Budget Blog

July 9, 2020 - Health Care Issues Update

By Stacey Mazer posted 07-09-2020 12:46 PM

  

Governors Call on the Administration to Renew the Public Health Emergency

The National Governors Association called upon the Trump Administration to renew the Public Health Emergency (PHE) for COVID-19, set to expire July 25. The NGA press release states how despite months of response to the coronavirus pandemic, many states have hit record numbers of confirmed COVID-19 cases, causing many governors to pause or roll back re-openings. The PHE declaration, along with Stafford Act declarations, ensures that critical resources, including the enhanced Federal Medical Assistance Percentage (FMAP), funding for testing the uninsured, and critical regulatory flexibilities, remain available at the federal and state level. Under the Families First Coronavirus Response Act, the duration of the 6.2 percent FMAP increase continues through the end of the quarter in which the public health emergency for COVID-19 ends.

 

CMS Releases 2020-2021 Medicaid Managed Care Rate Development Guide

The Centers for Medicare & Medicaid Services (CMS) released the 2020-2021 Medicaid Managed Care Rate Development Guide for use by states in setting their capitation rates between July 1, 2020 and June 30, 2021 for managed care programs subject to the actuarial soundness requirements. This guide includes information that states must include in their rate certifications to ensure that CMS can determine compliance with the applicable provisions in federal statute. A new addition to this year’s rate guide is the national roll-out of an accelerated rate review process. A new appendix to the rate guide summarizes the accelerated rate review process, participation criteria, and documentation requirements. States that elect to use the accelerated rate review process must submit a rate development summary identifying key elements.

 

CMS Updates Medicaid and CHIP FAQs

The Centers for Medicare and Medicaid Services (CMS) updated their frequently asked questions (FAQs) for state Medicaid and Children’s Health Insurance Program (CHIP) agencies. The new FAQs cover a variety of topics including eligibility and enrollment, optional COVID-19 testing group, premiums and cost sharing, and financing. The new FAQs were incorporated into a previously released document; a document containing only the new questions can be found here.

 

HHS Updates Fact Sheet and FAQs on Provider Relief Fund

The Health Resources & Services Administration (HRSA) in the Department of Health and Human Services (HHS) released a new fact sheet for Medicaid and Children’s Health Insurance Program (CHIP) Providers. On June 9, 2020, HHS announced the distribution of $15 billion from the Provider Relief Fund to eligible providers participating in Medicaid and CHIP and have not received a payment from the Provider Relief Fund General Distribution. The payment to each provider will be approximately 2 percent of reported gross revenue from patient care; the final amount each provider receives will be determined after the data is submitted. Applications must be submitted by July 20, 2020. Also, HHS updated their frequently asked questions (FAQs) related to the Provider Relief Fund, including for the Medicaid Distribution.

 

Medical Cost Trends with COVID-19

PwC Health Research Institute’s annual report analyzes various scenarios for employers’ medical cost trends with employers incurring unplanned COVID-19 testing and treatment costs in 2020 that will likely continue in 2021. In 2020, these unplanned costs are expected to be more than offset by the savings from delayed care during the pandemic. An increase in spending is expected in 2021 as the demand for care returns. Employers may face a spike in medical costs between 4 percent and 10 percent for their employees in 2021. The PwC report is based on 23 interviews from February through May with health industry executives, benefits experts, and health plan actuaries.