Health Plan Weekly

Interstate Telehealth Licensure Improved Access to Care During Pandemic 

During the early stages of the COVID-19 pandemic, states moved to temporarily allow health care providers licensed in other states to practice in their own jurisdictions with the goal of addressing staffing shortages and increasing access to telehealth. Many in the managed care industry have hoped that these short-term reforms would become permanent, with the goal of cutting costs and preserving telehealth access, but health policy experts are just beginning to make sense of the impact interstate licensure had during the early pandemic. 

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Major National Health Insurers Expand ACA Presence in 2023

Cigna Corp. will expand its Affordable Care Act exchange offerings in 2023 by 50 new counties in Georgia, Mississippi and North Carolina and add three new states — Texas, Indiana and South Carolina — the insurer said in August. If approved by the state regulators, Cigna’s market expansion has the potential to reach roughly 730,000 additional enrollees. The carrier has been expanding its footprint over the past few years, currently ranking 11th in national ACA enrollment with 340,000 members. Its major state markets are Tennessee (85,000 members), Virginia (62,000) and Missouri (49,000).

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Study Suggests Higher Priced Medicare Advantage Plans Aren’t Always Higher Quality

The quality of care and patient experience significantly varies among Medicare Advantage plans with similar monthly premiums, according to an analysis published on Aug. 26 in JAMA Health Forum. The retrospective, cross-sectional study also found that there was only a small mean difference in quality among low- and high-cost plans.

Amelia Haviland, the study’s lead author, tells AIS Health that the results indicate “how little guarantee there is that by paying more you’re going to wind up in a plan with higher quality. You might pick one of the plans that’s well below the mean within that cost tier or much higher.” However, she suggests insurers that offer low-cost Medicare plans can use the findings to show that people can still receive top-notch plans without paying high premiums.

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Health Insurers, Feds Gear Up to Steer People to ACA Marketplaces

With a law finally passed that extends enhanced Affordable Care Act subsidies for another three years, health insurers and government agencies can now start their consumer-outreach campaigns for the upcoming open enrollment period in earnest. But they’ll also be prepping for a bigger challenge down the road: Ensuring a smooth transition for people who will no longer be covered by Medicaid after the COVID-19 public health emergency (PHE) ends.

To that end, the Biden administration on Aug. 30 rolled out a plan called the “Assister Strategy to Support Medicaid Unwinding.” As part of that plan, HHS said it’s allocating $100 million to Navigator grantee organizations for the 2022-2023 budget period as well as reviving the Enrollment Assistance Program (EAP), which established temporary storefronts and labor forces that the Obama administration used in the ACA marketplaces’ early years to supplement Navigators’ outreach efforts. For the new version of the EAP, the Biden administration will deploy “mobile assisters” across population centers identified by HHS.

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HHS Rule Takes Aim at Bias in Health Care Algorithms

While a recently proposed rule from HHS would mostly reinstate nondiscrimination protections that the Trump administration unwound, it also addresses an emerging issue that is likely to stir up controversy in the health insurance industry: bias in clinical algorithms.

The regulation, posted Aug. 4 in the Federal Register, would for the first time at the federal level prohibit a covered entity “from discriminating against any individual on the basis of race, color, national origin, sex, age, or disability through the use of clinical algorithms in decision-making,” explains a July 27 Health Affairs article summarizing the proposal. “Covered entities” include all health programs and activities receiving federal financial assistance, including health insurance issuers that get federal funding.

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Multiple States Set Sights on Medicaid Expansion in Coming Election; Millions Could Gain Eligibility

About 3.7 million people could gain access to health care if the current 12 nonexpansion states were to fully implement a Medicaid expansion in 2023, according to a recent Urban Institute analysis.

In the upcoming gubernatorial elections in November, Medicaid expansion could be a key issue in several nonexpansion states, including Wisconsin, Kansas and Georgia. All three states had several failed attempts to fully expand Medicaid eligibility.

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News Briefs: Biden Admin Takes Steps to Streamline Medicaid, CHIP Eligibility

CMS on Aug. 31 proposed a new regulation aimed at streamlining applications, verifications, enrollment and renewals for Medicaid and Children’s Health Insurance Program (CHIP) coverage. The rule would make a host of changes, such as eliminating the requirement that individuals apply for other benefits as a condition of Medicaid eligibility, requiring that states conduct renewals no more than once every 12 months, and establishing specific guidelines for states to check available data prior to terminating eligibility when a beneficiary cannot be reached due to returned mail. CMS said it estimates that “this proposed rule would remove barriers to enrollment and increase the number of eligible individuals who obtain coverage and are continuously enrolled in Medicaid and CHIP.”

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AHIP Pledges to Step Up Mental Health Parity Compliance

The federal government and patient advocates have directed withering criticism regarding behavioral health coverage toward health plans in recent months. AHIP, the health insurance industry’s largest trade group, responded this week with a statement from its board emphasizing its commitment to equitable access to mental health benefits.

In January, the federal agencies that regulate health plans published a biannual report which found that health insurers have systematically failed to document the level of mental health care access they provide to members. That documentation is part of a yearslong federal effort to make plans comply with mental health care parity laws, which stipulate that health plans are not allowed to impose benefit limitations — non-quantitative treatment limits (NQTLs) — on mental health care that are more severe than limits placed on medical and surgical benefits.

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ICHRAs Begin to Gain Traction With Health Plan Purchasers

Employers are beginning to see the value of individual coverage health reimbursement arrangements (ICHRAs), managed care insiders tell AIS Health, a division of MMIT. Brokers and third-party experts say that while uptake has been slow so far, the ICHRA market could take substantive amounts of business away from both self-funded and fully insured commercial insurance books, particularly among medium-sized employers.

ICHRAs allow employers and employees to purchase Affordable Care Act marketplace plans. Employees select a plan on a health exchange or through a private broker, and their employer reimburses the member each month for a fixed amount of premium. Unlike exchange plans purchased by individuals, exchange plans purchased as part of ICHRA are not subsidized by advance premium tax credits. The market is still in its infancy: ICHRAs were created by the Trump administration in 2019, and the first policies in the segment were sold for the 2020 plan year.

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With Deal to Buy Trustmark, Health Care Service Corp. Continues Diversification Push

Health Care Service Corp. (HCSC) recently agreed to acquire Trustmark Health Benefits, a third-partner administrator (TPA) of health benefits. The pending deal continues HCSC’s expansion from its roots as primarily a traditional commercial insurer to other areas like TPAs and Medicare, and the diversification push is likely to continue, according to health insurance industry analysts who spoke with AIS Health, a division of MMIT.

For several years, HCSC has been a client of Trustmark Health Benefits, a firm that has more than 600 clients across the U.S. The companies Trustmark works with have self-insured health plans, meaning they are responsible for the cost of providing benefits to their employees. Trustmark generates revenue by helping companies in areas such as administering claims, managing risk, setting up virtual care and engaging with customers.

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