Tuesday, November 20, 2018

CMS Both Adds, Removes Regulatory Burden for Health Insurers


In two proposed rules issued one day apart, the Trump administration added regulatory burden for one type of health plans and increased flexibility for another.
In the first regulation, CMS aimed to "improve the integrity" of the Affordable Care Act (ACA) exchanges by proposing new initiatives that would place additional safeguards on the eligibility and enrollment process. What drew the most notice, though, was a provision that would require some ACA exchange insurers to send enrollees separate bills for the portion of their policies that covers abortion services.
Currently, when exchange insurers collect premiums from enrollees, they must funnel the part that goes toward abortion services — a minimum of $1 per person — into separate bank accounts, explains Dania Palanker at Georgetown University's Health Policy Institute.
Forcing insurers that cover abortion services to send two separate bills each month will result in a "more burdensome process" for such insurers, which will have to spend extra money to collect and process twice the payments per enrollee, she says.
Separately, CMS issued a notice of proposed rulemaking that aims to lift some of the regulatory burden from states — and by extension, the Medicaid managed care organizations they oversee. Perhaps the most notable part of the proposed rule is CMS's revision of the regulations governing how states determine whether MCOs' provider networks are adequate.
While the 2016 rule required states to measure how long or how far Medicaid beneficiaries had to travel to providers when determining plans' network adequacy, the new regulations would let states use a variety of different quantitative standards, such as minimum provider-to-enrollee ratios and maximum wait times for an appointment.
"I think the additional flexibility that the rewrite affords in terms of network adequacy is well deserved," says Alex Shekhdar, vice president of federal and state policy for Medicaid Health Plans of America. The current time and distance standards, he notes, have been difficult to apply uniformly across all states.

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