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CMS to cut Obamacare enrollment advertising budget by $90 million and adopt performance-based navigator funding

At the agencies

The Centers for Medicare and Medicaid Services (CMS) cut the budget for Affordable Care Act (ACA) enrollment outreach and education to $10 million from $100 million for the upcoming open enrollment period. CMS intends to focus advertising and outreach activities on educating consumers about the new dates of the open enrollment period using digital media, email and text messages. Outreach and education activities will also take a more targeted approach based on specific demographic and geographic information. Along with the funding reduction for outreach, CMS announced that it will grant funding to enrollment navigators (enrollment facilitators who help guide individuals through the enrollment process) based on their ability to meet their enrollment goals the previous year.

CMS recently published a county-by-county analysis of projected insurer participation in health insurance exchanges across the country. Current predictions show that 1,476 counties (45 percent of counties nationwide and as many as 2.6 million insurance exchange participants) could have only one insurance issuer for the 2018 plan year.

Legislators and governors have urged CMS to streamline the Medicaid waiver process by adopting time limits for approval of new waivers and expediting waiver renewals. Some members of Congress have vocally supported legislative reforms to expedite the waiver process, while governors have approached CMS directly to revise and streamline the review and approval of Medicaid waivers. Even with a longstanding interest in revising the Medicaid waiver process, many believe the proposed changes are consistent with the Trump administration’s objectives and are now more likely to advance.

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a new study, based on data from 428 participating accountable care organizations (ACOs), showing nearly $1 billion in savings tied to the Medicare Shared Savings Program. In addition to robust savings during their first three years, the participating ACOs showed improvements in quality of care, including a reduction in utilization of emergency department services. The ACOs in the Medicare Shared Savings Program served 9.7 million patients over the three years studied, and the highest-performing ACOs reduced Medicare spending by an average of $673 per beneficiary for key services.

The HHS OIG  issued an alert stating that it found a quarter of incidences of nursing home abuse and neglect may not have been properly reported to law enforcement and that CMS has inadequate procedures for ensuring these events are reported. Of the 134 emergency room records reviewed with indications of elder abuse or neglect, 28 percent of the incidents may not have been reported to law enforcement. OIG issued a number of recommendations to CMS in response, including comparison of emergency room Medicare claims for nursing home services to identify incidents of potential abuse or neglect of Medicare beneficiaries; periodic publication of such a report; and continued work between HHS and CMS to gain additional authority to impose civil monetary penalties on nursing homes for elder abuse and neglect violations.

On the Hill

Revisiting healthcare reform immediately upon their return to Washington, D.C., the Senate Health, Education, Labor and Pensions (HELP) Committee scheduled a series of hearings on stabilizing individual insurance markets. Hearing topics are likely to include funding for cost-sharing subsidies and granting states increased flexibility in designing their individual health insurance markets. Testimony from state insurance commissioners, governors and national health policy experts will inform the hearings. The stated goal of these hearings is to advance narrow legislation to stabilize the individual insurance market in advance of the next open enrollment period that begins Nov. 1, 2017.

Just before the August recess, the Senate unanimously passed a “right-to-try” bill, sponsored by Sen. Ron Johnson (R-WI), which would authorize the use of unapproved medical products by patients diagnosed with a terminal illness in certain circumstances. This bill includes a limited liability shield for prescribers, dispenser or other individual who assists a patient lawfully exercising his right to try experimental drugs after other options have been exhausted. There are two similar measures currently under consideration in the House.

For more information on this topic, or to learn how Baker Tilly healthcare specialists can help, contact our team.

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