Health Plan Weekly

Editor’s note: An earlier version of this article indicated that the star ratings released on Oct. 8 were for the 2022 plan year, but they were in fact for the 2021 plan year. This version has been corrected.  

Star ratings for Medicare Advantage plans declined across the board for 2021, signaling an overall drop of around 5.5% in the number of members enrolled in contracts with 4 or more stars, according to an analysis of MA data.

When the coronavirus pandemic bore down on the U.S., health insurers not only moved to waive cost sharing for COVID-19 testing and treatment but also for telehealth visits of all varieties, as shutdowns and fears of contracting the virus kept most Americans out of traditional clinical settings. And there’s clear evidence that consumers embraced virtual care with gusto: a recent analysis from FAIR Health found that telehealth claim lines (an individual service or procedure listed on an insurance claim) in the privately insured population increased 3,806% between July 2019 and July 2020.

However, some major insurers have now ended their across-the-board cost-sharing waivers for non-coronavirus-related telehealth visits, putting certain members on the hook again for copays, coinsurance and/or deductibles if they opt for a virtual appointment.

California recently passed a law requiring health plans to follow a more expansive definition of behavioral health reimbursement parity starting in 2021. Experts say that plans will have to spend more on behavioral health care than they did before, as payers’ utilization management practices will have to follow a more generous standard for medical necessity.

The new law, which passed the California Assembly as S.B. 855 on Sept. 23, expands the requirements of existing behavioral health parity statutes to require that plans reimburse all “medically necessary” behavioral health treatment, including substance use disorder treatment. The law also includes a provision that requires plans to limit cost sharing to in-network levels for members who are only able to access out-of-network providers.

✦ Insurers that recover funds from a favorable Supreme Court ruling in a case regarding Affordable Care Act risk corridors payments (HPW 5/4/20, p. 1) must share some of that money with customers, CMS proposed in a guidance document issued Sept. 30. “Issuers must submit a revised MLR reporting form(s) for the 2015 through 2018 reporting years for each state, market, and year in which the issuer has a greater rebate liability based on inclusion of the recovered RC [risk corridors] payment amounts,” the agency said. “Issuers must pay the outstanding rebate amounts to the enrollees who were enrolled in the respective MLR reporting year.” Read more at https://go.cms.gov/36mPQ6l.

✦ Between February and June 2020, Medicaid enrollment increased by 6.2% with nearly 4 million new enrollments, according to recent data from CMS. The agency’s first monthly Medicaid and CHIP Enrollment Trends Snapshot shows that overall enrollment in Medicaid and CHIP “sharply increased” during the COVID-19 public health emergency, and again with the passage of the Families First Coronavirus Response Act maintenance of effort requirement, which prohibited states from conducting eligibility redeterminations as a condition of receiving enhanced Medicaid funding. Visit https://bit.ly/2EPKrtb.