Health Plan Weekly

✦ During the 2020 open enrollment period for the Affordable Care Act (ACA) marketplaces, approximately 11.4 million people selected or were automatically reenrolled in plans across all 50 states and the District of Columbia, according to new data CMS released on April 1. That means signups held steady compared with 2019, when 11.4 million enrolled, and 2018, when 11.8 million signed up. Average premiums in the 38 states that use HealthCare.gov, meanwhile, dropped 3% from $612 in 2019 to $595 in 2020. Read more at https://go.cms.gov/3bOxGKu.

✦ On March 30, CMS unveiled several significant regulatory changes in response to the COVID-19 pandemic, including easing the conversion of outpatient facilities to hospital use. Other new or changed policies included rules allowing community COVID-19 screening sites, encouraging a move of non-COVID-19 hospital procedures to outpatient sites, allowing ambulances to transport patients to non-hospital facilities, and establishing special dialysis facilities for those stricken with COVID-19. The agency also suspended scheduled audits of Medicare Advantage organizations, Part D sponsors, Medicare-Medicaid plans and Programs of All-Inclusive Care for the Elderly organizations until further notice, and will focus instead on more pressing oversight priorities. Read more at https://go.cms.gov/2JvxMKR.

by Jinghong Chen NOTES: Data includes adults ages 18 and older, but excludes adults living in nursing homes and other institutional settings. Hospital-bed data includes staffed beds/rooms for community hospitals, which represent 85% of all hospitals. SOURCES: Kaiser Family Foundation, “State Data and Policy Actions to Address Coronavirus,” as of April 1, 2020. Visit https://bit.ly/2UZMEqe. AIS’s Directory of Health Plans. Visit https://aishealthdata.com. Click here for a pdf of the full issue

In an effort to help ease cost concerns for those infected with COVID-19, the disease caused by the novel coronavirus, several health insurance companies have waived cost sharing requirements related to COVID-19 treatment.

Besides all the other ways it’s changing American life, the COVID-19 pandemic is sure to have a major impact on how the health care industry does business going forward, equities analysts said during a March 31 panel discussion hosted by the USC-Brookings Schaeffer Initiative for Health Policy.

The 24th Wall Street Comes to Washington Health Care Roundtable was held virtually this year in accordance with social distancing guidelines aimed at slowing the spread of COVID-19, the disease caused by the new coronavirus that emerged in China in late 2019 and then spread throughout the world. As of press time, complications from the virus had killed more than 6,000 people in the U.S. and more than 54,000 globally.

In a first-in-the-nation move, Blue Shield of California has agreed to cover rapid and ultra-rapid Whole Genome Sequencing for critically ill infants and children in intensive care who have unexplained medical conditions. The agreement — which will use testing at Rady Children’s Institute for Genomic Medicine, a center of excellence in genetic testing — likely will spur additional insurers to add coverage for this diagnostic technology, observers say.

“I think the way the health plans are going to go about implementing this is exactly what you’re seeing in this case — they’re going to pick a center of excellence,” Ashraf Shehata, KPMG national sector leader for health care and life sciences, tells AIS Health. “I think they’re going to put some bumper guards around how they could go forward with these approvals. And I think in addition to that, you’re going to see their medical policies probably begin to adapt a bit more to accept the outputs that are coming from these types of tests.”