Payment Notice- The annual Notice of Benefit and Payment Parameters was released last week. Wakely will be providing a full write-up in the near future, but as a quick teaser the main theme this year was flexibility. CMS made proposals that would allow states greater flexibility and greater control over things like the MLR ratio, rate review, QHP certification, risk adjustment transfers, and eligible EHB benchmarks.
Open Enrollment - The Payment Notice release came right before the start of Open Enrollment, which started on November 1st. S&P’s expectation is that overall enrollment will decrease from 12.2 million to between 10.6 and 11.4 million.
1115 Waivers – CMS released a letter to Medicaid directors encouraging them to submit waivers to help combat the opioid epidemic. In general, CMS has been encouraging 1115 waivers.
Tax Reform – The Republican tax reform plan was released on Thursday. Generally, health issues were not included in the bill. Despite lobbying by some Republicans, a change to the individual mandate was not included in the bill. The bill is expected to be on a fast track for a vote in the House, potentially as soon as in two weeks.
Drug Suit- the American Hospital Association and several other hospital associations filed a suit against CMSafter CMS announced it would be cutting the 340B drug payments by $1.6 billion. The cuts specifically hurt safety-net hospitals.