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July 20, 2018

White House considers proposals intended to lower health insurance costs

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    The White House Office of Management and Budget (OMB) is reviewing federal regulations that could reinstate billions of dollars in payments to exchange insurers and increase U.S. residents' access to short-term health plans, CQ Health reports.

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    Risk-adjustment proposal

    According to Modern Healthcare, CMS on Wednesday sent an interim final rule to OMB named, "Ratification and Reissuance of the Methodology for the HHS-operated Permanent Risk Adjustment Program under the Patient Protection and Affordable Care Act." CQ Health reports that the interim final rule likely aims to overhaul CMS' methodology for calculating payments to and from exchange insurers under the Affordable Care Act's risk-adjustment program, and possibly reinstate those payments.

    A CMS spokesperson said the agency is "reviewing all regulatory and administrative options" regarding the risk-adjustment payments. The spokesperson added, "The OMB display is a standard part of the process for consideration of potential regulatory action."

    House Ways and Means Committee Chair Kevin Brady (R-Texas), who has been talking with the administration about resuming the risk-adjustment payments, said he thinks the interim final rule also could address whether CMS will recalculate previous risk adjustment payments using a new methodology. "I don't know for certain. I think the question is what is [CMS'] authority prospectively versus retroactively on that rule. I think that is sort of the key policy question they're examining," he said.

    Phil Waters, a clinical fellow at the Center for Health Law and Policy Innovation at Harvard Law School, said the interim final rule "appears from the title" to be CMS' an attempt to resume risk-adjustment payments.

    Chris Coleman, an attorney for the Tennessee Justice Center, said the interim final rule is "a good sign," but added that he "will suspend judgment until [he] see[s a] final rule in place and payments flowing again."

    Short-term health plan proposal

    According CQ Health, OMB also is expected to finalize a rule that would expand short-term health plans.

    HHS in February first proposed the rule, which would allow insurers to sell short-term health plans that are valid for up to one year. Insurers currently are permitted to sell short-term health plans that are valid for up to three months.

    Short-term health plans are not required to comply with certain ACA requirements, such as provisions that bar insurers from denying an individual coverage or charging him or her higher premiums based on pre-existing medical conditions. The plans also do not have to comply with the ACA's minimum coverage requirements (Clason, CQ Health, 7/19 [subscription required]; Dickson, Modern Healthcare, 7/19).

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