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Federal insurance rules proposed for 2021 Plan Year. Every year, the U.S. Department of Health and Human Services publishes a federal rule (the “Notice of Benefits and Payment Parameters,” or NBPP) to govern operations of the ACA marketplaces and ACA health plans for the coming year. The 2021 NBPP was published on Feb. 6, 2020, and is open for comment until March 2.  HFA has signed onto coalition comments – and, with NHF, plans to file additional comments presenting the perspective of the bleeding disorders community – with respect to the 2021 NBPP.

  • HFA joined coalition comments opposing rule changes that would end auto-renewal of health plans for insurance purchasers who receive subsidies that cover the full cost of their premiums. The coalition comments noted that already-existing processes and eligibility mechanisms prevent errors and overspending, while aiding consumers. Ending auto-renewal, as proposed in the NBPP, would expose low-income consumers to unexpected bills and the potential loss of coverage, while increasing customer confusion.
  • HFA and NHF will also file joint comments underscoring the bleeding disorders community’s opposition to proposed NBPP rules that would affirm health plans’ ability to implement accumulator adjuster programs. (When an accumulator is in place, an insurer accepts copay assistance for a patient’s out-of-pocket costs associated with a prescribed drug but then doesn’t credit that amount toward the patient’s overall deductible or out-of-pocket (OOP) maximum.) The HFA-NHF comments describe the importance of manufacturer copay assistance programs for people with bleeding disorders and the devastating impact that the NBPP could have on individuals and families who rely on such programs in order to afford and maintain access to clotting factor and non-factor treatments. The “All Copays Count” coalition, too, will submit comments (again joined by HFA) also opposing the NBPP’s proposal to allow health plans to continue using accumulator adjusters.

Medicaid work requirements invalidated. On Feb. 14, a three-judge panel for the U.S. Court of Appeals for the District of Columbia unanimously ruled against Medicaid work reporting requirements adopted by the state of Arkansas.

Last spring, a trial court had concluded that the Centers for Medicare and Medicare Services (CMS) approval of Arkansas’ work reporting requirements was “arbitrary and capricious.” The trial court faulted CMS for failing to address how the Arkansas requirements promoted the objective of Medicaid law. The appellate court affirmed that decision, citing the massive coverage losses that occurred during the four months the work requirements were in effect for Arkansas, and emphasized that CMS had acted inconsistently with the primary objective of the Medicaid statute: to provide low income individuals and families with access to medical care.

To date, CMS has approved Medicaid work reporting requirements for ten states, but those requirements have only gone into effect for a handful of states. Other states have paused or withdrawn requests for federal approval of such requirements, pending resolution of the appeals process. HFA continues to oppose Medicaid work reporting requirements and other restrictive Medicaid eligibility policies.

Quick Hits:

  • HFA staff participated with NHF and hundreds of community members at NHF’s Washington Days to advocate for federal funding of bleeding disorders programs, and for enactment of the “Hemophilia SNF Access Act” (S. 3233 and H.R. 5952). The SNF bills address the problem that, under current law, Medicare reimburses skilled nursing facilities on a bundled, per diem rate that doesn’t come close to covering the costs of treatments needed by people with bleeding disorders to enable their blood to clot. As a result, such patients typically cannot access SNF care. The bipartisan House and Senate bills will allow SNFs to bill Medicare a separate, additional amount for bleeding disorders treatments.
  • On Feb. 10, the White House released the President’s proposed budget for 2021. The White House budget proposes deep cuts to Medicaid spending and other federal health programs, including the Centers for Disease Control and Prevention, Medicare, the National Institutes of Health, and more. The Food and Drug Administration fares slightly better, as the President’s budget proposes a small increase in FDA funding. Observers say that Congress is unlikely to agree to the proposed budget cuts and, indeed, the Chairman of the Senate Budget Committee said he would not even hold a hearing on the President’s budget request.
  • As concerns mount over coronavirus (COVID-19), the CDC continues to monitor the spread of the virus, internationally and at home. For its part, the FDA is coordinating with drug and device manufacturers and with global regulators to identify any potential shortages or disruptions affecting medical supplies, while also facilitating efforts to diagnose, treat, and prevent COVID-19. HFA will continue to publish updates as more information becomes available.
  • California’s ACA Marketplace experienced a 41 percent jump in new sign-ups for the 2020 open enrollment period, following state action to increase premium subsidies and to enact a state-level individual mandate.California also created a special enrollment period through April 30 for consumers who did not know about the subsidies or mandate. Maryland and Washington state are now considering whether to enact similar subsidy expansions.
  • Georgia became the 13th state to secure a federal waiver allowing it to create a reinsurance program compensating insurers for exceptionally high-cost claims. While CMS approved the state’s reinsurance waiver, CMS (at Georgia’s request) “paused” action on the more controversial steps that Georgia had proposed to take: scrapping its state ACA Marketplace; allowing brokers to sell skimpy health plans side-by-side with plans that meet ACA standards; and capping the subsidies available to insurance purchasers. Meanwhile, Georgia’s application to undertake a very limited, partial expansion of its Medicaid program is still pending with CMS.
  • New Mexico’s Governor said she would sign bills allowing the state to import prescription drugs from Canada (subject to federal approval) and letting the ACA Marketplace board expand open enrollment beyond six weeks. The latter bill would also standardize Marketplace plans so that consumers will be able to choose from three levels of coverage within each metal tier (bronze, silver, and gold).


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