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 Legislative & Policy Corner

Health Reform Implementation

Access to Preventive Services
The U.S Department of Health and Human Services (HHS) recently issued a press release highlighting key findings from the Assistant Secretary of Planning & Evaluation (ASPE) Data Point report. According to the press release, approximately 137 million individuals with private insurance have access to free preventive services. According to Sec. Burwell, "These services can substantially improve the health of families, and in some cases even save lives. We urge all individuals with health care coverage to take advantage of these services. This can make a tremendous difference in the health of Americans (HHS, May 2015)." HHS also has a helpful breakdown of the preventive services that are offered to the millions of adults, women, and children through the Marketplace and Qualified Health Plans in and out of the Marketplace. 

CMS Notice of Proposed Rulemaking – Medicaid & CHIP
Fresh off the press, the Centers for Medicare & Medicaid Services (CMS) announced a notice of proposed rulemaking to modernize Medicaid and the Children's Health Insurance Program (CHIP) managed care regulations. The proposed rule would strengthen the delivery of quality care at the state level and in a cost-effective manner. Specifically, CMS proposed to modernize managed care in the following ways (CMS press release):

  • Beneficiary experience: The proposed regulation includes provisions that would improve the beneficiary experience in enrollment, communications from the state and managed care plans, care coordination, and the availability and accessibility of covered services.
  • State delivery system reform: The proposed regulation supports states' efforts to encourage delivery system reform initiatives within managed care programs that strive to improve health care outcomes and beneficiary experience while controlling costs.
  • Quality improvement: The proposed regulation sets forth a quality framework focused on transparency, alignment with other systems of care, and consumer and stakeholder engagement.  The proposed rule would require a quality strategy for an entire state Medicaid program and also establish a Medicaid managed care quality rating system that would include performance information on all health plans and align with the existing rating systems in Medicare Advantage and the Marketplace.
  • Program and fiscal integrity: The proposed regulation includes provisions that would strengthen the fiscal and programmatic integrity of Medicaid managed care programs and rate setting by clarifying actuarial soundness requirements.
  • Managed long-term services and supports (MLTSS) program: The proposed regulation would implement best practices identified in existing MLTSS programs.
  • CHIP: The proposed rule would align the CHIP managed care regulations, where appropriate, with the proposed revisions to the Medicaid managed care rules in order to ensure CHIP beneficiaries the same quality and access in managed care programs. 

Currently, the proposed rule is available here. Starting Jun. 1, the proposed rule will be available on the Federal Register. The deadline to submit comments is Jul. 27, 2015. AMCHP will continue to monitor this proposal.

Marketplace Navigators
As a reminder, CMS recently announced the federal grant opportunity for Navigators for the third year of open enrollment. This grant is for Navigators in federally facilitated or state-partnership marketplaces. The funding announcement expands the project from one year to three years and a total of up to $67 million. Applications are due by Jun. 15. More information can be found here.

Medicaid Benefit Designs
A new report by The Commonwealth Fund reviews benefit design choices made by states that expanded Medicaid by the end of 2014. The analysis found that the majority of expansion states offered selected benchmarks with generous coverage for newly eligible adults, "eliminating the distinction between coverage levels for newly eligible adults and those for traditional adult beneficiaries, such as pregnant women, parents and guardians, or beneficiaries with disabilities. This suggests that states view the newly eligible beneficiaries as having the elevated health and health care needs that are common among low-income populations."  

Access to quality and adequate health care is especially important during the preconception period. Medicaid expansion provides an opportunity for coverage for adults without dependents. AMCHP recently released an issue brief highlighting the importance of access to health care for women and men during the preconception period.