Democrats and Republicans have reportedly reached an agreement on an appropriations bill for the remainder of fiscal year 2017, which lasts through September. According to a summary of the portion of the legislation covering the Department of Health and Human Services, it contains appropriations provisions affecting the Affordable Care Act much like those in last year's bill.
Risk Corridor Payments
Like the 2015 and 2016 appropriations bills, the legislation prohibits the Department of Health and Human Services from paying out more in risk corridor payments to health insurers that have excess losses in the marketplaces than it collects from health insurers that make excess profits. This provision guarantees that health insurers will not be paid the full amounts owed them for the program in its final year unless the Federal Court of Appeals holds that HHS owes the insurers the full amount that they would be due under the ACA's risk corridor formula. To date lower courts have ruled both for and against the insurers on this issue.
IPAB
Second, as it did last year, the appropriations bill removes all funding for the Independent Payment Advisory Board (IPAB). The ACA requires the IPAB to make recommendations for cutting Medicare spending in years when the CMS Actuary concludes that the projected average Medicare growth rate for the 5-year period ending 2 years later will exceed the target growth rate for the year ending that period. The 15 members of the IPAB have never been appointed, but it has not mattered until now because the growth rate has not exceeded the target. But Medicare costs have been trending upward and 2017 may be the first year that the CMS Actuary reports that action is needed.
The Actuary's report was supposed to have been made by April 30. In recent years, however, it has not been made on time and the report will be late again this year. In any event, the ACA's IPAB provision states that if the IPAB fails to submit a proposal, as it certainly would not this year as it does not exist, then HHS can submit a proposal in its stead. Congress would then have to act on the proposal or it would be implemented. Republicans (and many Democrats) have long opposed the IPAB, and whether or not the Price HHS would submit a proposal is an open question.
Cost-Sharing Reduction Payments
The bill does not include a provision for payments to insurers for cost-sharing reductions for low-income marketplace enrollees. The Trump administration has sent mixed signals on whether it will continue the payments.
The bill also contains language much like that contained in earlier appropriations bills concerning ACA implementation. CMS must notify the appropriate congressional committees two days before ACA-related data or grant opportunities are publicly released. HHS must publish information on ACA-related spending by category, as well as information on the number of employee, contractors, and activities involved in implementing, administering, or enforcing ACA provisions. The bill does not include a rider that would have prohibited the IRS from enforcing the individual mandate.
The bill would also provide a $2 billion increase for the National Institutes of Health, $801 million for fighting Opioid abuse (a 430 percent increase over last year), level funding for community health centers and the preventive health services block grant program, and, reportedly, no defunding of Planned Parenthood.
HHS Taking Over Connecticut Reinsurance Program
On April 28, 2017, the Centers for Medicare and Medicaid Services announced that as of April 7, 2017 it is taking over the operation of the ACA reinsurance program in Connecticut for payments for the remainder of 2015 and for 2016. Connecticut was the only state operating its own reinsurance program. Although the ACA's temporary reinsurance program ended in 2016, CMS still must make payments owed to insurers to wrap up the program. CMS will make the payments to Connecticut insurers and manage reinsurance appeals there.
The ACA permitted states to operate their own reinsurance programs. The fact that only one—Connecticut—did so, and that it is now ending its program, might hold a lesson for the Republicans' proposed American Health Care Act, which would also look to the states to run reinsurance or other premium stabilization programs.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/2pQrLRc
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