Health Policy News – April 2019


In this month’s edition of Health Policy News, we delve into two of last month’s breaking Federal litigation updates: the decisions issued in cases regarding the Association Health Plan Final Rule and the use and operationalization of Medicaid work requirements. As both decisions reverse course on recent health policy developments, we analyze their likely impact on both present and prospective state policy directives.

Additionally, on April 18th, the Centers for Medicaid and Medicare Services (CMS) released their annual Exchange guidance, which included final timelines for qualified health plan filing and rate review. To support states as they head into another year of qualified health plan review and approval, PCG has prepared a summary of the guidance that tracks the changes finalized for 2020. We will also post a slide presentation on the Health Policy News blog in the coming days that highlights and discusses key changes.

Lastly, Nile Kazimer shares highlights from her time at the recent Workers Compensation Research Institute’s 35th Annual Issues and Research Conference. This event provided a valuable venue for industry experts to converge and discuss topics related to this year’s theme: “Breaking Down Barriers to Improved Injured Workers’ Outcomes.”

Major Federal Court Decisions put a Stop to Recent Health Policy Developments

March went out with a bang in the world of health policy, with two major court decisions issued as the month came to a close. Both reverse course on major health policy developments from the last year.

Association Health Plans

On March 28, 2019, Judge John D. Bates of the Federal District Court for the District of Columbia issued a ruling invalidating major provisions of last summer’s final rule on Association Health Plans (AHPs). Attorneys General in 11 states and the District of Columbia filed suit shortly following release of the final rule, which established additional and more flexible criteria under which an association of small employers may be treated as a single employer for the purposes of offering AHPs. Judge Bates agreed with the plaintiffs that major provisions of the new rule exceed statutory authority and undermine Federal law. For more on the ruling and next steps, click here.

Work Requirements Rulings

On March 27, 2019, District Judge James Boasberg issued a ruling on back-to-back cases addressing the issue of work requirement eligibility criteria included in Section 1115 waiver applications submitted by the states of Arkansas and Kentucky. Judge Boasberg again ruled against the implementation of a Medicaid work requirement in Kentucky, while simultaneously ruling that Arkansas must halt the operation of its work requirement program, vacating the CMS approval of the waivers in both states. To read more about the findings in these cases, as well as next steps for Arkansas and Kentucky, click here.

Texas v. United States

PCG Health subject matter experts also continue to follow the Texas v. United States case challenging the validity of the Affordable Care Act (ACA). After the Department of Justice changed its position on the lawsuit—agreeing with plaintiffs and supporting the decision of the District Court that the entire ACA should be invalidated based on the zeroing out of the individual mandate penalty—the Fifth Circuit Court of Appeals agreed to expedite oral arguments, which will happen the week of July 8th. Over the next several months, we will provide updates on major developments in the case.

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CMS Releases the Final 2020 Exchange Guidance

The Centers for Medicare & Medicaid Services (CMS) released the annual Exchange guidance on April 18, 2019, via the final Notice of Benefit and Payment Parameters for 2020, the 2020 Letter to Issuers in the Federally-facilitated Exchanges, and ancillary guidance. While declining to implement many proposed changes for 2020, CMS did include some policy changes, as well as operational and technical guidance for health plan regulation, Exchange operations, and premium stabilization programs for the 2020 plan year. To read PCG’s summary of these notable changes, click here.

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Highlights from The Workers Compensation Research Institute 2019 Annual Issues and Research Conference

PCG’s Nile Kazimer recently attended the 35th annual Workers Compensation Research Institute’s (WCRI’s) Issues and Research Conference, and shares her session highlights with Health Policy News readers this month. The theme of this year’s conference, “Breaking Down Barriers to Improve Injured Workers’ Outcomes,” signified two core ideas that were evident in each session: first, that workers’ compensation can no longer operate in a silo, and second, the importance of treating injured workers not just as patients and claimants, but as participants in the workforce as a whole—and thus, an important indicator of the nation’s economic health.

Highlighted topics include: opioids; return to work programs; telemedicine; the impact of health insurance deductibles on workers compensation claims; nationwide trends in workers compensation; the question of whether workplace benefits are in decline; and policies impacting the U.S. and global workforce.

To read these highlights in full, click here.

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