Health Policy News – January 2019

 Introduction As readers are likely aware, the Centers for Medicare and Medicaid Services’ (CMS) long-awaited annual Exchange guidance was released on January 17, 2019, and, as in past years, PCG subject matter experts have prepared a summary of notable changes to assist states in parsing through this voluminous guidance. In addition to the summary, PCG ...

CMS Releases Its Long-Awaited Exchange Guidance for 2020

The Centers for Medicare & Medicaid Services (CMS) released first drafts of its long-awaited annual Exchange guidance on January 17, 2019 – the Proposed Notice of Benefit and Payment Parameters for 2020 (NBPP) and the 2020 Draft Letter to Issuers in the Federally-facilitated Exchanges (Letter) as well as ancillary guidance (the draft Actuarial Calculator and ...

A Reminder from PCG’s Cost Allocation Team to Reference the Correct Federal Guidance in Cost Allocation Plans and Indirect Cost Rates

December marked five years since the Federal Office of Management and Budget (OMB) consolidated eight prior OMB Circulars into a single source of federal guidance, and four years since that guidance went into effect. Yet, despite all the years, our Cost Allocation team still sees federal, state, and other agencies referencing the former OMB Circulars—such ...

Update on Medicaid Buy-In Efforts: Public Impressions and Specific Approaches to Medicaid Buy-in Programs

Many states considering a Medicaid buy-in public option have expressed the hope that it will provide an affordable coverage option for individuals, noting that insurance remains highly costly even for those individuals receiving Federal premium subsidies or employer contributions. States across the country have or will be exploring the feasibility and options available to them ...

Health Policy News December Edition

Introduction As in years past, the primary focus of the December edition is highlighting some of the important topics we wrote about in 2018, while also foreshadowing policy trends that we believe will be of particular importance to states in 2019. Before many of you take a break to spend time with family and friends, ...

A Look at Two States’ Responses to the Association Health Plan Final Rule

Implementation of the new Federal Association Health Plan (AHP) Rule—and new options for associations seeking to offer health insurance coverage—is well underway. The new rule became effective for all fully-insured AHPs seeking to operate under the new rule in September, and will go into effect for existing self-insured AHPs seeking to operate under the new ...

Two Insurance Markets, Similar Stories to Tell

Massachusetts and New Hampshire held public meetings this past fall aimed at providing insights into the factors affecting health care costs in their respective states. The Massachusetts Health Policy Commission (HPC) held its sixth annual Cost Trend Hearing on October 16th and 17th. The New Hampshire Health Insurance Department (NHID) held its annual hearing at ...

A Preliminary Decision in the Newest Lawsuit Challenging the Affordable Care Act

On December 14th, a decision was published in the Texas v. U.S. case that challenged the validity of the Affordable Care Act (ACA). The case – which was brought by 20 states (“plaintiff states”) and later joined by two individual plaintiffs – contends that the “zeroing out” of the shared responsibility penalty through the 2017 ...

2018 Retrospective & Looking Forward to 2019

This past year brought increased flexibility for states related to both public health care programs and commercial health plans, with the Federal administration announcing numerous policies to give states more control over the design / regulation of the coverage offered to consumers. We saw first-of-their-kind waivers approved at the Federal level, including community engagement / ...

Early Lessons Learned from Implementing Community Engagement Requirements

Sixteen states have submitted Section 1115 Waivers to the Center for Medicare and Medicaid Services (CMS), requesting that a person’s eligibility to receive Medicaid be contingent on their participation in community engagement activities (also referred to as “work requirements”). States have flexibility to define the activities that would meet community engagement or work requirements, and ...

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