News

CMS Hold Harmless/Tax Arrangement Guidance

• CMS recently provided additional sub-regulatory guidance on new and existing health care-related tax arrangements. The guidance provides additional information on the agency’s enforcement discretion regarding new and existing health care-related tax arrangements following the April 2024 Informational Bulletin and publication of the Managed Care Final Rule (CMS, September 9; AEH, September 16).

CMS Requests Public Comments on the New MHPAEA Compliance Tools

• Following its September 2023 informal request for comments on mental health (MH) and substance use disorder (SUD) parity requirements, CMS has decided to establish a standardized and simplified parity compliance documentation process. CMS developed comprehensive templates and instructional guides for states and plans to document how benefits are provided within managed care in compliance with the requirements set forth in the Medicaid and CHIP Mental Health Parity and Addiction Equity Act. The guides and templates are available for download in an excel and PDF format and include a State Summary Template, an Instruction Guide for Parity State Summary, Parity Plan Reporting, Parity State FFS Reporting, and an Instructional Guide for Parity Plan and State FFS Program Reporting. Notably, the templates include specialized worksheets for each program type, the analysis of aggregate lifetime and annual dollar limits, as well as financial requirements, quantitative treatment limitations, and non-quantitative treatment limitations. CMS seeks informal public comment on the tools to gather feedback on utilization and possible improvements that can be made prior to finalization. Comments should be submitted to MedicaidandCHIP-Parity@cms.hhs.gov by October 29, 2024 (CMS, September 9).

Federal Legislation

U.S. House Energy & Commerce Committee Announces Upcoming Votes on Telehealth Related Bills

• This week, the House is scheduled to convene and vote on a variety of telehealth related bills, including the Supporting Patient Education and Knowledge (SPEAK) Act of 2023, which would establish an HHS run task force to improve access to health-related IT for individuals with Limited English Proficiency (LEP) and individuals who are visually or hearing impaired. A vote will also occur on the Telehealth Enhancement for Mental Health Act of 2024, which would require HHS to create guidelines for the facilitation of tele-mental health services to LEP, visually and hearing-impaired individuals, as well as provide for a Medicare modifier for these services. A vote is scheduled on the Telehealth Modernization Act of 2024, which if fully enacted, would extend the telehealth flexibilities permitted during the pandemic for another two years (Inside Health Policy, September 17).

Federal Litigation

PBM Express Scripts Sues the Federal Trade Commission

• Express Scripts, a major pharmacy benefit manager (PBM), is suing the Federal Trade Commission (FTC) and seeking to retract an agency report released earlier this year that Express Scripts claims is false and defamatory. The report released by the FTC in July found that six PBMs, including Express Scripts, fill 95% of prescriptions in the U.S. and that these dominant PBMs can raise the cost of drugs. The lawsuit comes as the FTC gears up to sue the three largest PBMs in the country over their role in an alleged anticompetitive scheme to steer patients to high-cost drugs. This coincides with PBMs’ business practices facing general bipartisan scrutiny in Congress as lawmakers seek increased transparency (Politico Pro, September 17).

Federal Studies and Reports

Census Bureau Report Finds the Uninsured Rate was Stable in 2023

• The Census Bureau reports that the proportion of Americans without health insurance remained stable in 2023 and close to the record low achieved in 2022 through the expansion of the Affordable Care Act. However, the Census Bureau findings are based on surveys conducted early this year and count individuals as uninsured only if they lacked insurance coverage for all of 2023. Therefore, the report likely does not capture the unwinding of the Public Health Emergency (PHE), during which tens of millions of Americans lost Medicaid coverage after the PHE protections expired. It is not yet clear what effect the unwinding has had on insurance coverage, and the Census Bureau plans to release additional data that looks closer at this information in their 2026 report. The Medicaid unwinding has been completed in most states and over 25 million people have been disenrolled. While many people disenrolled from Medicaid have successfully reenrolled or obtained other coverage, some individuals remain uninsured (Modern Healthcare, September 16).