Health Policy News April 2018

After months of uncertainty and waiting, guidance on various regulatory and policy changes have been issued this month by the federal administration. While we still await final guidance on association health plans and short term limited duration plans, the Centers for Medicare & Medicaid Services (CMS) has released the final Benefit and Payment Parameters, and the 2019 Letter to Issuers in the FFM- which includes the finalized federal timeline for Qualified Health Plan (QHP) certification and rate review. PCG subject matter experts prepared a summary that highlights key changes related to QHP certification in particular.

Additionally, this edition includes a summary of the proposed rule changes related to Medicaid Access to Care Requirements released in late March.

Lastly, this edition includes a short feature on pending state based individual mandate legislation and an impact study conducted by the State of Vermont. Health Policy News will continue to include pieces in the upcoming Summer editions that provide options and thought pieces for those states working on new policy and ideas for 2018 and beyond.

As always, you can contact us at healthpolicynews@pcgus.com for more information on any of these pieces.


CMS Releases Final Exchange Guidance

On April 9, 2018, CMS released the long-awaited final Exchange guidance for the 2019 plan year- the final Notice of Benefit and Payment Parameters for 2019 (NBPP) and the final Letter to Issuers in the Federally-facilitated Exchanges (Letter). Together, the NBPP and Letter set forth changes to rules and operational and technical guidance for health plan regulation, Exchange operations (including plan certification and financial parameters), and premium stabilization program. PCG subject matter experts prepared a summary that highlights key changes from previous years’ guidance. Click here to read more.

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CMS Proposes Changes to Rules related to Medicaid Access to Care Requirements

On March 23rd, CMS issued a proposed rule that would exempt states from requirements to analyze and monitor access to care in the Medicaid program under certain circumstances. This proposal seeks to amend various reporting and oversight processes, including the documentation required to prove that Medicaid payments in fee-for-service (FFS) delivery systems are sufficient to ensure appropriate access to services, the public process requirements when states seek to change provider rates, and more. Click here to read more.

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Mitigating the Loss of the Individual Mandate – State Based Health Insurance Mandates

States continue to explore ways to stabilize their markets, contain premium costs, and ensure access for individuals to high quality, affordable health care. 2017 was reactionary for many regulators. Quick decisions were needed to adapt to changes in policy, including the loss of federal funding for cost-sharing reductions, but sweeping policy changes still loom including the phase out of the individual mandate penalties. Vermont, given its merged market and relatively low uninsured rate is seeking ways to maintain market stability and continued enrollment with one option being a state based individual mandate. Click here to read more.

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We want to hear from you!

Please do not hesitate to contact us with any questions or requests for additional information.  Also, if you have suggestions or feedback related to the newsletter, please let us know. Contact us today at HealthPolicyNews@pcgus.com.


PCG helps state and local health agencies achieve their performance goals. Our seasoned professionals and proven solutions help agencies to increase program revenue, cut costs, and improve compliance with state and federal regulations. From behavioral health cost reporting to public hospital rate setting, PCG offers a wide array of consulting services to help state and local health agencies operate more efficiently and improve service to the populations they serve. To learn more, visit www.PublicConsultingGroup.com/Health.

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