Week in Washington 04/03/2024

CMS regulations and releases

Final Notice/Rate Notice

CMS finalized the 2025 Rate Announcement for MA and Part plans. CMS also finalized the structure of the Part D drug benefit for 2025 that resulted from the Inflation Reduction Act. The rule can be found here. MA payments will increase by 3.7%. Insurers lobbied the federal government for a higher increase given larger than expected 2023 fourth quarter expenditures. Wakely will be releasing a summary of rule in the near future.

ACA Final Payment Notice

CMS released the final 2025 Payment Notice rule. Generally, things were finalized as proposed. You can read the proposed rule summary here. Healthcare.gov user fees were lowered. HHS proposed to keep user fees at 2.2% for issuers in the Federally-facilitated Exchange (FFE) and 1.8% for issuers in state-based Marketplaces operated by HHS (SBE-FPs) but FINALIZED an FFE user fee rate of 1.5% of total monthly premiums and an SBE-FP user fee rate of 1.2% of total monthly premiums. Similarly, 2025 risk adjustment user fees were lowered. The proposed rule had a $0.20 PMPM for RA user fees. The final rule has a RA fee rate of $0.18 PMPM. Note the reason for both is CMS is increasing is estimate of 2025 enrollment relative to what they initially projected.

Medicaid SEP

CMS extended a temporary special enrollment period (SEP) for people who lose Medicaid or CHIP coverage until November 30, 2024. Previously this SEP ended July 31, 2024.  Medicaid disenrollment has had a significant impact.

Short-Term Plans

The Biden Administration finalized rules surrounding limits on short-term limited duration plans. The final rule rolls back relaxations enacted during the prior administration and limits short-term limited duration plan coverage to 12 months. The rule goes into effect on or after September 1, 2024 (i.e., STLDI sold or issued before Sept 1, a consumer could have renewed for up to 36 months). Consequently, most of the effects of the rule are not expected until 2026.

CMMI Update

CMMI released an update on its progress towards its strategic objectives. In their Health Affairs post CMMI leadership discuss their key initiatives

Why all the activity

Given the litany of released, a question may be asked as to why. The Congressional Review Act allows Congress to overturn certain federal actions.  In particular rules finalized after May 22, 2024, could be subject to the CRA. Consequently, there is incentive for the current Administration to finalize rules this month to avoid the potential for their rules to be overturned. 

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