Health Plan Weekly

✦ HHS Secretary Xavier Becerra renewed the COVID-19 public health emergency (PHE) for an additional 90 days on July 19. The decision was something of a formality, as statements by Biden administration officials have indicated that the PHE will extend through the end of 2021 at the soonest. The Biden administration also promised in January that it would give governors at least 60 days’ notice before ending the emergency, to ensure stability in programs like Medicaid and CHIP, which have been bolstered by emergency pandemic funding. Citi analyst Ralph Giacobbe wrote in a July 19 note to investors that “the PHE should help many aspects related to reimbursement for both MCOs and healthcare providers, [and] the renewal of the PHE also ensures that COVID-19 molecular test reimbursement mechanism will also remain….Overall, we see the extension of the PHE as beneficial to our coverage universe in totality given the increased flexibility and reimbursement related to the COVID-19 pandemic.”

✦ The Missouri Supreme Court on July 22 issued a unanimous opinion upholding a voter-approved expansion of Medicaid. After the state’s Republican-controlled legislature refused to allocated funds for an expansion initiative backed by a successful ballot initiative, Gov. Mike Parson (R) informed CMS that the state was withdrawing its plans to expand Medicaid eligibility in the state, prompting the legal battle. The state Supreme Court’s ruling reverses a circuit court decision.

by Jinghong Chen

Due to the pandemic-driven economic crisis and the launch of a special enrollment period for the federal health insurance exchange, member enrollment has continued to shift from commercial health coverage toward managed Medicaid and exchange plans, according to AIS’s Directory of Health Plans. Among the top five national insurers in the commercial risk market, all but Anthem, Inc. saw enrollment declines last month compared with June 2020. As the Blues’ market leader, Anthem also picked up significant market share in both Medicare Advantage and Medicaid markets nationwide over the past year.

While the COVID-19 pandemic complicated many smaller Medicare Advantage organizations’ efforts to connect with members during the Medicare Annual Election Period (AEP) last fall, reports of aggressive and misleading marketing practices also resulted in the unintentional disenrollment of individuals from their plans, which not only hurts from a revenue perspective but can negatively impact their star ratings. According to several sources who spoke with AIS Health, a division of MMIT, these tactics were more egregious than usual during the 2021 AEP and the Open Enrollment Period (OEP) that ran from January through March, when members who selected an MA plan in the fall may make a one-time coverage switch.

“We’ve always seen some very aggressive marketing practices, especially from some of the large, national players. But over the last two years, and especially in the last six months, it’s gone from aggressive marketing tactics to what many plans would qualify as teetering on the side of deceptive marketing practices. And it’s not just one large player,” says a source who works with health plans and asked not to be identified for this article.

Anthem, Inc.’s stock took a dive after its second-quarter 2021 earnings conference call on July 21, surprising equities analysts who saw the large Blue Cross Blue Shield insurer’s financial performance and outlook as relatively solid.

Jefferies’ David Windley, in a note issued to investors on the evening of July 21, attributed the “negative reaction” regarding Anthem’s results to “fear of the unknown.” The insurer’s management “didn’t bless growth above target range for ’22, despite several favorable indicators,” Windley acknowledged, and “it offered a couple of start-up headwinds” related to recent contract wins, “though nothing big enough to overwhelm unwinding COVID headwinds and already conservative balance sheet in ’21.”

The growth in hospital trauma center designations has coincided with increases in improper “trauma alert” coding and billing, leading to astronomical bills for patients and payers. This finding, reported in an investigation by Kaiser Health News (KHN), means payers will have to step up their scrutiny of emergency claims, experts say.

Trauma centers are special designations given to hospitals that can provide the highest standard of care in cases of severe, time-sensitive injuries. They employ a specially trained, highly experienced team of doctors and nurses who can scramble to attend to a severely wounded patient in minutes. Traditionally, these teams were stationed in one of several local hospitals and activated when EMTs requested they be ready as soon as the ambulance arrived at the emergency room door.