Health Policy News – February 2021

In the month since the presidential inauguration, the Biden administration has been busy putting its mark on U.S. health policy. A new Marketplace Open Enrollment Period has begun, and the administration has promulgated guidance and executive orders, weighed in on pending legislation, and begun revisiting regulations and waivers approved by the prior administration.

Additionally, the nation is currently watching to see what the newest COVID-19 relief legislation will contain. Final legislation is expected to include funding for vaccines, testing, contact tracing, and providers, as well as unemployment and nutrition assistance, stimulus checks and tax credits, small business and housing aid, and educational funding. Also on the table are broader health policy provisions, such as a temporary extension and expansion of Marketplace advance premium tax credits (APTCs); eliminating APTC reconciliation; and boosting the federal match rate for Medicaid expansion.

Health Policy News continues to monitor action on that legislation. In the interim, this month’s coverage of COVID-19-related health policy activity focuses on the work states should be doing now to plan for the eventual end of the public health emergency (PHE).

We revisit the topic of prescription drug cost control efforts this month, focusing specifically on efforts underway in Massachusetts. While we have previously tracked the overall picture of state and federal drug pricing legislation, this month’s piece marks the first in a planned series of state-focused spotlights that will appear in the next few editions of Health Policy News.

This edition also includes a piece by HPN’s quality improvement subject matter expert, Aaron Holman—containing lessons learned and insights on how to best design a value-based payment program for both public and private payers.

Finally, we share an update on the Marketplace timelines for 2022 Qualified Health Plans (QHPs) finalized by the Biden administration.

States Should Start Planning Now for Adapting Their Medicaid Programs Post-COVID-19

While the COVID-19 PHE is expected to last through 2021, the Centers for Medicare and Medicaid Services (CMS) released a State Health Official Letter (SHO Letter) in December encouraging states to start planning now for the changes and activities they will need to implement as the PHE ends. CMS has provided flexibility and increased funding relative to state Medicaid and other public programs; states have also had to function within temporary maintenance of effort requirements. The SHO Letter provides guidance to states on planning for a return to regular operations of Medicaid, Children’s Health Insurance Program and Basic Health Plan following the end of the PHE, with a focus on steps states should start taking now to address eligibility backlogs.

Click here to read more about actions states should start taking now, considerations for approaching CMS requirements, and funding that may be available to assist in these efforts.

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Prescription Drug Pricing Reform Efforts Continue

This month, we feature the first in a planned series of updates on state-specific prescription drug cost control measures: the ongoing efforts through legislative action and budget proposal legislation in Massachusetts. Stay tuned to Health Policy News throughout 2021 for installments in this series—our next edition will include a spotlight piece on activity underway in California!

Click here to read more about the drug pricing negotiation approach MassHealth is currently utilizing, as well as proposed prescription drug pricing reforms under debate in the Commonwealth.

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Migrating Incentives from Measurement to Learning

Over the past three decades, an overreliance on quality measures as a material driving factor in value-based payment (VBP) arrangements has established an adverse trade-off within delivery systems. Whether applied to large integrated delivery systems or among primary care practices, quality measure- based VBP designs continue to limit the ability of providers and groups to explore novel ways of improving patient care through systematic quality improvement efforts.

To learn more about how to design VBP programs for public and private payers that do not put quality metrics at the center of incentive designs, click here.

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Update regarding Marketplace Guidance

Our January edition outlined the latest on Marketplace guidance for 2022 Qualified Health Plans (QHPs). Since then, the new administration finalized timelines for certification and rate filings of 2022 QHPs, making few changes to the proposed timelines. Click here to read our coverage from January, which has been updated with links to the final timelines.

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