Dishing from the 32nd National Academy of State Health Policy Annual Conference (#NASHPCONF19)

The Health Policy News team continued our summer conference travels and spent time in Chicago from August 21st-23rd at the 32nd Annual #NASHPCONF19. While we heard from many of our clients and listened to them speak about projects with which we are presently assisting, we also met many newcomers who were attending for the first time – in particular, many newly elected officials from states across the country. The theme for this year’s conference was “The Deep Dish on State Health Policy,” with recurring topics like prescription drug pricing reform and surprise billing. The agenda included a few interesting new items like hospital consolidation, market stabilization efforts, mental health parity and public option programs. We have provided a brief summary on these new topics below.

Market Stabilization & Reinsurance Programs

One of the breakout sessions at #NASHPCONF19 focused on state activity to promote market stability. The panel featured representatives working on reinsurance programs in Colorado and Montana and distinguished them from the failed attempt to enact reinsurance in Washington, which stalled due to an inability to secure a state funding source. The Colorado Commissioner of Insurance pointed out that the percentage of residents receiving premium subsidies in the state and silver-loading impact the amount of pass-through funding available to the state. The Governor’s policy advisor in Montana noted the importance of the state’s unique structure of establishing the reinsurance program as a non-profit organization rather than running it through a state agency.

The panelists also explored the featured states’ activity to advance a public option, outlining the plan moving forward in Washington and the options being considered in Colorado. The CEO of the Exchange in Washington noted the importance of running the public option through a state entity that has experience negotiating with providers (in Washington, the entity responsible is the Washington State Health Care Authority) and the role of reference pricing. She also noted that standardized plans provide a good foundation for the public option and noted the importance of offering the plans through the Marketplace so they are accessible and subsidy eligible. Finally, the Governor’s policy advisor in Montana outlined the use of reference-based pricing in the state’s employee benefit plan.

Hospital Consolidation

A lower profile—but equally important—topic addressed at the conference was hospital consolidation. Ninety percent of hospital markets are already highly concentrated, yet consolidation continues at a rapid rate. Panelists outlined the features and concerns related to specific types of hospital consolidation (horizontal, vertical and cross-market) and outlined options for states seeking to constrain mergers that raise red flags. Speakers encouraged states to consider legislation allowing states to review and regulate mergers and / or to improve transparency related to mergers, in addition to retroactive litigation tools. Speakers from UC Hastings College of the Law and  the Idaho Attorney General’s Office highlighted two high profile lawsuits – California v. Sutter and Federal Trade Commission v. St. Luke’s Health System. The value of increasing transparency in mergers was also discussed, with the Executive Director of the Massachusetts Health Policy Commission highlighting the impact of Massachusetts’ Material Change Notice requirement.

Mental Health Parity Review

#NASHPCONF19 allowed state Medicaid staff, thought leaders, and members of the commercial insurance community to put their collective heads together during a workshop on mental health parity. In many instances, the compliance standards and review for mental health parity are ever-changing and state-specific, but attendees welcomed the opportunity to learn about how other state insurance and Medicaid departments are structuring their programs. Staff from Washington, Pennsylvania and Oregon were on hand to provide lessons learned from both the commercial and public program parity review perspective. The workshop imparted a few interesting takeaways to consider when implementing or doing ongoing parity review, including:

  • The more a state can prescribe the standards for review (in particular, the data requested), the easier it makes the review for the state.
  • It is important to ensure that carriers are conducting their own review of provider credentialing and utilizing the same evidentiary standards (for both MH/SUD and Med/Surg), particularly if an EHO is utilized.
  • Review the utilization control strategies in place and the standards applied for review of the strategies (for example, is a carrier asking MDs to review the medical/surg utilization control decisions but using a non-BH RN for MH/SUD?).

Health Policy News published a fact sheet earlier this month demonstrating PCG’s efforts in helping states ensure compliance with regulations set forth to ensure equal access to, and coverage of, mental health and substance abuse treatment services.

Public Option Prescription Drug Plan

In a session focused on new approaches to prescription drug cost containment, a presenter from Georgia State University of Law work-shopped the idea of a public option prescription drug (RX) plan that could utilize an existing state employee drug plan. This interesting concept would leverage state purchasing power, streamline the administrative burden of drug purchasing, increase the number of covered lives, and extend the per-person drug discount percentage to a larger pool of purchasers. The option to utilize the state employee drug plan could be extended to populations such as self-funded plans, employer sponsored plans, and country/municipal employees.

The presenter did note that this structure could potentially threaten ERISA plan exemptions and potentially create a MEWA.  A state could create a separate stand-alone drug plan that would ensure clear legal distinctions with the buy-in open to non-state employees. The integration of a public option RX program would be well-timed to occur during pharmacy benefit management (PBM) renegotiation—and, if possible, the roll-out of state PBM regulations.


As always, if you have questions or would like more information about any policy items we have discussed in brief in this article, please feel free to contact us directly at

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