February 17, 2017 Edition

Trump Administration releases new proposed rule on the Affordable Care Act

On Wednesday, the Centers for Medicare and Medicaid Services issued a proposed rule on health care. Key changes proposed by the rule include:

  • Shortening the upcoming annual enrollment period from November 1, 2017, to December 15, 2017.
  • Adjusting the de minimis range used for determining the level of coverage provided by insurers.
  • Requiring additional supporting documentation for special enrollment periods.
  • Requiring unpaid premiums to be paid before enrolling a patient into the next year’s plan.
  • Deferring to states to assess network adequacy.
  • Revising the timeline and health plan certification and rate review process for 2018.

In the past, open enrollment begins November 1 and ends January 31. The Trump Administration reasons that this change will align the Marketplaces with the Employer-Sponsored Insurance Market and Medicare, which will help lower insurance prices. However, the proposed change raises the question of whether shortening open enrollment would result in less individuals enrolled in coverage.

The Center on Budget and Policy Priorities, a nonpartisan research and policy institute, concluded that the new proposed rule would weaken marketplace stability. They noted that the adjusted de minimus range included proposed rule would allow individual-market insurers to offer lower priced plans with higher deductibles and out-of-pocket costs.

The deadline to submit public comments for consideration is 5 p.m. EST on March 7, 2017. Comments can be submitted electronically or by mail. Submitted comments will be made available to the public.

A Better Way Policy Brief

House Republicans released a broad policy brief on their developing ACA replacement plan, which included talking points around their plan to modernize Medicaid, utilize State Innovation Grants, enhance Health Savings Accounts, and to provide portable, monthly tax credits.  This document is meant to provide House Republicans with information to take home with them during their one-week President’s Week break to discuss with their constituents.  While still relatively short on details, the policy brief highlights:

  • Modernizing Medicaid, which includes repealing the Medicaid expansion and utilizing per capita caps and allowing states to opt for Medicaid block grants.
  • Creating a new universal tax credit.
  • Encouraging the creation of high-risk pools through State Innovation Grants.
  • Allowing individuals to fund their health care though the expanded use of Health Savings Accounts.

Comparing ACA Replacement Plans

The Kaiser Family Foundation created a tool to compare the ACA replacement ideas that have been proposed at the federal level. The tool can compare up to three plans and includes the current ACA law, HHS Secretary Tom Price’s Empowering Patients First Act, House Speaker Paul Ryan’s A Better Way plan, Senator Bill Cassidy’s Patient Freedom Act and Senator Rand Paul’s Obamacare Replacement Act.

Upcoming Hearing on Risks to Federal Health Care Funding

The Assembly Budget Subcommittee No. 1 on Health and Human Services will convene a hearing to discuss the risks to federal health care funding in light of the threats to the Affordable Care Act. The hearing will take place on Wednesday, February 22 at 2:30 pm. Hearing materials will be posted here.

DHCS Proposes Network Adequacy Standards

Last Spring, the Centers for Medicare and Medicaid Services (CMS) issued the Medicaid and CHIP Managed Care Final Rule, which addressed beneficiary rights and protections, program integrity, care coordination and network adequacy. In the Final Rule, states were required to implement state-specific standards for network adequacy in regards to time and distance.

This week, DHCS released their proposed network adequacy standards which would apply to:

  • Medi-Cal managed care;
  • County Mental Health;
  • Drug Medi-Cal; and
  • Dental Managed Care Plans.

DHCS also presented an update on their proposal at the Stakeholder Advisory Committee Meeting yesterday, February 16.

Public comment on the proposed standards are due to DHCS by February 28, 2017, and can be submitted to dhcsmcqmdnau@dhcs.ca.gov.

LAO Cannabis Proposal Analysis

The Legislative Analyst’s Office (LAO) released a report earlier this week on Governor Brown’s cannabis implementation proposals.  The LAO agreed with the Governor that aligning the statewide regulatory structures for both medical and adult use cannabis is reasonable, but noted several uncertainties regarding the resources needed to implement both programs, the aggressive timeline for implementation, and potential impact of federal cannabis enforcement actions.

Legislative Hearings on Cannabis

This week two Senate Committees held cannabis related hearings.  The Senate Governance and Finance Committee, chaired by Senator Mike McGuire (D-San Rafael), convened on Tuesday to mainly discuss compliance issues with industry and law enforcement as well as issues about the administration of cannabis taxes statewide.  Arguably, the star of the hearing, however, was an appearance by Colorado Governor John Hickenlooper who discussed Colorado’s experience in legalizing cannabis use for adults.  Of interest to local health departments, he noted Colorado did not see a spike in teenage use of cannabis nor a dramatic increase in adult consumption.  Governor Hickenlooper also mentioned that they ensured that some of their tax revenues were directed to significant youth prevention efforts.

On Thursday, the Senate Budget & Fiscal Review Committee, chaired by Senator Holly Mitchell (D-Los Angeles), held a nearly three-hour oversight hearing to discuss the potential revenues generated by legalized cannabis and what potential community impacts could be.  Senators had many questions for the Department of Finance, Legislative Analyst Office representatives and one of the Prop 64 initiative drafting attorneys about how revenues could be collected and how they may be apportioned out.  A second panel focused on the social justice aspects of Prop 64 including the decriminalization of certain cannabis offenses and the investment of Prop 64 revenues directed to the Community Reinvestments grant program, which is envisioned to support job placement, mental health treatment, SUD treatment, and other services for communities “disproportionately affected by past federal and state drug policies.”

DHCS Selects 15 Local Dental Pilot Projects

This week DHCS announced they have selected 15 Local Dental Pilot projects as part of the Dental Transformation Initiative (DTI).

The selected applicants, with a total funding request of approximately $150 million, are:

  • Alameda County
  • California Rural Indian Health Board, Inc.
  • California State University, Los Angeles
  • First 5 Kern
  • First 5 San Joaquin
  • First 5 Riverside (includes San Bernardino County)
  • Fresno County
  • Humboldt County
  • Northern Valley Sierra Consortium (Butte, Nevada, Plumas, Sutter, and Yuba Counties)
  • Orange County
  • Sacramento County (includes Amador County)
  • San Luis Obispo County
  • San Francisco City and County Department of Public Health
  • Sonoma County
  • University of California, Los Angeles

More information can be found on the DHCS website.