Health Plan Weekly

Risk adjustment transfers reached $10.8 billion in the Affordable Care Act program for the 2019 benefit year, with the individual market accounting for about $7.98 billion, according to CMS. Among the 561 issuers that participated in the program, a handful were slated to receive significant payments. Blue Shield of California was due to collect more than $1 billion, with $873.8 million related to its individual market plans. Florida Blue followed with an expected $773.9 million payout. Meanwhile, Kaiser Foundation Health Plan, Inc. in California will have to pay nearly $796.6 million into the risk adjustment program.

A Trump administration rule expanding the availability of short-term, limited duration (STLD) health insurance plans will continue after an appeals court panel ruled 2-1 against a suit brought by the Association for Community Affiliated Plans (ACAP). A July 17 statement by ACAP CEO Margaret Murray suggests the trade group for safety net health plans is likely to continue pursuing the case.

“We are disappointed in the court’s decision but remain firm in our belief that junk insurance plans violate both the Affordable Care Act and the Administrative Procedure Act,” Murray wrote in the statement. ACAP has the option of petitioning the D.C. Circuit Court of Appeals to hear the case en banc, which would bring every member of the circuit’s bench together to hear the suit again. Murray’s statement indicates ACAP is likely to pursue that option. “We’re confident the full D.C. Circuit will agree,” Murray added.

Both UnitedHealthcare and Humana Inc. are rolling out new disease-specific care management programs aimed at providing patients with the tools they need to help control their chronic conditions.

The programs — UnitedHealth’s focusing on type 2 diabetes and Humana’s on chronic kidney disease — highlight both new digital and time-tested interpersonal ways of managing chronic conditions, observers say.

In recent years, high-deductible health plans (HDHPs) — now common in both employer-sponsored and individual markets — have faced increasing scrutiny as evidence emerges that they may not actually cause people to be savvier health care consumers. Now, a new study adds another layer to the debate by finding that access to and uptake of health savings accounts (HSAs) is low among people enrolled in HDHPs. Experts have varied opinions on the study’s implications, but they agree that the findings underscore the need for better consumer education about the benefits of HSAs.

The study, published on July 17 by JAMA Network Open, details findings from a 2016 survey of a nationally representative sample of U.S. adults ages 18 to 64 who were enrolled in an HDHP for at least 12 months. Researchers reported that 32% of HDHP enrollees did not have an HSA, and 55% of HDHP enrollees who did have an HSA had not contributed any pretax funds to their account in the past 12 months.

Stakeholders across the health care industry praised recently finalized revisions to the Substance Abuse and Mental Health Services Administration’s 42 CFR Part 2 rule. The changes loosen disclosure and privacy requirements about a patient’s history of substance use disorder (SUD) treatment. Experts say the rule should improve care coordination for people with SUD challenges, though some expressed concerns about limited care resources and patient privacy.

“I think [the final rule] provides more freedom for using information that previously was more confidential under Part 2. It seems to be geared towards practical considerations that had inhibited the use of such data,” health care lawyer Raja Sekaran, a partner at Nossaman LLP, tells AIS Health. Sekaran previously worked as an attorney in HHS’s Office of Inspector General. “What I see in it are a lot of opportunities for broader waivers and consents for information to be shared in different contexts.”