At the agencies
The Centers for Medicare and Medicaid Services (CMS) has released a proposed rule which seeks to stabilize the individual and group health insurance markets through new reforms. The proposed rule would makes changes to special enrollment periods; guaranteed availability; standards related to network adequacy; essential community providers for qualified health plans; and rules involving actuarial value requirements. It additionally intends to shorten the open enrollment period from November 1 to December 15 rather than to the end of January as under the Obama Administration. CMS will accept comments on the proposed rule until March 7.
The Department of Health and Human Services (HHS) has delayed publishing a final rule on substance use disorder data-sharing. The delay is due to the Trump Administration’s executive order allowing officials additional time to review regulations finalized under the Obama Administration. The Substance Abuse and Mental Health Services Administration (SAMHSA) regulation allowed researchers greater access to substance abuse related medical records and lifted the automatic requirement that a patient’s consent be obtained every time their records are shared with a physician.
CMS announced awards totaling $100 million given to 11 organizations to provide on the ground training and education about the Quality Payment Program. These awards are for the first year of a five year program. The awards, roughly $20 million each, focus on local community based organizations and hands-on training for small, typically rural practices of less than 15 clinicians which are historically under resourced. CMS is expected to invest an additional $80 million over the remaining four years of the program.
In the marketplace
The health insurance company, Humana, has announced they will be pulling out of Affordable Care Act (ACA) individual insurance marketplaces in 2018. The company cited concerns about the size of the market’s risk pools which they gleaned from the 2017 open enrollment results. Humana stated they were expected to lose $45 million in its ACA exchanges in 2016 and can no longer justify the losses. The company currently has 152,000 individual market customers.
On the Hill
The Senate confirmed Representative Tom Price (R-GA) as Secretary of Health and Human Services by a 52 to 47 vote. Price is the first physician to lead the Department of Health and Human Services since 1993.
On Feb. 16 the Senate Finance Committee heard testimony from Seema Verma, President Donald Trump’s pick for CMS Administrator. While Verma did not provide specifics on many of her positions, she did voice her disapproval of a potential Medicare-to-voucher program transformation. She declined to answer any questions on mental health services, citing her husband’s employment as a child psychiatrist and on the advice of the Office of Government Ethics. Ms. Verma now faces a full committee vote and full Senate vote in order to take over the lead position at CMS.
In the courts
The U.S. Supreme Court is scheduled to hear arguments in a Kentucky nursing home arbitration case on Feb. 22. The case comes from the Kentucky Supreme Court, which rejected the use of arbitration agreements signed by representatives of patients, citing the lack of proper authority of patient representatives to enter into arbitration agreements. Long term care groups have indicated that they believe the decision could have lasting implications for long term care facilities.