RISE summarizes recent regulatory-related headlines.
ACA ENROLLMENT BREAKS NEW RECORD WITH DAYS STILL LEFT TO APPLY FOR COVERAGE
More than 20 million people have selected an Affordable Care Act (ACA) Health Insurance Marketplace plan since the launch of the 2024 Marketplace Open Enrollment Period— a record number of enrollments, according to the U.S. Department of Health and Human Services (HHS).
The open enrollment period launched November 1, 2023, and extends through January 16 for states using the HealthCare.gov plan.
HHS said that 3.7 million people are new to the Marketplaces for 2024, and 16.6 million people had active 2023 coverage and either selected a plan for 2024 coverage or were automatically re-enrolled. Plan selections so far represent an increase of over eight million more people who have coverage since President Biden took office. A new KFF analysis cites Medicaid unwinding, enhanced Marketplace subsidies that make coverage more affordable, and increased marketing, outreach, and enrollment assistance as playing a role in this growth .
“Today is a momentous day. A record number of people in the United States have health care coverage through the Affordable Care Act’s Marketplace—more than at any point in history. More people with access to preventive care means a healthier country and lower health care costs across the board,” said HHS Secretary Xavier Becerra in the Wednesday announcement.
ELEVANCE HEALTH SUES FEDS OVER MA STAR RATINGS TECHNICAL CHANGES
Elevance Health and its state-based subsidiaries have filed a lawsuit against HHS and the Centers for Medicare & Medicaid Services (CMS) claiming methodology changes to Medicare Advantage Star ratings were arbitrary and capricious and caused the ratings to drop significantly across the industry. Modern Healthcare reports that Elevance Health had one of the largest rating declines among insurers and estimated it would lose $500 million in revenue in 2024 as a result. The lawsuit argues the drop in ratings is due in part to CMS’ introduction of the Tukey outlier deletion beginning with the 2024 Star ratings. CMS announced the calculation change in its 2020 final rule, but in a May 2022 final rule CMS removed the outlier deletion from the regular text due. CMS later indicated the removal was a codification error that it intended to fix. Tukey is a statistical method that removes outliers when calculating Star measure cutpoints that CMS said would improve predictability and stability in Star ratings. But the insurer said CMS failed to follow regulations that require it apply guardrails that prohibit it from changing any cut point by more than five percentage points from year to year. Instead of ensuring stability and predictability of cutpoints, CMS achieved the opposite result, the lawsuit states.
65 ORGANIZATIONS URGE CMS TO MAINTAIN STABILITY IN MEDICARE ADVANTAGE PROGRAM
In a letter to CMS, Better Medicare Alliance and 65 health care organizations urged the agency to institute policies that promote stability and support a strong, sustainable Medicare Advantage (MA) program for more than 31 million seniors and people with disabilities who rely on it. The letter comes as CMS prepares for the 2025 Medicare Advantage rate and policy setting process and continues to implement policy changes to the MA program. “As programmatic changes are implemented, as well as continued implementation of significant changes finalized in the CY 2024 Rate Announcement, we want to emphasize the need for stability and further understanding the impact recent changes have on beneficiaries to ensure successful implementation and minimal disruption to beneficiaries in receiving care,” the organizations wrote.
FEDS ISSUE NEW NONDISCRIMINATION FINAL RULE TO PROTECT CONSCIENCE RIGHTS
The HHS Office for Civil Rights this week issued a final rule that partially rescinds a 2019 rule under the Trump administration that gave broader rights to medical workers to refuse to perform services, such as abortions, if they conflicted with their religious or moral beliefs. The latest final rule takes effect March 11 and clarifies the process for enforcing federal conscience laws and strengthens protections against conscience and religious discrimination.
“Today’s rule is another promise delivered by President Biden, working to strengthen conscience protections and advance health care, free from discrimination,” said Secretary Xavier Becerra in the announcement. “The Final Rule clarifies protections for people with religious or moral objections while also ensuring access to care for all in keeping with the law.”