Week In Washington: ACA Payment Notice Released

January 17, 2019

In the first full week of the year, healthcare policy news was fairly overwhelming. Here’s a quick run-down of things developing across the country…

Payment Notice Released – The annual ACA Notice of Benefit Payment Parameters (Payment Notice) was released yesterday. Wakely will release an in-depth summary of the Payment Notice shortly but for a now a few short highlights:

  • Ending Silver-Loading? HHS raised the potential for ending silver loading as soon as 2021. Silver-loading has had a significantly positive impact on enrollment.
  • Ending Auto-Enrollment? HHS raised the potential for ending auto-enrollment in the FFM as soon as 2021. Approximately 20% of FFM enrollees are auto-enrolled.
  • Changes to Indexing (premium adjustment percentage) – HHS proposed changing a key indexing provision that if enacted would increase net premiums for subsidized enrollees, increase the maximum out of pocket by a larger amount than expected, increase employer shared responsibility payment, and increase the health insurance provider fee.
  • Abortion - Require QHP issuers that provide coverage of non-Hyde abortions to offer at least one “mirror QHP” that omits coverage with non-Hyde abortions services, to the extent permissible under state law.
  • User Fees – Reduction in FFE user fees to 3.0 and for SBE-FPs down to 2.5%

New Value Based Insurance Design Model (VBID). CMS announced a broad array of MA plan innovations for CY 2020. THE VBID interventions would include CBID by condition, socioeconomic status or both, MA and rewards and incentives programs, increased access to telehealth, and coordinated approaches to wellness and health care planning. Additionally, beginning in 2021, VBID will also test the Medicare hospice benefit in Medicare Advantage. You can read more here. The Administration has focused on increasing the number of innovation models so expect more information and more innovation models out of CMMI in the coming year.

Shutdown Update: As the longest shutdown in US history continues, a few additional things could be affected that you may not realize. First, food stamps will technically run out in the not so distant future. Additionally, the Federal judiciary may also slow down as attorneys will need to work without pay. Finally, there are some concerns about overall economic slowdown.

Research You Can Use: An article in JAMA discusses the potential effects of the recent proposed changes to Medicare Part B drug pricing.

Interesting Research: While not directly related to pricing Medicare or Commercial plans, ESPN reported that insurers are no longer covering general liability for head trauma for NFL players. The lack of insurance is becoming a threat to the league according the report.