Policy and advocacy sessions were among the many programs on tap at HFA’s recently concluded 2021 Symposium. Thank you to all who attended! It was wonderful to “see” you at our virtual event – even as we plan, and fervently hope, to see you in person at HFA’s 2022 Symposium in San Antonio. For those who couldn’t join us in real time, you can still view the recorded sessions at your convenience via HFA’s website. Check in for tips on dealing with common insurance issues, including copay accumulator adjusters; hear about efforts to attain health equity for people living with bleeding disorders; watch or re-watch the two remarkable keynote speeches that did so much to set the tone for this year’s Symposium; and much, much more.

Quick Hits:

  • HFA and coalition partners have been advocating for three key policy priorities in the reconciliation bill: extending the increased subsidies (“advance premium tax credits” or “APTCs”) that help Americans buy Marketplace health insurance; closing the coverage gap for low-income adults living in Medicaid non-expansion states; and implementing a national paid family and medical leave program. The contours of the reconciliation bill change almost by the hour, as Congressional Democrats strive to reach an agreement by October 31. (Republicans uniformly oppose the bill; passage of the legislation will require unanimous Democratic support.) With Sens. Manchin and Sinema opposing the Administration’s initial $3.5 trillion spending target, negotiators have scaled back or dropped various policy goals. A White House-released framework indicates that the reconciliation bill may end up including short-term and/or narrowed versions of the APTC enhancements, the coverage gap fix, funding for home and community-based services, and more. The White House framework makes no mention of Medicare negotiation of prescription drug prices, leading some observers to conclude that this hotly-debated policy will not be part of the reconciliation bill. HFA will continue to provide updates via our Word from Washington posts.
  • The Hemophilia Skilled Nursing Facilities [SNF] Access Act went into effect on October 1, 2021. Thanks to this new law, SNFs can now bill Medicare separately for clotting factor that they administer to patients with bleeding disorders. This eliminates a reimbursement gap that previously made it hard or impossible for Medicare-enrolled bleeding disorders patients to access care in SNFs.
  • On October 7, federal agencies published a second set of rules implementing aspects of the No Surprises Act, a law protecting patients against surprise medical billing. The latest rule spells out procedures for determining out-of-network (OON) rates between providers and payers (with patients being taken out of the middle); requires providers to estimate health care costs for uninsured and self-pay individuals; outlines a payment dispute resolution process for uninsured or self-pay individuals; and beefs up the external review process so insured individuals can dispute denied payment for certain claims.
  • The Senate Finance Committee held a hearing on October 20, exploring options for improving access to health care. Senator Warnock appeared as a witness to reiterate the moral imperative for action to close the Medicaid coverage gap in Georgia and other non-expansion states. Other witnesses highlighted additional potential ACA improvements: fixing the family glitch, addressing affordability concerns, and implementing auto-enrollment procedures.
  • Medicare’s annual open enrollment period began this year, as always, on October 15. During this timeframe (Oct. 15 – Dec. 7), Medicare enrollees can, if they choose: switch from one Medicare Advantage plan to another; enroll in or switch between Medicare Part D prescription drug plan(s); and switch between Original Medicare and Medicare Advantage. Read more in Dear Addy.
  • The Biden administration extended the COVID-related declaration of a public health emergency(PHE) for another 90 days, from October 18, 2021 through January 16, 2022. The extension of the PHE means that states will continue to receive enhanced federal funding for their Medicaid programs, pursuant to the terms of the 2020 Families First Coronavirus Response Act; it also means that states cannot disenroll Medicaid beneficiaries for the duration of this period. HFA and other patient advocates have written to state and federal lawmakers about implementing protections to ensure that eligible patients maintain their Medicaid coverage when the PHE ends and coverage redeterminations resume.

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