Health Policy News – January 2020


Happy 2020 Health Policy News readers! We hope you all had an enjoyable and relaxing holiday season. As we continue to await the proposed Marketplace guidance for 2021, we wanted to take this opportunity to share recent health policy developments from the federal and state levels.

In breaking news, our first article includes our initial take on the federal Medicaid block grant guidance released just yesterday. While HPN subject matter experts continue to review the guidance in detail, we share an initial synopsis and resources for states. We encourage you to keep an eye on the blog next week for more to come from HPN.

Also from the federal level this month, we include an article flagging for readers that the comment period for the proposed Transparency in Coverage rule was extended until January 29th. In this piece,  we highlight some of the state efforts underway to increase consumer transparency into health care costs.

Our third article focuses on a recent development at the state level in California. We share an update on California’s efforts to control prescription drug spending in the state with an innovative proposal to get the state engaged in pharmaceutical sales.

Our final article draws readers’ attention to one of the CMS Section 1332 State Relief and Empowerment Waiver concepts that has garnered less attention from states but holds great promise-the State Complex Care Plan model. Many states across the nation are pursuing 1332 waivers, with many focused on a reinsurance program to stabilize markets but we wanted to also outline the State Complex Care Plan model for risk stabilization as an option for states.

As always, we are watching closely for the release of Marketplace guidance and we expect to share our analysis in the next edition of Health Policy News.

UPDATED: Centers for Medicare and Medicaid Services releases Long-Awaited Block Grant Guidance

From the federal level, comes the breaking news of Centers for Medicare and Medicaid Services’ release of its long-awaited guidance promoting block grants—being referred to as the Healthy Adult Opportunity—on January 30, 2020. HPN subject matter experts have since prepared a fact sheet containing a detailed overview and analysis of the guidance. To view it, as well as other materials that you may find helpful as you consider the implications for your state, click here.

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Public Comment Period on draft Transparency in Coverage rule extended until January 29th.

The proposed Transparency in Coverage rule developed by the Departments of Treasury, Labor and Health and Human Services was published on November 27, 2019. The proposed rule applies to group plans and health insurance issuers in the individual and small group markets.

The draft rule’s public comment period was extended by 15 calendar days due to the holiday season until January 29th. To read more about the proposed rules and efforts underway in other states to increase consumer transparency, click here.

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California’s Innovative Approach to Address Rising Pharmaceutical Costs

Addressing rising prescription drug costs has been a top priority for California Governor Gavin Newsom’s administration and the governor’s efforts continued into 2020 with an announcement as part of his budget proposal that he will seek to have the state to sell its own generic prescription drugs. Governor Newsom hopes that by doing so, the state can increase competition in the generic market and drive down prices. For more information about how this would work in California and similar initiatives, click here.

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Chronic Care Alternative for Marketplace Enrollees: State Complex Care Plan

Over the past four years, thirteen states have received approval to implement State Innovation Waivers (renamed “State Relief and Empowerment Waivers” by CMS in October 2018) under the authority of Section 1332 of the Affordable Care Act. Twelve of those states (all except Hawaii) leveraged Section 1332 to implement reinsurance programs aimed at reducing premiums. However, the “risk stabilization” waiver concept shared by the Centers for Medicare and Medicaid Services (CMS) in November 29, 2018 has a broader focus. This article takes a closer look at a program model shared by CMS, referred to as a State Complex Care Plan (SCCP). CMS described SCCP as taking risk stabilization a step further than reinsurance by attempting to reduce the total cost of the enrollee’s care, not just financing the cost of care differently. To read more about this model, click here.

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