Health Policy News – Summer 2021

As in past years, the Health Policy News team is releasing one Summer Edition that includes both special content dedicated to timely topics, such as the American Rescue Plan, as well as federal and state-level health policy and regulatory updates from June and July.

We hope our readers enjoy the remainder of the summer and look forward to the exciting line-up of content we have planned for the fall. In particular, be on the lookout for the special edition release of our annual policy white paper, which will discuss federal health policy changes under the Biden administration, as well as an accompanying policy discussion webinar series.

As always, Health Policy News will provide timely updates and analysis on applicable health policy developments as they occur, but you can contact us at with any questions or comments related to this summer edition.

ARP Includes Significant Funding Opportunity for States to Invest in HCBS

In a special two-part piece dedicated to the American Rescue Plan (ARP), specifically Section 9817 funding for home and community-based services (HCBS) programs, our PCG subject matter experts assembled a guide outlining the options for states to reinvest the ARP’s additional HCBS FMAP funding. Additionally, we provide examples of how states are engaging with their the HCBS community while simultaneously working with the Centers for Medicare and Medicaid Services (CMS) on spending plans in order to meet the deadlines for access to the enhanced FMAP.

PCG Subject Matter Experts Outline Opportunities for States

By PCG Health Management Team

In order to assist states in the creation of spending plans, subject matter experts at PCG compiled a guide entitled “How can your state reinvest the ARP’s 10 percent enhancement to FMAP?”. In it, they present options for states to maximize the impact of the one-year 10% increase to the share of Medicaid spending for HCBS and certain behavioral health services as outlined in Section 9817 of the ARP.

To read the full insight from our team and access the guide, click here.

State Spending Plan Approaches 

By Margot Thistle

In May 2021, CMS released a letter to all state Medicaid Directors outlining the guidance for implementing section 9817 of the ARP, including reporting and spending plan requirements. CMS is requiring states seeking funds to submit both initial and quarterly HCBS spending plans detailing how the state will supplement existing spending and programming. In order to ensure the most impact of the funds, some states, like Massachusetts, have broken out the funding initiatives into “rounds.”

To read more about how states are balancing the reporting timeline with ensuring sustainable and equitable distribution of funds, click here.

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Summer 2021 COVID-19 Updates

The summer months have seen a downturn in the spread of COVID-19 throughout the United States, with 56.1% of the total population having received at least one dose of a COVID-19 vaccine and 48.6% fully vaccinated. However, the recent spike in cases due to the Delta variant has brought the virus back into the forefront of restrictions and policy creation. To read about recent policy and legislative developments from June and July related to the COVID-19 pandemic, click here.

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Post-Pandemic Telehealth Utilization

The last year saw a significant increase in the use of alternative health care delivery methods due to the COVID-19 pandemic, resulting in a surge of telehealth utilization. During the public health emergency, many telehealth regulations were removed, or additional flexibilities granted, through the use of federal waivers and federal action—but many were time limited, meaning they have either already expired, or will soon. This provides an opportunity for federal- and state-level action to expand these telehealth flexibilities more permanently.

To read more about recent action at the federal and state level to continue expanded access to telehealth post-public health emergency, click here.

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Following the Supreme Court Decision upholding the Affordable Care Act, the Department of Health and Human Services issues Proposed Regulations on the Exchange and the No Surprises Act

As expected and previewed in Part 2 of the final Notice of Benefit and Payment Parameter for 2022, the Biden Administration issued its first independent Exchange rule on June 28, 2021. This proposed rule came on the heels of the much-awaited Supreme Court decision in California v. Texas, which upheld the Affordable Care Act. In the rule, CMS has proposed broader changes to the Exchange standards than it was able to enact in the process of finalizing the NBPP, representing a reset similar to President Trump’s issuance the Market Stabilization Rule after entering office. Comments on the proposed rule are due on July 28, 2021.

Shortly after the Exchange rule, the Departments of Health and Human Services, Labor and Treasury and the Office of Personnel Management issued an interim final rule to implement portions of the No Surprises Act (NSA) (which protects individuals against surprise medical bills for emergency services and air ambulance services, as well as certain non-emergency services provided by out-of-network providers at in-network facilities). The NSA Rule will go into effect on January 1, 2022 and comments may be submitted through September 7, 2021.

To read more about both rules, click here.

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