Week In Washington: New Inoperability Rules

February 14, 2019

New Proposed Rules on Inoperability

CMS released a major proposed rule by CMS and ONC (Office of the National Coordinator). The rule would require payers and providers to make more electronic data to patients. In particular, the rule requires that Medicaid, the Children's Health Insurance Program, Medicare Advantage plans and Qualified Health Plans in the federally facilitated exchanges must provide enrollees with immediate electronic access to medical claims and other health information electronically by 2020. CMS estimates this could affect upwards of 125 million individuals. You can read about it here and here.

Fed Watch

  • Democrats, in both the House and Senate, have been introducing a steady stream of new bills aimed at expanding coverage. Some of the bills have some chance of being enacted (those focused on prescription drugs or balanced billing) and some are more aspirational (i.e., kinds of bills Democrats would pass if they controlled all Congress and the Presidency).
  • On the aspirational bills side:
    • Some Democratic Senators and Congressmen introduced 8 separate bills that are aimed at increasing coverage. They propose to do so through a myriad of ways including lowering the Medicare eligibility age to 55, requiring a public option on the Exchange, allowing anyone to purchase Medicaid. Again these are bills that will not be passed into law but will dominate the Democratic Party policy ideas for the next few years.
    • In a similar aspirational category: several bills on improving the ACA/stabilizing the individual market were also introduced. The bills focused on undoing some of the regulatory changes the Trump Administration made on short-term duration plans, 1332 waivers, and Exchange outreach and advertising.
  • On the more immediate front: A new bill on prescription drugs that would limit exclusivity periods was introduced by Congressman Golden. You can read it here.

State Watch

  • Utah passed a bill that could have huge ramifications for Medicaid. Last fall, Utah’s voters approved a referendum to enact full Medicaid Expansion. The Republican state legislature passed a bill that over-rode the referendum and will apply for an 1115 waiver that does three things: 1) asks for partial Medicaid expansion only up to 100% FPL (as opposed to the normal 138% FPL limit) 2) includes Work Requirements; and 3) asks for annual spending caps. If the state reaches the spending caps, the state could limit enrollment. Partial expansion, spending caps, and enrollment limits for Medicaid Expansion have never been approved before and are likely subject to lawsuits. If the waiver fails, Utah may still apply for full Medicaid expansion.
  • However, if successful, several other states may immediately follow suit on these ideas. Georgia is poised to pass a bill exploring an 1115 waiver that would also seek partial expansion. Idaho is also considering something similar.

Research You Can Use

  • Wakely released a 2017 RADV whitepaper. RADV potentially will have a large impact on ACA risk adjustment. You can read Wakely’s research here.
  • HCCI released their annual report on health cost and utilization. Individuals with private insurance spending hit $5,641 in 2017. You can read it here.
  • KFF released a database on Medicaid Benefits Coverage. You can check it out here.