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.
Week in Washington
This week saw the first documented case of COVID reinfection. While not surprising to epidemiologists, it does raise an important point about immunity. Generally, there are four types of immunity: 1) sterilizing (you can’t get it again), 2) functional immunity (you can get the disease again, but it’s likely that reinfections are far milder), 3) waning immunity (you can get it again and the severity of the reinfection increases over time), and 4) lost immunity (over time all immunity is lost). Ultimately the question as to if COVID will remain present in the US as a significant health concern will be influenced by what kind of immunity individuals will have to COVID
In a potentially monumental decision, the FDA approved Abbott’s rapid antigen test. The test would cost $5, produce results in 15 minutes, and not require lab equipment. Abbott announced this is on track to produce 50 million tests a month, starting in October (as context the US tested 22 million people last month).
New CMS Regulation
- ACA (individual/small group) 2020 Risk Adjustment and MLR
- Issuers that provide temporary premium reductions should make those adjustments in their risk adjustment and MLR reporting.
- Medicare Advantage.
- CMS decided to temporarily suspend the 60% rule in their Extreme and Uncontrollable Circumstances (EUC) policy but keep the 25% rule in place.
- For STARS RATINGs this means:
- 2020 measurement year (MY) data will be used to determine the 2022 Star Rating cut-points on all non-CAHPS measures
- For all non-CAHPS measures, contracts will receive the higher of their measure-level ratings from 2021 (2019 MY) or 2022 (2020 MY)
- As you may recall, CMS canceled the collection of 2019 MY HEDIS data and planned to use 2018 MY for a second year. This means that plans will get the better of their 2018 MY or 2020 MY Star Ratings on the HEDIS measures only.
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08/06/2020: Week in Washington
07/30/2020: Week in Washington