Week in Washington

Week in Washington is brought to you by Michael Cohen, PhD. Tune in each week to read the latest on healthcare policy and get a glimpse of what’s on the horizon.


July 19, 2018   Week in Washington: HHS Regs are Coming


Federal regulations have a standard path. They usually have a torturous path of sign offs with a governmental agency. Before they are released to the public their last stop is the Office of Management and Budget (OMB). The public is notified that a regulation is potentially imminent when OMB announces that it is reviewing a particular regulation. Three regulations reached OMB this week that could have major implications. All of the rules were deemed economically significant (i.e., they have an impact in excess of $100 million dollars). There are no details about what the rules include.

  1. Risk Adjustment Interim Final Rule (IFR)

One potential solution to the halting of risk adjustment payments and charges due to a recent ruling, was the release of an IFR that could better justify the risk adjustment methodology. It is unclear if the rule is aimed at trying to address the judge’s concerns or attempts to do something more drastic.

  1. Final rule on short term duration plans

Earlier this year the administration proposed relaxing the restrictions on short term duration plans (non-ACA compliant plans). You can read Wakely’s analysis on the topic here.

  1. A rule on “Removal Of Safe Harbor Protection for Rebates to Plans or PBMs Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection”

As part of HHS’ blueprint, this administration has discussed changing the safe harbor on rebates. Again unclear what the rule includes.  

As always we’ll provide an update on these regulations after they are released.  You can view all of the regulations currently under review at OMB here.

Additional news items

  • Commonwealth Fund released an outstanding map of what states are up to in regards to actions affecting the individual market (these include mandates, reinsurance, restrictions on short term duration plans, etc.). You can access it here.
  • Politico reported that CMS was working on addressing the judge’s concerns about work requirements in regards to Kentucky’s Medicaid waiver. 
  • Illinois became the first state to address the opioid crisis through proposed changes to the EHB benchmark plan. If approved by CMS, the new benchmark would go into effect for the 2020 benefit year.
  • Research of the day at Health Affairs found that primary physician participation increased following Medicaid expansion. However, Medicaid patients remained concentrated among a few physicians. 



Previous editions:


06/22/2018:  AHP Regulations, Budgets, and More  

06/15/2018:  Risk Corridor Lawsuits and More Lawsuits

06/06/2018:  Medicare Trustees Report

05/31/2018:  Mandates and Medical Expansion

05/24/2018:  CBO Releases New Scores






05/17/2018:  More Prescription Drug News

05/10/2018:  Prescription Drug News

05/03/2018:  News & Notes

04/26/2018:  Encounter Data is Coming!

04/19/2018:   Medicaid Expansion and Lawsuits

04/13/2018:   Regulations! Get your Regulations!




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