Health Plan Weekly

During a Sept. 20 KFF webinar, presenters and panelists seemed to agree on one thing: Regulations aimed at curbing misleading Medicare Advantage TV ads are a welcome fix for a mounting problem. Even an executive from the largest health insurance trade group acknowledged that “bad actors” in the MA marketing space need to be reined in — although he also stressed that most people are satisfied with their private Medicare plans.  

Meanwhile, CMS Administrator Chiquita Brooks-LaSure, who kicked off KFF’s hour-long virtual event, made it clear that the Biden administration is ratcheting up scrutiny of MA plans primarily in response to rising consumer complaints.   

Regulators on Sept. 20 released the latest in many iterations of rulemaking related to the No Surprises Act (NSA), the 2021 law that banned surprise medical billing. Meanwhile, one expert tells AIS Health, a division of MMIT, that evidence is growing that insurers have gained a notable advantage in rate negotiations with emergency departments. 

The new proposed rule deals with fees related to Independent Dispute Resolution (IDR), the arbitration system set up by the NSA. Previous rulemaking, which was challenged in court by provider groups, required each party to pay $350 per case when they submit a batch of cases to an IDR entity. The new proposed rule requires each party to pay $150 per case, according to Manatt, Phelps & Phillips LLP partner Harvey Rochman. 

The latest round of mental health care parity regulations would require health plans to detail members’ access to mental health care and the extent of behavioral health networks in much greater detail than before — and a recent federal report says that most plans were not in compliance with previous reporting standards. Experts say that the reporting requirements are a drastic change from previous standards, and plan sponsors and insurers have asked the Biden administration for more time to review the proposed rule. 

The Biden administration has made significant changes to regulators' mental health parity enforcement powers in the past, and the latest set may be the boldest yet. The latest proposed rules, issued July 25, include specific data reporting requirements around non-quantitative treatment limits (NQTLs) and more stringent network adequacy requirements. Indeed, insufficient network adequacy now could count as an NQTL for enforcement purposes. 

Bright Health Group, Inc. — the struggling “insurtech” firm that is in the process of pulling out of the health insurance business entirely — disclosed recently that it has failed to deliver $380 million to other health plans that it’s required to pay under the Affordable Care Act’s risk adjustment program. The firm therefore has entered into a repayment agreement with the federal government. 

In a press release, Bright touted the agreement as a sign the company is making “significant progress” toward the wind down of its ACA exchange business. Bright stopped offering ACA plans in all 15 states in which it operated starting in 2023 amid ongoing financial troubles.  

Most of the health plans ranked by the National Committee for Quality Assurance received an overall rating of 3.5 stars or higher, according to the NCQA’s 2023 health plan ratings.

Of the rated plans, only two out of the 1,095 plans listed received five stars this year: Kaiser Foundation Health Plan of the Mid-Atlantic States and Independent Health Association, Inc. In the 2022 ratings, six out of 1,048 health plans earned five stars. Commercial health plans had a higher overall rating compared to Medicaid and Medicare health plans.