Health Plan Weekly

Demand for mental health care has ballooned since the onset of the COVID-19 pandemic, and lawmakers from both parties have introduced legislation designed to improve access to such care. But while the idea of increasing access to mental health care is appealing to virtually all members of Congress, there is a tangle of policies that could achieve it, and legislators haven’t been able to agree on which threads should be spun into a high-profile reform bill. One such proposal that is backed by the White House and just passed the House of Representatives — H.R. 7780, the Mental Health Matters Act (MHMA) — was attacked by employer plan sponsors this week. 

Congress seems poised to act on mental health issues this year, Joel White, president of Horizon Government Affairs, tells AIS Health, a division of MMIT. White is a veteran lobbyist and a former Republican staffer in the House of Representatives. The House has passed several mental health measures — including, on Sept. 28, H.R. 7780 — but the Senate’s work is moving at a slower pace. 

Many of the medical loss ratio (MLR) reports that Medicaid managed care organizations submit to states are incomplete, and much of that missing data concerns how much MCOs are spending on administrative services, according to a new report from the HHS Office of Inspector General (OIG).  

The report, published in September, is part of a “body of work” that the watchdog agency initiated a few years ago that focuses on the implementation of the federal MLR requirements for Medicaid managed care ushered in via the 2016 update to MCO regulations, the HHS-OIG Office of Evaluation and Inspections tells AIS Health via email. The new report builds upon a data brief issued in August 2021 that “served as a first-of-its-kind nationwide landscape of Medicaid managed care MLRs,” and found that most states established a minimum MLR of 85% for their contracted MCOs. That means plans must spend at least 85% of their premium revenue on covered health care services and quality improvement activities. 

The Texas Medical Association (TMA) doubled down on its lawsuit to overturn federal regulations implementing the No Surprises Act (NSA), the 2020 law that banned balance medical billing, even though national provider groups like the American Medical Association (AMA) and American Hospital Association (AHA) abandoned their suit against the Biden administration after federal agencies released the latest NSA regulations in August.  

Meanwhile, insurers and providers have already filed tens of thousands of balance billing cases with arbitrators — which means that providers have ample financial incentive to pressure the administration through legal action, experts tell AIS Health, a division of MMIT. 

Nebraska on Sept. 23 revealed that it awarded Medicaid managed care contracts to three health plans: Molina Healthcare of Nebraska, Nebraska Total Care (a subsidiary of Centene Corp.) and UnitedHealth Care of the Midlands. The contracts, which the state awarded after reviewing five total bids, will last five years with two-year optional renewals. The transition to the new contracts will take place on Jan. 1, 2024. Community Care Plan of Nebraska (doing business as Healthy Blue) and Medica Community Health Plan were the two bidders that were not selected. 

The Medicare Part B standard monthly premium will fall 3% in 2023, going from $170.10 to $164.90, CMS said on Sept. 27. The decline — which President Joe Biden noted is the first in more than a decade — is due in part because lower-than-expected spending on the Alzheimer’s treatment Aduhelm increased the funds available in the Supplementary Medical Insurance Trust Fund. The Medicare Part B standard premium jumped by $21.60 in 2022, which CMS blamed in part on the anticipated costs associated with Aduhelm. The annual deductible for all Medicare Part B beneficiaries, meanwhile, will also drop next year, by $7 to reach $226.