HealthCare Roundtable e-News – April 28, 2020



Roundtable Signs Multi-Stakeholder Letter to Congress Recommending COVID-19 Priorities

The Public Sector HealthCare Roundtable joined a letter to congressional leaders on April 23 led by Families USA and signed by a diverse set of national stakeholder organizations recommending a range of policy priorities to address the COVID-19 pandemic. The policy recommendations articulated in the letter include a range of issues intended to mitigate the impact of the national emergency, including: 1) ensuring all individuals have equitable access to testing and treatment for COVID-19; 2) equipping states and localities with sufficient financial support to combat the crisis; 3) providing protection and support to the health care workforce and others on the frontlines of the pandemic; 4) assuring access and capacity in the health system; and, 5) protecting against high and unexpected health care costs.

The full text of the letter can be found HERE. Please reach out to Andrew MacPherson, Roundtable Senior Policy Advisor, with questions or comments.

U.S. Supreme Court Rules in Favor of Insurers in Risk Corridor Case

Yesterday, the U.S. Supreme Court issued an opinion in Maine Community Health Options v. United States, which overturned the U.S. Court of Appeals for the Federal Circuit’s ruling and concluded that insurers operating in the individual marketplace are owed risk corridor payments originally required by the Affordable Care Act (ACA). The total reimbursed amount is expected to be approximately $12 billion.

The risk corridor program was an original part of the ACA’s “Three Rs” (risk corridors, reinsurance, risk adjustment) and was implemented to help mitigate the costs of insuring beneficiaries seeking coverage through the individual marketplace. It was intended only to last three years – 2014 through 2016 – as a means of stabilizing the new marketplace. However, in each of those years Congress passed appropriations language that effectively precluded the use of any HHS-appropriated funds for the risk corridor program. Thus, insurers never received any of the risk corridor payments that were promised under the ACA.

In response, insurers filed a series of suits in federal court and saw mixed results. Eventually the matter was appealed to the U.S. Court of Appeals for the Federal Circuit. In 2018, the Federal Circuit Court ruled against the insurers and concluded that the ACA’s offer of covering some of the risk associated with this population as a means of incentivizing insurers to participate in the marketplace did not create a contractual agreement. In yesterday’s 8-1 ruling, the U.S. Supreme Court disagreed with that conclusion and said Congress is obligated to pay the total amounts for the three years of the program.

President Signs $484 Billion Emergency Spending Package to Aid COVID-19 Efforts

Many small businesses will see an increase in paid protections over the coming weeks as Congress passed its latest emergency spending bill last week, which was signed into law by President Trump on Friday (April 24). The $484 billion package includes $320 billion for small businesses via the Payment Protection Program, as well as $75 billion for providers and $25 billion for COVID-19 testing, of which $11 billion goes to states.

The president stated that the package would be “great for small businesses, great for workers…this is a tremendous victory,” when signing the bill into law in the oval office last week. The package also includes $50 billion for Economic Injury Disaster Loans, $10 billion for Economic Industry Disaster Loans advance grants, and $2.1 billion for Small Business Administration administrative expenses. (InsideHealthPolicy)

The latest package leaves out the $500 billion that was requested by the National Governors Association. Governors across states and political parties have asked that state aid be included in future spending packages, though their requests have met criticism by some in the Senate. Majority Leader Mitch McConnell stated last week that he would “certainly be in favor of allowing states to use the bankruptcy route,” instead of seeking federal funding.

Insurers Pressure CMS to Push Deadline for Submitting 2021 Rates Amidst Coronavirus Crisis

Deadlines for submitting 2021 qualified health plan rates are looming, even as the coronavirus crisis continues to unfold across the country. Insurers will be expected to start submitting rates now (as of April 23) through July, with final rates having to be submitted by August 19, but many insurers are seeking additional time to submit rates. (InsideHealthPolicy)

In a letter sent earlier this month, the Association for Community Affiliated Plans (ACAP) wrote to CMS Administrator Seema Verma and Exchange Director Randy Pate explaining how most estimates suggest the COVID-19 virus will peak in May and taper off by mid-June across the country. The current timeline that’s been approved by the agency would only give plans a month to estimate and account for the impact on their finances and next year’s rates.

“ACAP urges CMS to delay the recently-finalized rate filing deadlines by at least 30 days in order to allow health plans dealing with the worst of the pandemic sufficient time to revise their rates accordingly. Health plans will not know the full impact of the pandemic on their finances for many months at least and will need time to factor this new reality into next year’s rates,” ACAP says.

Other groups, including the Alliance of Community Health Plans (ACHP), America’s Health Insurance Plans and Blue Cross Blue Shield Association have requested that CMS consider moving deadlines for Medicare Advantage and finalizing rate filings until September. Additionally, insurers are asking CMS to push the date for publishing proposed rates from July 31 to August 17, and believe the agency should encourage states to extend rate filing deadlines to July 22 to align with the federal deadlines. (InsideHealthPolicy)

CMS had previously stated that it would not be extending its final deadline at this time, though many groups are hopeful the agency will reconsider as COVID-19 cases rise and the crisis continues to unfold. (InsideHealthPolicy)

CDC Grants $631 Million to States for Virus Response, Testing, and Tracking

HHS announced last week that it will be granting $631 million to 64 states and local jurisdictions in an effort to guide social distancing restrictions and states’ efforts to reopen. The grants were awarded by the CDC from the CARES Act, and each grantee is part of the Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) cooperative agreement. (InsideHealthPolicy)

In a statement, Secretary of HHS Alex Azar confirmed that the funding will help public health departments across America continue to battle COVID-19. Robert Redfield, Director of the CDC, said that the funding will help to implement aggressive contact tracing, surveillance, and testing as the country looks to reopen in the coming months.

The CDC did not specify which 64 states and jurisdictions would be receiving the grant money. Many activists and lawmakers have pleaded for more pandemic aid to go to rural and tribal communities whose hospitals are underfunded or without resources to be able to respond to an increasing number of cases.