Health Policy News November 2017

Along with the changing weather, this time of year brings some typical health policy events, which are the focus of this month’s edition of Health Policy News. We start with our in-depth analysis of the Proposed Notice of Benefit and Payment Parameters (NBPP) for 2019, which the Centers for Medicare & Medicaid Services (CMS) released at the end of October. PCG subject matter experts have been analyzing the policy changes announced in NBPPs since the first version and, with the administration change, this year’s proposals are among the most significant for states. PCG subject matters are currently reviewing the Draft 2019 Letter to Issuers in the Federally-facilitated Exchanges and will be sharing updates on that guidance shortly.

The start of November also marks the annual Open Enrollment Period (OEP) and in this edition, we explore the fifth enrollment period (OEP 5) and highlight major changes this year.

Finally, we round out this month’s Health Policy News with two other breaking and major health policy issues: the latest news regarding efforts to reauthorize the Children’s Health Insurance Program (CHIP) as well as the recent administration announcements regarding the opioid crisis.

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

CMS releases several major policy changes and expanded roles for states in its Proposed NBPP for 2019

At the end of October, CMS released its annual Proposed NBPP for 2019 (along with accompanying guidance, including a Draft 2019 Actuarial Value Calculator). As in past years, the NBPP for 2019 addresses a breadth of issues related to health plan regulation, Exchange operations (including financial parameters), and premium stabilization programs. However, as the first NBPP released by the new administration, the direction of this year’s NBPP is a stark departure from prior years. The stated goals of the NBPP are to increase state flexibility, decrease regulation of insurance plans, and improve program integrity.

Click here to continue reading about the Proposed NBPP for 2019, including typical changes and major direction changes released by the new administration, and to access a new summary created by PCG subject matter experts. This resource is designed to help regulators across the country understand how the proposed changes would impact state markets and regulation health plans.

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Impact of recent federal policy changes on open enrollment

The OEP 5 kicked off on November 1, 2017, with a shortened enrollment period compared to previous years. With only until December 15th to make eligibility and enrollment changes, states have been urging consumers to make selections early and seek assistance from application assisters, navigators and insurance agents / brokers. includes a function where consumers can enter their zip code and find assistance nearby, as well as a premium estimator tool. There are an abundance of new policies related to OEP 5 including new special enrollment period (SEP) guidelines.

Click here to learn more about the new SEP guidelines as well as the impact of the loss of cost sharing reduction (CSR) payments and reduced consumer choice on the OEP 5.

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CHIP funding crisis remains unresolved

Congressional authorization of Federal funds for CHIP expired on September 30, 2017. Nine million children depend on this program. States are now operating CHIP on carryover and redistribution payments from prior years. CMS estimates that at least one state will exhaust such funding in this month. Most states could exhaust such funding by March 2018.

On November 3, 2017, the U.S. House of Representatives passed H.R. 3922, the Championing Healthy Kids Act, which includes a five-year extension of CHIP through Federal fiscal year 2022. Federal funding for CHIP in FFY 2018 would be $21.5 billion under that bill. Such funding would reach $25.9 billion in FFY 2022.

Click here to continue reading about the CHIP funding crisis and the bulletin CMS released earlier this month.

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White House releases report on opioid crisis

On November 1, 2017, the White House released a report drafted by the President’s Commission on Combatting Drug Addiction and the Opioid Crisis. The report offers 56 recommendations for action by Congress, federal agencies, state governments, health care provider organizations, and health care payers.

Click here to learn more about the recommendations presented in the report and to access the President’s statement from the end of last month declaring that the opioid crisis is a public health emergency.

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