THIS WEEK’S DOSE
With the midterm elections less than two weeks away, Republicans and Democrats remain focused on campaigning and voter messaging. An uptick in congressional news is expected when the House and Senate return to session the week of November 14.
House Democrats Release Report on Contraception Coverage. On October 25, House Oversight and Reform Committee Chair Maloney (D-NY) released a report analyzing contraceptive coverage and costs for patients with private insurance. The Affordable Care Act (ACA) requires issuers and health plans to cover US Food and Drug Administration-approved contraceptive products without cost-sharing. The report presents findings from the committee’s review of five of the nation’s largest health insurers and four of the largest pharmacy benefit managers (PBMs).
Findings include the following:
- Health plans and PBMs have coverage exclusions or cost-sharing requirements for at least 34 different contraceptive products.
- Insurers and PBMs disproportionately impose cost-sharing or coverage exclusions for newer contraceptive products.
- Many contraceptive products used by patients with distinct healthcare needs or disproportionately used by people with lower incomes are subject to cost-sharing or exclusions.
- Health insurers and PBMs on average deny at least 40% of exception requests.
- Exceptions processes are inadequate and often have significant delays.
Upon release of the report, Chair Maloney called upon the Administration to further update guidance on contraceptive coverage under the ACA to address the concerns identified in the committee report.
Administration Launches “Window Shopping” for ACA Healthcare Marketplace. The US Department of Health and Human Services (HHS) announced that starting on October 26, healthcare consumers can preview their coverage options and view available savings in the ACA Marketplace. This preview period allows consumers to view detailed information about the insurance plans and prices offered in their area in advance of the upcoming open enrollment period.
The Marketplace open enrollment period on HealthCare.gov runs from November 1, 2022, to January 15, 2023. Those who enroll by midnight on December 15, 2022, can get full-year coverage that begins January 1, 2023. A fact sheet for plan year 2023 Marketplace open enrollment can be found here.
This announcement from HHS came a day after the agency released a new report showing gains in health insurance coverage during the 2021 and 2022 open enrollment periods among populations with historically higher uninsured rates. According to the report, Black consumers saw a 49% increase in enrollment from 2020, Latino consumers saw a 53% increase in enrollment from 2020, and American Indian and Alaska Native consumers saw a 32% enrollment increase from 2020.
- HHS, through the Substance Abuse and Mental Health Services Administration, announced more than $100 million in funding to states and territories for mental health emergency preparedness and crisis response. The announcement included $59.4 million through the Community Mental Health Services Block Grant program, and $50 million in supplemental grant funding to help states and territories expand and enhance 988 Suicide and Crisis Lifeline services.
- HHS, through the Health Resources and Services Administration, announced $13 million to strengthen nursing education and training to grow the nursing workforce and improve access to nursing education.
- The HHS Office of Inspector General issued a report titled “Payments Made to Providers Under the Covid-19 Accelerated and Advance Payments Program Were Generally in Compliance with the CARES Act and Other Federal Requirements.”
- On November 1, HHS will hold a webinar on independent dispute resolution (IDR) under the No Surprises Act. The webinar will focus on the notice of offer web form in the federal IDR portal, and will also review changes to the notice of initiation web form.
- The Centers for Medicare & Medicaid Services announced that more than half of all states have expanded access to 12 months of Medicaid and Children’s Health Insurance Program coverage after pregnancy. Georgia and Pennsylvania are the 25th and 26th states to be approved for the extended coverage.
- Reps. Issa (R-CA) and Hudson (R-NC) wrote to HHS Secretary Becerra expressing concerns about the Strategic National Stockpile’s supply of smallpox vaccines and requesting information on the agency’s plan to ensure that the United States is fully prepared to respond in the event of a smallpox attack or outbreak.
- Kaiser Health News published an article titled “Hospitals Said They Lost Money on Medicare Patients. Some Made Millions, a State Report Finds.” The article highlights a report from the North Carolina state treasurer’s office describing how hospitals’ self-reported Medicare profit margins differed from the financial picture they provided to the public through Internal Revenue Service records, annual reports and community benefit documents.
NEXT WEEK’S DIAGNOSIS
Congress remains in recess until after the midterm elections on November 8. Regulatory updates, including the release of final payment rules for end-stage renal disease, physicians and hospital outpatient services, are expected imminently.
For more information, contact Debra Curtis, Kristen O’Brien or Erica Stocker.
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