By Leslie Small
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.
From Health Plan Weekly
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