Medical RAC Audits Reviewed by Statistician Frank Cohen Medical RAC Audits Reviewed by Statistician Frank Cohen

CMS And HHS Issue First Rules Under New Leadership

By Grant Huang, CPC, CPMA ,Director of Content at DoctorsManagement.

As the two federal agencies that wield the greatest power over the healthcare industry, CMS and HHS have been making a quiet transition to new management for nearly three months. During that time, which included a 60-day freeze on all new rulemaking and an initial failure by Republicans to repeal the Affordable Care Act (ACA), CMS Administrator Seema Verma and HHS Secretary Tom Price have settled into their new roles while offering only measured comments on the repeal effort.

One of the first major indicators for how much Verma would involve herself in the effort came in the middle of April, when she met with representatives from top insurance companies who were hoping for answers on whether the Trump administration would continue federal subsidies for ACA premiums. However, Verma appeared to be non-commital, and CMS offered only a vague statement after the meeting, saying that “All parties came to the table committed to maintaining an active dialogue to improve care for patients and focus on long-term solutions that will fix the problems created by the ACA.”

Ultimately, President Trump and Republican leaders in Congress decided to keep the ACA subsidy cash flowing until at least September, via the $1 trillion budget bill that marked the first major piece of bipartisan legislation passed under President Trump.

Policy shift toward state-level regulation

More telling is a recent move by CMS to issue a checklist tool to states who wish to opt out of ACA requirements. The Section 1332 State Innovation Waiver Checklist is designed to make it easier for states to complete waiver applications that would allow them to create high-risk pools and help insurers purchase reinsurance to offset coverage costs.

“Today’s guidance addresses the ACA’s impact in driving up insurance costs and reducing choices,” Verma said in a May 16 statement, the date CMS released the checklist. “State initiated waivers that implement high-risk pool/ state-operated reinsurance programs will help lower premiums, stabilize the health insurance exchange, and meet the unique needs of each state.”

It’s fitting that Verma is pushing state-specific innovations; in her previous career, she rose to national prominence by working to implement conservative reforms of state Medicaid programs.

Secretary Price also framed the checklist tool as a necessary hedge against the effects of the ACA as it is currently implemented. “The failure of the individual marketplaces under Obamacare is driving insurers out of counties and states at an alarming rate, leaving millions of Americans without choices for affordable health insurance,” Price said in a statement. Earlier this month, Price sent letters to the governors of all 50 states encouraging them to seek ACA waivers.

Rulemaking resumes as Price anticipates ACA repeal

With the end of the 60-day regulatory freeze issued by President Trump, both HHS and CMS are back to issuing transmittals and policies. One of the more consequential changes is a streamlining of the web enrollment process for insurance plans on the ACA’s exchanges. The new “Proxy Direct Enrollment Pathway” allows patients to find and apply for insurance plans entirely through third-party insurer websites. This bypasses the federal exchange site, Healthcare.gov, entirely, giving patients an uninterrupted experience on the insurer website.

Though both Verma and Price are opposed to the ACA and looking forward to its repeal, they are also in the position of having to keep it running as smoothly as possible to avoid patient coverage disruptions until a new law is passed. The Proxy Direct Enrollment Pathway is an effort to keep the ACA’s exchange markets stable, Verma said in a statement. “It is common sense to make it as simple and easy as possible for consumers to shop for and access health coverage. It is time to get the federal government out of the way and give patients the best tools to make their own healthcare decisions. We look forward to continuing to work with private partners to make sure these streamlined enrollment pathways are available, secure, and ensure a high degree of program integrity.”

In March, Price lamented the first failed attempt by Republicans to pass a repeal bill in the House of Representatives, saying then that lawmakers had moved too quickly to set an artificial timeline. Now that a modified bill has managed to pass in the House, Price is bullish on a Senate version passing sometime this summer, telling conservative radio host Hugh Hewitt that a Senate bill could be ready by August.

Grant Huang, CPC, CPMA (ghuang@drsmgmt.com). The author is Director of Content at DoctorsManagement.