of important initiatives.

Click here to access our complete special feature article on the Act.

Special Feature Contributors:

  • Margot Jones with assistance from EVV Workgroup
  • Jay Peck
  • Margot Thistle

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