Category: Private Insurance

Health Policy News – March 2020 Special Edition

  Introduction Health Policy News had planned content for the month of March, but given the unprecedented times we are all living through, we thought it best to dedicate this month’s entire edition to recent federal and state efforts to support consumers, providers, and health insurance carriers in combating COVID-19. Just in the past week, ...

Health Policy Responses to COVID-19

In this unprecedented time, much attention has been paid to Congressional response to the clinical and economic needs resulting from the COVID-19 pandemic. At the same time, Congress, the Centers for Medicare and Medicaid Services (CMS) and other federal agencies have actively put forth legislation and guidance aimed at providing greater flexibility to states and ...

Comments on 2021 Proposed Payment Notice and Draft Letter to Issuers in the FFM Due March 2nd

On January 31, 2020, the Centers for Medicare and Medicaid Services (CMS) released the proposed Notice of Benefit and Payment Parameters (NBPP) and the draft Letter to Issuers in the Federally-facilitated Exchanges (hereafter “the Letter”)[1] as well as accompanying guidance and timelines.[2] CMS is accepting comments on these items through 5pm on March 2, 2020. ...

Public Comment Period on Draft Transparency in Coverage Rule Extended Until January 29th

The draft Transparency in Coverage rule was developed by the Departments of Treasury, Labor and Health and Human Services (hereinafter “the Departments’) and published on November 27, 2019.  This rule was developed in response to the President’s Executive Order on Improving Price and Quality Transparency. The proposed rule applies to group plans and health insurance ...

Bipartisan Federal Surprise Billing Legislation Likely to Pass

Although it has been discussed and debated at the federal level for years, viable bi-partisan surprise billing legislation had not been proposed until recently, in the form of the No Surprises Act (“the Act”). It seems likely that the current federal legislation will pass soon, which would be a first step towards a nationwide approach ...

Department of Transportation to Establish Committee to Study Air Ambulance Billing Practices

Concern about out-of-pocket costs associated with air ambulance transport has been growing for some time. Groups such as the National Association of Insurance Commissioners (NAIC) have advocated for state flexibility to regulate the billing practices of the industry. A small but meaningful step forward came last fall with the passage of a legislative requirement that ...

Federal Departments Finalize Rule to Expand Access to Short Term Health Plans that are not ACA-Compliant

On August 1, 2018, the Department of the Treasury, the Department of Labor, and the Department of Health and Human Services (together, “the Departments”) jointly promulgated a final rule on Short-Term Limited-Duration Insurance (“final rule”). The final rule further amends the proposed rule released in February and seeks to carry out the directions given in ...

CBO estimates that AHCA would severely increase the number of uninsured persons

On May 24, 2017, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released estimates on the impact of the proposed H.R. 1628, the American Health Care Act of 2017 (AHCA), as passed by the U.S. House of Representatives on May 4, 2017.  AHCA would partly repeal the Affordable Care Act (ACA). ...

PCG creates summary of the House-passed health care bill

The American Health Care Act (“the bill”) passed the House of Representatives on May 4, 2017. As outlined in greater detail in the PCG summary, the bill does not repeal the Affordable Care Act (ACA) in full, but rather proposes changes primarily focused on the ACA’s insurance affordability, Medicaid expansion, coverage requirements and revenue provisions. ...

Transitional health plans to continue through 2018

In November of 2013, the Centers for Medicare & Medicaid Services (CMS) introduced the concept of “grandmothered plans,” coverage in place prior to 2014 that would have been prohibited as of 2014 as a result of changes under the Affordable Care Act (ACA). CMS issued guidance permitting those plans to be renewed for existing policyholders ...