Academy activities, legislative/regulatory updates, and more.
August 14, 2019
Barbara Klever, chairperson of the Individual and Small Group Markets Committee, gave an update to the National Association of Insurance Commissioners’ (NAIC) Health Actuarial (A) Task Force (HATF) at the NAIC Summer 2019 National Meeting on the Academy’s recent public policy work at the state, federal, and international levels, including our recent meetings with various federal agencies and congressional committees on the topics of long-term care (LTC), social determinants of health, Medigap, surprise billing, and health savings accounts.
Warren Jones, chairperson of the LTC Combo Valuations Work Group, gave a presentation on Aug. 2 to the NAIC’s LTC Actuarial (B) Working Group regarding the recently exposed Long-Term Care (LTC) Combination Product Valuation Practice Note, which was published to provide information to actuaries on current and emerging practices in which their peers are engaged with respect to the considerations in the statutory Generally Accepted Accounting Principles (GAAP) and tax valuation of long-term care combination products. The deadline for members to send comments is Sept. 2.
Bob Yee, member of the LTC Valuations Work Group, presented an update on Aug. 2 to the NAIC’s LTC Actuarial (B) Working Group regarding the work group’s activities, including the proposed factors for the tables, mortality and lapse rates, as well as next steps.
The Health Practice Council submitted comments on July 31 in response to the Actuarial Standards Board’s second exposure draft of a proposed actuarial standard of practice titled Setting Assumptions.
The Medicaid Subcommittee sent comments seeking additional clarification to the Centers for Medicare & Medicaid Services (CMS) on July 17 regarding the May 15, 2019, CMCS Informational Bulletin (CIB) titled Medical Loss Ratio (MLR) Requirements Related to Third-Party Vendors.
CMS released a proposed rule on Aug. 9 aimed at improving price transparency and lowering costs for Medicare beneficiaries. Provisions in the proposed rule would require hospitals to make information about standard charges, commonly used billing codes, and payer-specific negotiated costs for common services available to the public.
CMS issued a final decision on Aug. 7 allowing Medicare to cover a form of cancer treatment that uses a patient’s own genetically modified immune cells to fight disease.
CMS issued a statement on July 29 announcing that it will no longer approve requests by states to expand Medicaid to a limited population of adults with incomes above the federal poverty limit, rather than the full expansion group defined by the Affordable Care Act (ACA).
The U.S. District Court for the District of Columbia issued a ruling on July 29 vacating a New Hampshire requirement that non-disabled adults complete 100 hours of work or “community engagement” each month as a condition of eligibility for the state’s Medicaid program.
The U.S. District Court for the District of Columbia issued a ruling on July 19 allowing a Trump administration policy that expands the sale of short-term, limited duration insurance plans to remain in place.
The Internal Revenue Service (IRS) issued guidance on July 17 expanding the definition of preventive care to allow individuals enrolled in high-deductible health insurance plans to purchase drugs and medical equipment for chronic conditions such as hypertension and asthma without first having to pay down their deductibles.
The U.S House of Representatives passed a bill on July 17 that would repeal an excise tax (known as the Cadillac tax) on high-cost employer health insurance plans. The legislation, which was approved with limited debate and no amendments, passed on a vote of 419-6. The bill now goes to the U.S. Senate for consideration. Read the Academy alert.
The U.S. Government Accountability Office (GAO) issued an opinion on July 15 finding that Congress has the authority, under the Congressional Review Act, to review and potentially overturn guidance issued by the Trump administration in October 2018 intended to increase flexibility for states seeking Section 1332 waivers from certain requirements of the ACA.
CMS published several resources on July 15 to provide states with more information and clarity on the agency’s October 2018 guidance concerning Section 1332 waivers under the ACA. The materials released by CMS include a checklist for waiver applications, as well as waiver concept and application templates.
CMS released a proposed rule on July 15 that would overturn administrative requirements established in 2015, which mandated that states develop, submit, and regularly update an access monitoring review plan in order to ensure that their Medicaid programs provide sufficient access to care and services across geographic areas.
The Trump administration withdrew a proposed rule on July 10 that would have sought to exclude rebates on prescription drugs paid by manufacturers to pharmacy benefit managers (PBMs), Part D plans, and Medicaid managed care organizations from safe harbor protection under the Anti-Kickback Statute; and create a new safe harbor for prescription drug discounts offered directly to patients, as well as for fixed fee service arrangements between drug manufacturers and PBMs.
In the News / Media Activities
AIS Health reported on the Individual and Small Group Markets Committee’s issue brief on 2020 premium drivers. Senior Health Fellow Cori Uccello was interviewed for and is quoted in the story.
Think Advisor cited the Long-Term Care Combination Product Valuation Work Group’s presentation at the NAIC Summer 2019 National Meeting in New York City in a story on regulators’ discussion of LTC hybrid products.
Registration Deadlines Approaching
Annual Meeting and Public Policy Forum: Early registration ends next month for the Academy’s Annual Meeting and Public Policy Forum, to be held Nov. 5–6 at the Capital Hilton in Washington, D.C. New to the agenda is Pennsylvania Insurance Commissioner Jessica Altman, chair of the NAIC’s Health Insurance (B) Committee, who will deliver plenary remarks during the Nov. 6 lunchtime session. She will share her perspective on proposals to reform and improve the nation’s health care system, offer insight on the state of and potential future changes to the Affordable Care Act, and provide an outlook on options for expanding health insurance coverage through public plans. Don’t miss out on early registration rates—register by Sept. 13 and save.
LHQ Seminar: The early registration deadline is also quickly approaching for the Academy’s Life and Health Qualifications Seminar, to be held Nov. 10–14 at the Key Bridge Marriott in Arlington, Va. (just outside Washington, D.C.). This seminar provides attendees with the opportunity to obtain qualifications or relevant continuing education (CE) credit necessary to issue actuarial opinions for either the NAIC Life and Accident & Health (A&H) Annual Statement or the NAIC Health Annual Statement. Make sure to register by Sept. 16 for this popular event.