This week, leadership changes at CMS continue, Montana’s Governor introduces Medicaid expansion legislation, and the California Marketplace allows new health plan entrants into the individual and SHOP Marketplaces for the 2016 open enrollment period.
FEDERAL NEWS:
CMS Administrator Tavenner Resigns; Deputy Administrator Slavitt Becomes Acting Administrator
Marilyn Tavenner, the CMS Administrator charged with overseeing key elements of ACA implementation, resigned after five years of holding the post. Andrew Slavitt, the Agency’s Principal Deputy Administrator, will step in as Acting Administrator. Slavitt joined CMS in June 2014 from Optum, one of the contractors that helped develop Healthcare.gov. He has since overseen improvements to the site and helped coordinate and manage Medicare, Medicaid, CHIP and Marketplace coverage initiatives within the Agency. Slavitt must be confirmed by the Senate.
Federally-Facilitated Marketplace Enrollment Reaches Nearly 7.2 Million
Enrollment as of January 16 in the Federally-Facilitated Marketplace has reached nearly 7.2 million, according to the most recent HHS’ Weekly Snapshot. During the last week to obtain coverage beginning February 1, 400,000 individuals selected a plan, and HHS officials anticipate additional increases as open enrollment enters its final month. The HHS Snapshot has also begun featuring state-by-state cumulative enrollment figures, which indicate that Florida tops the list, with 1.2 million enrollees.
Office of Inspector General Identifies Concerns with CMS’ Contracting Efforts on Healthcare.gov
A new report from HHS’ Office of the Inspector General (OIG) found numerous shortcomings in CMS’ contracting and procurement processes for Federal Marketplace contractors, which may have contributed to the rocky rollout of Healthcare.gov in October 2013. Among OIG’s key findings are that CMS did not choose a lead systems integrator to help coordinate across contractors, lacked a written acquisition strategy, and did not adequately review two key contractors’ past performance. The report outlined six recommendations to prevent future issues, which CMS agreed with but noted that a majority of the Healthcare.gov contracts did not have the same technical and performance issues, according to Law360.
ACA Helps Reduce Uninsurance Rate and Improves Access to Health Services According to Commonwealth Study
Findings from the 2014 Commonwealth Fund Biennial Health Insurance Survey indicate that the ACA has made significant strides in reducing the adult uninsurance rate and the difficulties associated with paying for health coverage and services. Marking the first decline since 2001, the number of uninsured individuals decreased from 37 million people in 2010 to 29 million people by 2014 (from 20% to 16% of the population). In addition, the number of working-age adults reporting challenges accessing needed health care services for cost-related reasons declined from 80 million to 66 million from 2012 to 2014 (from 43% to 33% of the population).
STATE HEALTH REFORM NEWS:
California: Marketplace Allows New Issuers in the 2016 Open Enrollment Period
The Covered California Board approved a Qualified Health Plan certification regulation that will allow new health plan entrants into the individual and SHOP marketplaces in regions where competition is limited for the 2016 open enrollment period (OEP). Previously, Covered California required issuers to offer plans in the 2014 Marketplace to participate in subsequent years. Covered California will give priority to issuers that participated in the 2015 OEP that want to expand coverage in underserved regions.
Georgia: Hospital Association Proposes Medicaid Expansion Plan
The Georgia Hospital Association has developed an expansion proposal using existing Medicaid managed care companies. The proposal, which was acquired by Georgia Health News, includes a provision to sunset at the end of 2017 and additionally recommends the creation of a commission to analyze the fiscal impact of expansion and a comprehensive health care strategy for the State. The Association has declined discussing the proposal, and the Governor and General Assembly remain opposed to expansion.
Kansas: Governor's Budget for FY 2016 Includes Medicaid Reform but Not Expansion
Governor Sam Brownback's (R) administration proposed a budget report for fiscal year 2016 that seeks to save approximately $50 million through "policy and contractual changes" to KanCare, the State's Medicaid managed care system. The proposal includes shifting responsibility for determining Medicaid eligibility from the Department for Children and Families to the Department of Health and Environment in an effort to reduce incorrect eligibility approvals. Budget Director Shawn Sullivan indicated that lowering the error rate to 2% could save the State approximately $26 million. Additional changes to Medicaid include amending prescription drug reimbursement procedures by adjusting the pharmacy dispensing fee, altering the formula for the pricing of drugs and modifying billing requirements for drug testing codes.
Kansas: House Representative Introduces Medicaid Expansion Bill
While the Governor’s proposed budget for fiscal year 2016 excludes Medicaid expansion, Representative Jim Ward (D) on the House Health and Human Services Committee has introduced a Mediciaid expansion bill, HB 2045, according to The Topeka Capital-Journal. Kansas’ House and Senate are Republican-dominated and has generally opposed expansion, however Representative Tom Sloan (R), a chairman of the House Vision 2020 Committee, plans to host a series of hearings on Medicaid expansion with the objective to draft legislation “most suitable for Kansas.”
Montana: Governor Releases Medicaid Expansion Legislation
Governor Steve Bullock (D) released legislation (HB 249) to expand Medicaid to Montana residents under 138% of the federal poverty level. The bill would require the State to contract with a private "third party administrator," which would be responsible for establishing a network of providers and paying health care claims. According to the Governor's press release, enrollees would have access to a "broad private provider network" and the third party administrator would provide healthcare at negotiated rates. The bill aligns with the Governor's previously announced Medicaid expansion proposal, and also includes payment and delivery reforms for the existing Medicaid enrollees, such as care coordination for high need patients.
New Hampshire: Report Details Higher Enrollment and More Efficient Assistance in 2015 Open Enrollment
Covering New Hampshire, the official state resource for the New Hampshire Marketplace, released a summary report comparing the first month of the current open enrollment period (OEP) to the first five weeks of last year’s OEP. The report indicates that assisters have touched nearly double the number of applications and halved application completion times, contributing to a significant improvement in the rate of enrollment both for qualified health plans (QHPs) and Medicaid. As of December 15, 2014, 9,748 individuals had selected a QHP compared to 1,569 in the first two months of last year’s OEP, while 5,005 individuals were determined eligible for Medicaid, compared to 1,204.
Pennsylvania: Governor-elect Names Teresa Miller as New Insurance Commissioner
Governor-elect Tom Wolf (D) announced Teresa Miller as the State's new Insurance Commissioner. Miller is currently focusing on implementation and enforcement of the Affordable Care Act in private practice, and previously Miller served as Acting Director of the State Exchanges Group, the Oversight Group and the Insurance Programs Group at the Center for Consumer Information and Insurance Oversight (CCIIO) at CMS. Prior to the State Exchanges Group, Miller served as administrator of the Oregon Insurance Division.
Wyoming: Legislative Committee Hears Public Testimony in Favor of Medicaid Expansion
In the Senate Labor, Health and Social Services Committee’s first public hearing to discuss Medicaid expansion legislation, members of the public and stakeholder groups, such as the Wyoming Business Alliance, the Wyoming Hospital Association, and members of the Northern Arapaho Tribe, testified in favor of the expansion. The Committee is considering legislation that would require enrollees to pay into health savings accounts, but a vote on the bill is not expected until later in the legislative session.