Issue #162

Advisory Committee on Long COVID

• On November 16, HHS introduced plans to create an advisory committee focused on the effects of long COVID. The idea to establish the committee was first mentioned in the August 2022 National Research Action Plan on Long COVID. Individuals diagnosed with long COVID and multidisciplinary experts will serve on the panel that is designed to inform action on long COVID with a focus on health equity. The committee comes after $45 million in grants for long COVID clinics throughout the country was announced so access to long COVID care can be coordinated for individuals in underserved areas. HHS also established the Office of Long COVID Research and Practice while the National Institutes of Health has asked individuals to participate in clinical studies to examine potential treatments (Inside Health Policy, November 16).

Federal Regulation

• On November 15, HHS released a Notice of Benefit and Payment Parameters for 2025 with the proposed rule scheduled to be published in the Federal Register on November 24. In the proposed rule, CMS addresses standards for issuers and Marketplaces, as well as proposed requirements for agents, brokers, web-brokers, direct enrollment entities, and assisters that help Marketplace consumers. It also advances the Biden administration’s goal of promoting health equity and improves upon the Affordable Care Act (ACA) objectives by expanding access to quality, affordable health coverage and care, streamlining choice and enhancing the plan selection process, simplifying the enrollment process, increasing standards for consumer protections, clarifying the authority to access certain data through Medicaid, CHIP, and Marketplace Hub services, and enhancing markets (CMS, November 15).

Federal Studies and Reports

• A study completed by the Employee Benefits Research Institute (EBRI) found that regular visits to a primary care physician between 2013 and 2021 were in significant decline but resources allocated towards primary care were significantly up between 2010 (11.7%) and 2020 (15.1%). Researchers used claims data and insurance information in conducting the study. The study also found that a larger portion of primary care services are being handled by non-physician health care providers. Additionally, EBRI researchers found that younger enrollees are the least likely to access care at general medicine and internal medicine practices, while middle-aged employees are shifting to nurse practitioners, with all age groups moving toward seeking care from physician assistants (Health Payer Specialist, November 20).

Waivers

• Section 1115
  • Arizona
    • On November 15, 2023, Arizona requested to amend its demonstration to raise the CHIP eligibility threshold from 200% FPL to 225% FPL. This amendment is titled, “Arizona KidsCare Expansion.” The federal public comment period is open from November 20, 2023, through December 20, 2023. Public comments can be submitted here.
  • North Carolina
    • On October 31, 2023, North Carolina submitted an application to extend its section 1115(a) demonstration titled “North Carolina Medicaid Reform Demonstration.” The state is seeking to renew its demonstration for an additional five year period. Through this renewal request, North Carolina is requesting for extension of the ongoing managed care authorities, an expansion of and refinements to the Health Opportunities Pilot Program, and authority for new initiatives in line with state goals. The new initiatives will streamline Medicaid enrollment for children and youth; improve care for justice-involved individuals; and invest in behavioral health. The federal public comment period is open from November 20, 2023 through December 20, 2023. Public comments can be submitted here.

SPAs

• A provision in the federal spending bill approved last year ensures all individuals 18 and under who are Medicaid or CHIP beneficiaries will be covered continuously starting January 1, 2024. Missouri has been among the states that does not offer yearlong coverage. However, starting January 2024, those enrolled in Missouri’s Medicaid or CHIP programs will not be removed for 12 months. This change comes as the state is going through its redetermination process, and according to the Kaiser Family Foundation (KFF), Missouri has removed nearly 110,000 people from the rolls, close to half of which are children. However, the 12-month coverage will apply to those who enroll after January 1, but those who are determined to be ineligible or who the state cannot reach during the Medicaid review process will still be taken off coverage (KSMU, November 20).
• Pennsylvania is in the process of restoring Medicaid coverage for 105,000 residents who were terminated for procedural reasons during the unwinding period. CMS notified several states, including Pennsylvania, of a procedural error in ex parte eligibility determinations, in which the state was determining eligibility at the household level and not the individual level. This eligibility determination method disproportionately impacted children, who have higher income thresholds for eligibility. Pennsylvania is providing retroactive coverage to the date when the individual or family lost Medicaid coverage. From April through August the state disenrolled 119,894 people for procedural reasons and another 143,310 due to no longer qualifying for the program (MSN, November 17).
• Pennsylvania Governor Josh Shapiro has announced that all commercial insurers in the state will be required to cover autism benefits starting January 1, 2024. In support of mandating such coverage for autism benefits, the governor cites to the Mental Health Parity Laws, which requires coverage for mental health to be as accessible as coverage for other physical conditions. Though the laws have been in effect since 2008, Governor Shapiro’s administration has been more heavily involved in their enforcement than prior administrations (WDIY, November 8).
• Effective October 1, 2023, Kentucky received federal approval to become the first state to implement continuous coverage for 12 months for children in the state without having to complete the renewal process. The increased flexibility will last through the entire unwinding period, ending in April 2024. This allows the state to delay the unwinding process for children 18 and under, keeping more than 600,000 children covered by Medicaid and K-CHIP. Kentucky plans to allocate its resources to focus on contacting adult Medicaid members going through the redetermination process (WUKY, November 16).
• Iowa has awarded contracts to two dental providers, Delta Dental of Iowa and DentaQuest USA Insurance Company, to provide dental services to individuals enrolled in Iowa’s Medicaid and Well Kids (Hawki) programs. The contract will begin on July 1, 2024, and serve more than 825,000 individuals (Yahoo, November 14).

News

• As healthcare struggles with one of the most challenging years for cybersecurity on record, health systems executives are making data security solutions a budget priority. Guidehouse, a consulting firm, surveyed health system CEOs and chief financial officers to determine the top three IT investment priorities in 2024. The five main takeaways from the survey of 144 executives are as follows:
  • Prioritizing cybersecurity upgrades such as vulnerability management, data security, and threat detection software.
  • Spurred investment due to more IT systems to attack and more to defend.
  • AI indirectly plays a role in budgets as better data security systems will only become more critical as health systems implement AI.
  • Despite tight margins, IT budgets are increasing overall.
  • IT is not exempt from a larger effort across health systems to reduce costs and those efforts to cut costs overall will persist (Modern Healthcare, November 20).

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