Health Plan Weekly

Even after a rule requiring unprecedented price transparency from hospitals was upheld in federal court, it remained unclear whether the health insurance industry would go to court to challenge a similar rule targeting their industry. Now, just months from when the “transparency in coverage” regulation is slated to go into effect, that question has an unexpected answer: A lawsuit has been filed, but not by health insurers.

Instead, the U.S. Chamber of Commerce and chief PBM trade group Pharmaceutical Care Management Association (PCMA) filed a pair of lawsuits seeking to strike down the transparency in coverage rule, which was proposed in November 2019 and finalized last October. While it isn’t clear yet how the courts will respond to the litigation, one health insurer trade group says plans are proceeding as though the rule will be implemented as written.

✦ The U.S. Court of Appeals for the District of Columbia Circuit on Aug. 13 overturned a key court victory notched by UnitedHealthcare regarding Medicare Advantage overpayments. In 2018, a lower federal court sided with the insurer’s challenge of a CMS rule, which required MA payments to be actuarially equivalent to those in Medicare fee-for-service and which UnitedHealth claimed resulted in the federal government underpaying MA plans. But D.C. Circuit Judge Cornelia Pillard ruled that actuarial equivalence did not apply to the overpayment rule.

✦ CVS Health Corp.’s Aetna launched what it called the “first nationwide virtual primary care” program, which will be available to self-funded employer plans through a partnership with Teladoc Health Inc. Per an Aug. 10 press release, the program will place members in “a continuous relationship with a virtual care physician beginning from the first 30-45 minute comprehensive primary care visit and extending to every visit thereafter” and will offer a $0 copay “for virtual primary care visits and select in-person services at MinuteClinic and CVS HealthHUB locations.”

CMS will refocus and redouble its efforts on health equity and whole-person health outcomes as the Biden administration evaluates ongoing and potential programs and initiatives, CMS Administrator Chiquita Brooks-LaSure said during an Aug. 12 webcast. Brooks-LaSure, who was confirmed to the post on May 25, spoke during the webcast sponsored by Health Affairs about the overarching goals and principles that CMS will follow under her leadership. Health equity forms the bedrock, she said. “Last year at the start of this pandemic, I think the world got a lesson on the holes in our health care system and what that means when we are not providing equal care across the country,” Brooks-LaSure said. “We cannot be in this position again. And so the first question that we are asking ourselves as a team is, does our policy, does our operation advance health equity? Changing that lens and focus is very much changing...

By Jinghong Chen

Covered California, the state’s health insurance marketplace, will see a preliminary average rate increase of 1.8% in 2022, California revealed on July 28. As several carriers expanded their coverage areas and a new carrier joined the exchange, there will be 12 issuers providing coverage across the state, with all Californians having two or more choices for the 2022 plan year. Among them, Anthem Blue Cross of California, L.A. Care Health Plan, Molina Healthcare and Sharp Health Plan proposed rate decreases. Kaiser Permanente led the market, with more than 570,000 members as of March 2021.

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