HHS Releases Policies to Make Coverage More Accessible and Expand Behavioral Health Care Access for Millions of Americans in 2024

The Biden-Harris Administration released the 2024 Notice of Benefit and Payment Parameters Proposed Rule that aims to further advance the Administration’s efforts to build on the Affordable Care Act’s (ACA) efforts to provide and expand access to quality health care options for millions of consumers. The proposed rule would increase access to health care services, simplify choice and improve the plan selection process, and reduce consumer barriers.

“The Biden-Harris Administration has taken historic action to expand access to health care, and the Affordable Care Act Marketplace provides millions of Americans vital coverage,” said HHS Secretary Xavier Becerra. “As we make a final push now during Open Enrollment, we are encouraged that so many people are signing up for Marketplace health plans. Already we are working to build on this success.”

“We know that access to affordable health care is a concern across the nation. During the first several weeks of Affordable Care Act Marketplace Open Enrollment, we have already seen 5.5 million people select a Marketplace health plan, an 18% increase compared to last year” said CMS Administrator Chiquita Brooks-LaSure. “Continuing to propose policies that help make it easier for consumers to choose and maintain the health coverage that best fits their needs is vital. If finalized, this proposed rule does just that.”

Increasing access to health care services

The Biden-Harris Administration has made expanding access to behavioral health care a top priority. As part of that effort, the proposed rule includes two new major essential community provider (ECP) categories that are critical to delivering needed behavioral health care: Substance Use Disorder Treatment Centers and Mental Health Facilities. The rule also furthers access to providers by including a proposal to extend the current overall 35% provider participation threshold to two major ECP categories: Federally Qualified Health Centers and Family Planning Providers. These changes, in conjunction with a proposal to expand Network Adequacy requirements, would increase provider choice, advance health equity, and expand access to care for consumers who have low income, complex or chronic health care conditions, and/or who reside in underserved areas, as these consumers are often disproportionately affected by unanticipated costs associated with provider network status and limited access to providers.

Simplifying choice and improving the plan selection process

In response to public feedback, the rule includes proposals to make it easier for consumers to pick a health plan that best fits their needs and budget by updating designs for standardized plan options and limiting the number of non-standardized plan options offered by qualified health plans (QHPs) through the Federally-facilitated Marketplaces (FFMs) and State-based Marketplaces on the Federal Platform (SBM-FPs). The average number of plans available to consumers on the Marketplace has increased from 27.1 in PY2019 to 131.4 in PY2023. Having too many plans to choose from can limit consumers’ ability to make a meaningful selection when comparing plan offerings. Streamlining the plan selection process would make it easier for consumers to evaluate plan choices available on the Marketplaces and to select a health plan that best fits their unique health needs.

Making it easier to enroll in coverage

The proposed rule would give the Marketplaces the option to implement a special enrollment period for people losing Medicaid or Children’s Health Insurance Program (CHIP) coverage. This option would mean that consumers would have 60 days before, or 90 days after, their loss of Medicaid or CHIP coverage to select a Marketplace plan. CMS believes that this new proposed special rule would help mitigate coverage gaps when consumers lose Medicaid or CHIP while allowing for a more seamless transition into Marketplace coverage…

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For more information on the proposed rule, consult the fact sheet.

To review the Notice of Benefit and Payment Parameters for 2024 Proposed Rule, visit the CMS website. The 45-day public comment period will begin once published in the Federal Register.  

Most Health Systems Are Deploying Home-Based Care to Reduce Hospitalizations & ED Visits, Report Shows

MedCity News / By Katie Adams
  
The majority of health systems now offer some sort of home-based care program. The biggest goals of these programs are to improve patient outcomes through reductions in readmissions, hospitalizations and emergency room visits, according to a report released Wednesday by Current Health.
 
Current Health is a remote patient monitoring company that was acquired by Best Buy last year for $400 million. For its report, the company partnered with independent research firm Sage Growth Partners to survey 103 hospital and health system leaders. The respondents, who all worked for organizations with more than $100 million in patient revenue, included CEOs, CFOs, CIOs, chief nursing officers and vice presidents of finance.
 
One of the report’s more interesting findings was that respondents ranked improving health equity relatively low among the goals of home care models. This is despite the idea that being in a patient’s home often gives providers a better understanding of their life and how it is impacted by social determinants of health.
 
This survey finding was notable because Pippa Shulman, Medically Home’s chief medical officer, identified solving equity and access issues as one of the most important goals in home care during a recent interview.
 
“As a doctor, I can ask a lot of questions, but time is quite limited,” Shulman told MedCity News last month. “When I have my primary in-home clinician at the bedside of the patient and the tablet camera opens up, I can now see pictures on the wall. I see plants, I see mess, I see tidiness, I see dogs and cats roaming by.  Think of all of the information that can go into medical planning — people are not diseases, people are the accumulation of all of their life experiences and the people they’re around.”. . .

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U.S. Congress Could Punt Funding Bill into 2023, McConnell Says

Reuters | By David Morganand Moira Warburton

WASHINGTON, Dec 6 (Reuters) - The U.S. Congress may be forced to delay until early 2023 final agreement on funding the government through the end of its fiscal year, instead relying on a stopgap measure to keep the lights on, the top Senate Republican said on Tuesday.

The federal government is currently set to run out of money on Dec. 16 without a vote on either an "omnibus" bill funding the government through Sept. 30, 2023, or a short-term bill known as a "continuing resolution," or CR.

"We're running out of time, and that may end up being the only option left that we could agree to pursue," Senate Republican leader Mitch McConnell told reporters a day after meeting his Democratic counterpart Chuck Schumer to discuss a comprehensive omnibus package.

"We don't have agreements to do virtually anything," McConnell said. "We don't even have an overall agreement on how much we want to spend."

An omnibus bill would be expected to exceed the $1.5 trillion funding package Congress approved last March. Senator Richard Shelby, the top Republican appropriator, said the two sides were about $25 billion apart, which he described as "pretty close."

McConnell spoke the day after House Republican leader Kevin McCarthy told Fox News negotiators should hold off until January, when the new Congress with a slim Republican majority in the House is sworn in.

A Republican congressional aide, who asked for anonymity to describe intra-party dynamics, said McCarthy's warning was meant to pressure Democrats to move forward on an omnibus deal. The aide added that McCarthy has privately backed a longer-term bill to avoid a funding stand-off early in 2023.

Schumer acknowledged that there was still "a lot of negotiating left to do" to get an omnibus bill.

"Leader McConnell and I have agreed to try and work together to make sure we get a year-long omnibus funding bill done. We hope it can be done this year," Schumer told reporters.

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Confluence of RSV, COVID-19, and Influenza

Healthcare Ready Alert

• New hospitalizations for respiratory illnesses, especially influenza and COVID-19, are spiking following the Thanksgiving holiday. Flu hospitalizations “remain at a decade high” and COVID-19 hospitalizations have increased more than 20% compared to the previous week.

• While RSV may have peaked in some areas, overall increases in hospitalizations from COVID-19 and flu in adult and pediatric populations puts additional strain on hospitals that are already at or above capacity. Such strain, especially with months of the respiratory season still ahead, may further constrain capacity to care for critically ill patients of all ages across the US. 

• Some facilities have reported upticks in illness in staff, creating staffing impacts that further constrain the surge capacity of hospitals and other facilities.

• CDC is encouraging use of masks to help prevent spread of COVID-19, flu, and RSV during the holiday season.

• The uptake of COVID-19 and influenza vaccines will be a crucial factor for limiting respiratory-related hospitalizations throughout the winter months. 

• Vaccination rates of children for both COVID-19 and influenza remain very low. American Academy of Pediatrics analysis based on CDC data shows only 10% of children aged 6 months to 4 years old have received at least one dose of the COVID-19 vaccine. 

• As of 11/19, about 40% of children between the ages of 6 months and 17 years have been vaccinated for influenza for the 2022-2023 season.