Manatt on Health Reform: Weekly Highlights

Rebecca TorreyPartner, The Torrey Firm


HHS proposes significant new network adequacy standards and surprise billing protections for 2017 QHPs; Louisiana’s Governor-elect reiterates his intent to expand Medicaid on “Day One”; and California considers pursuing a 1332 waiver. Read on for more details.




Federal Regulatory Activity


HHS Proposes Standard Cost-Sharing Designs & “Leasing” Fees for the Federal Marketplace
The Department of Health and Human Services (HHS), in a draft Notice of Benefit and Payment Parameters, has proposed several significant regulatory changes for 2017, including: establishing voluntary standard cost sharing designs for bronze, silver, and gold plans; creating provider network adequacy standards based on time and distance; and creating protections against excessive cost sharing for services rendered by out-of-network providers in in-network facilities. Read more

HHS Announces Intent to Make Full Risk Corridors Payments to Issuers
The Department of Health and Human Services (HHS) released guidance reiterating the Secretary’s requirement to make full 2014 risk corridors payments to issuers, after announcing in October that it would make payments totaling 12.6% of issuers’ 2014 benefit year payment requests. Read more


Federal & State Marketplace News


New Reports on Health Care Affordability, Cost Sharing, and Plan Shopping Are Released
Reports released this week by the Commonwealth Fund and the Kaiser Family Foundation (KFF) show that cost sharing continues to be a challenge for some populations, while a second KFF report indicates shopping for Marketplace plans may help to alleviate these concerns. Read more

Study Finds Low Take-Up Rates during Special Enrollment Periods
Fewer than 15% of uninsured consumers eligible to enroll in Marketplace coverage during special enrollment periods (SEPs) do so, according to a new report by the Urban Institute and Robert Wood Johnson Foundation. Read more



Medicaid Expansion Updates


Alabama: Task Force Recommends Expanding Medicaid Coverage
The Alabama Health Care Improvement Task Force, commissioned by Governor Robert Bentley (R) via Executive Order in April, has recommended expanding health care coverage to Alabamians who currently fall into the “coverage gap” because they do not qualify for Medicaid or subsidies in the Marketplace and are unable to purchase health insurance through their employer or on the individual market. Read more

Louisiana: Governor-Elect Lists Medicaid Expansion Among Highest Prioritiest
Receiving 56% of the vote in Saturday’s gubernatorial runoff election, John Bel Edwards (D)—campaigning on a promise to expand Medicaid on “Day One”—became Louisiana’s Governor-elect over David Vitter (R). Read more


State Health Reform News


California: Marketplace Proposes 1332 Waiver Exploration Process
Covered California Executive Director Peter Lee proposed to the Marketplace board a process for partnering with the Department of Health Care Services (DHCS), the State’s Medicaid agency, to assess potential ideas for a 1332 waiver proposal. Read more

Rhode Island: Statewide Healthcare Survey Reveals Primary Care Access Gaps and Delayed Care
The Department of Health (DOH) released the results of a statewide healthcare access and utilization survey of facilities and community members, conducted as part of a State Innovation Model (SIM) initiative to reform Rhode Island’s healthcare delivery and payment systems. Read more



State Staffing Updates


Minnesota: Marketplace Names Internal Candidate as New CEO
The Board of MNSure, Minnesota’s State-based Marketplace, announced the selection of Allison O’Toole as their new chief executive officer. Read more

Utah: Governor Appoints New Inspector General of Medicaid Services
Governor Gary Herbert (R) appointed Gene Cottrell to serve as Inspector General of Medicaid Services, where he will be responsible for identifying fraud, waste and abuse, recovering inappropriately paid funds, and strategic planning. Read more






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