Health Plan Weekly

The federal government may be spurred to action on several fronts, from seeking to maintain elevated health insurance exchange subsidies to further extensions of the COVID-19 public health emergency (PHE), which would have beneficial short- and long-term financial implications for health insurers in 2022.

Those are just two areas that, pending federal action, could deliver significant wins for health plans this year, according to a panel of experts from Avalere Health during the Jan. 6 webinar, Avalere 2022 Healthcare Industry Outlook: Advance Your Opportunity.

For health insurers that operate in the Affordable Care Act exchanges, 2022 is shaping up to be a relatively stable, profitable year with few regulatory surprises, health policy experts tell AIS Health. Still, there will be some regulatory uncertainty that plans must grapple with as well as a newly proposed rule effective in 2023 that imposes tighter controls on benefits and network design than even the Obama administration attempted.

That regulation is the Notice of Benefit and Payment Parameters (NBPP) 2023 Proposed Rule, released by the Biden administration on Dec. 28. Perhaps the biggest change included in the annual omnibus exchange rule — the move to require standardized ACA marketplace plans — was already known to the industry but still promises to make a significant impact.

UnitedHealthcare — which last summer drew the ire of provider groups when it announced plans to roll out more restrictive coverage policies for emergency care — is now making it clear that it has no plans to implement such a change.

In a letter sent Dec. 30 to the American Hospital Association (AHA), the insurer sought to reassure the trade group that “consistent with our prior communication in June 2021, UnitedHealthcare is not implementing any new policy regarding coverage criteria for emergency level care on January 1, 2022.”

For the Medicare Advantage industry, change wasn’t a major outcome of the Biden administration’s first year in office. But for 2022, MA organizations face a host of unknowns — such as potential risk adjustment and star ratings changes that could impact plan revenue — and challenges that include staying competitive in an increasingly rich benefits landscape. For AIS Health’s annual roundup of perspectives on the year ahead, industry experts weigh in on how doing business in 2022 might differ from previous years.

AIS Health: What do you view as some of the biggest challenges or uncertainties facing MAOs in 2022?