RISE summarizes recent regulatory news, including announcements and proposals from the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services.
Early rate filings in ACA marketplace suggest COVID-19 will not affect costs
A new report from the Kaiser Family Foundation finds that most individual market insurers participating in the Affordable Care Act marketplace are expecting a return to normal in 2022 without the pandemic playing a large role.
The review of insurers’ preliminary rate filings in 13 states and the District of Columbia reveals that most expect health utilization patterns to return to their pre-pandemic levels and generally aren’t expecting any additional costs or savings related to COVID-19 in their 2022 rates. Of the 75 insurer filings submitted in these states, 16 predict that COVID-19 will have an impact in 2022, generally pushing rates up by less than 1 percentage point.
The pandemic led to a sharp drop in health spending in April 2020, as many providers cancelled elective procedures and patients practiced social distancing and avoided health care facilities. Since then, spending has mostly rebounded, though utilization this year remains somewhat lower than normal. According to the review, other factors that will impact insurers’ 2022 rates include continued use of telehealth services in place of in-person visits and a somewhat healthier marketplace population due to increased tax credits included in the American Rescue Plan Act. Few mentioned any impact from the No Surprises Act, which prohibits most surprise out-of-network bills starting next year.
The brief is available on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.
HHS to spend $103M to reduce burnout in the health workforce
The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced this week it will use an estimated $103 million in American Rescue Plan funding over a three-year period to reduce burnout and promote mental health among the health workforce. The funding will focus on the needs of rural and medically underserved communities and is meant to help health care organizations establish a culture of wellness among the health and public safety workforce. Applications are now being accepted for the following funding opportunities: promoting resilience and mental health; training for health and public safety workforce resiliency, and the health and public safety workforce resiliency technical assistance center. To apply, visit Grants.gov. Applications are due August 30.
HHS extends COVID-19 public health emergency for sixth time
HHS Secretary Xavier Becerra extended the public health emergency declaration for another 90 days. The renewal comes amid worries over the contagious Delta variant of coronavirus, which now makes up 83 percent of COVID-19 cases nationwide, according to U.S. Centers for Disease Control and Prevention Director Dr. Rochelle Walensky. The emergency declaration allows providers and health plans to better respond to COVID-19 by taking advantage of flexibilities, including the waiving of telehealth restrictions and cost-sharing for COVID-19 tests. Former HHS Secretary Alex Azar first declared the coronavirus as a public health emergency on January 27. It has now been renewed six times. As of July 21, the Johns Hopkins University of Medicine’s Coronavirus Resource Center reports that there have been more than 34 million confirmed cases of COVID-19 and more than 609, 576 deaths. Globally, COVID-19 cases climbed to over 191.6 million cases and the death toll is above 4.1 million.
OPPS proposed rule aims to increase price transparency, access to care, health equity
The Centers for Medicare & Medicaid Services (CMS) this week proposed updated Medicare payment rates for hospital outpatient and ambulatory surgical center services (ASC) via the Calendar Year 2022 Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System Proposed Rule. The rule includes proposals to increase the penalty for some hospitals that do not comply with Hospital Price Transparency final rule; changes to the radiation oncology model to improve the quality of care for cancer patients receiving radiotherapy; and halt the phased elimination of the inpatient-only list (procedures that Medicare will only pay for when provided in the inpatient setting). The agency is also seeking feedback on ways to make reporting of health disparities based on social risk factors and race and ethnicity more comprehensive and actionable and input on the extent to which hospitals are using flexibilities offered during the COVID-19 public health emergency to provide mental health services remotely and whether CMS should consider changes to account for shifting practice patterns. For more information, click here to read the full proposed rule (scheduled for publication in the Federal Register on August 4) and here for a CMS fact sheet.
Recommended reading on Medicaid expansion
COVID-19 has made it more critical to ensure people have access to affordable insurance. But would states terminate their Medicaid expansion if a new federal pathway to coverage is created? It’s unlikely, writes Sara Rosenbaum in a blog post for The Commonwealth Fund. Rosenbaum, who serves as the Harold and Jane Hirsh professor of health law and policy, Milken Institute School of Public Health at the George Washington University, noted states that expanded Medicaid have realized enormous health and economic benefits. It’s possible that states could abandon their Medicaid expansion efforts because the Supreme Court in June 2012 made expansion an unenforceable mandate. However, she doubts it will happen given the risk of leaving people without health care coverage, administrative burdens, capacity issues, and purchasing advantages. Read the full post here.