Appeals court temporarily blocks ruling that threatens free preventive services under ACA
The Fifth U.S. Circuit Court of Appeals this week temporarily blocked a federal judge’s ruling that struck down a popular provision in the Affordable Care Act (ACA) that requires insurers to provide coverage for preventive care at no-cost to members. The appeals court granted the Biden administration’s request for an administrative stay while the court reviews the case.
The March 30 ruling by U.S. District Judge Reed O’Connor struck down the requirement that insurers cover preventive care services, such as some cancer screenings, a move that could affect 150 million Americans enrolled in private health insurance. Medical organizations, including the American Hospital Association, supported the Justice Department’s appeal, filing a brief arguing that patients are less likely to seek preventive services if they must pay out-of-pocket. ”Cost often drives whether a person will obtain health care. Numerous studies have shown that cost-sharing, even if the amount is relatively modest, deters patients from receiving the preventive services covered by the ACA,” the brief said.
CMS releases quality reporting requirements for MA plans
The Centers for Medicare & Medicaid Services (CMS) this week issued a memo to Medicare Advantage plans that outlines the reporting requirements for quality measures due to the National Committee for Quality Assurance (NCQA) on June 14, 2024. The memorandum also includes information about which contracts are required to participate in the Medicare Health Outcomes Survey (HOS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey administered in 2024, as well as information regarding the timing of HOS and HOS-M survey administration.
Medicare Advantage plans must begin reporting the following four Electronic Clinical Data Systems (ECDS) measures in MY 2023:
- BCS-E - Breast cancer screening
- DSF - Depression screening and follow-up for adolescents and adults
- AIS - Adult immunization status
- SNS-E - Social need screening and intervention
Need to learn more about ECDS reporting? RISE will cover ECDS reporting at the upcoming Qualipalooza 2023 conference, June 20-22 at the Hyatt Regency Miami, as well as the 13th Annual RISE Symposium on Required Quality Reporting Measures, October 15-17, in New Orleans.
Report details how post-Roe abortion bans are harming patients and providers
A report from University of California San Francisco’s Advancing New Standards in Reproductive Health (ANSIRH) shows how, since the Supreme Court struck down Roe v Wade 10 months ago, health care providers have been unable to provide standard medical care in states with abortion bans, leading to delays, denials of care, and worsened health outcomes.
The briefing offers an early look at how patients have been impacted since the fall of Roe through 50 narratives provided anonymously by their providers from September 2022 to March 2023. The report also includes quotes highlighting the types of complications that providers observed.
“The report paints a stark picture of how the fall of Roe is impacting health care in states that restrict abortion,” said Daniel Grossman, M.D., lead report author and director of ANSIRH, said in an announcement. “Banning abortion and tying providers’ hands impacts every aspect of care and will do so for years to come. Pregnant people deserve better than regressive policies that put their health and lives at risk.”
The study documents a wide range of harm occurring among pregnant people in states with abortion bans, including increased morbidity and complications that could result in serious impairment and risk of death. It also underscores the emotional and professional impacts on providers. Health care providers expressed moral distress at being forced to follow medically unsound practices, with one noting that anti-abortion restrictions are “a gross violation of common sense and the oath I took when I got into this profession to soothe my patients’ suffering.” Some felt this distress so acutely that they were considering relocating to a state where abortion remained legal. Others observed how abortion bans increased both the cost of services due to complications and the amount of time needed to care for a patient, leaving them with less time to spend on all their patients.
KFF report: Private insurers to pay $1.1B in rebates this year for setting premiums too high
A new Kaiser Family Foundation (KFF) analysis finds that private insurance companies expect to pay out about $1.1 billion in rebates this fall under the ACA provision that requires insurers to spend the bulk of customers’ premium payments on care. Rebates are based on insurers’ experiences over the previous three years. This year’s estimated total is similar to the $1 billion paid out last year but well short of the $2.5 billion record total paid out in 2020 and $2 billion paid out in 2021.
Insurers in the individual market expect to owe about $500 million to consumers, including those with ACA marketplace plans, while those in the small-group market expect to owe about $330 million, and those in the large group market expect to owe about $250 million. Insurers will determine the final amounts later this year and will issue the rebates to eligible consumers and purchasers in the fall.
The rebates are the result of insurance companies not meeting the ACA’s medical loss ratio threshold, which requires insurers to spend at least 80 percent of premium revenues (85 percent for large group plans) on health care claims or quality improvement activities. KFF said this year’s rebates reflect the continued impact of the COVID-19 pandemic, which led to much lower medical-loss rations in 2020 as many people skipped care amid stay-at-home orders and medical offices’ closures. The estimates are based on an analysis of preliminary data reported by insurers to state regulators and compiled by Mark Farrah Associates.