Below are Legislative & Regulatory updates related to the Health Care Industry for June, 2019

The Administration Finalizes Rule Expanding Access to Health Reimbursement Arrangements - The Departments of Health and Human Services, Labor and Treasury have released a final rule that will make it easier for employers to use health reimbursement arrangements (HRAs) to fund premiums and out-of-pocket costs for their employees in the individual health insurance market. The rule also creates a new Excepted Benefit HRA (EBHRA) that employees can use to pay premiums for excepted benefits, including short-term plan premiums. The administration estimates that 11.4 million workers will eventually gain coverage through HRAs, of which it estimates 800,000 are currently uninsured. The administration also anticipates 800,000 companies will take advantage of the new rule, with nearly 90 percent of them having fewer than 20 employees. The final rule includes safeguards preventing employers from dumping their sickest workers onto the ACA marketplace. The rule will go into effect beginning on January 1, 2020.

House Committee Leaders Concerned About Recent HHS Policy Changes - Energy and Commerce Chairman Frank Pallone (D-NJ), Ways and Means Chairman Richard Neal (D-MA), and Education and Labor Chairman Bobby Scott (D-VA) sent a letter to HHS Secretary Alex Azar asking questions about an internal HHS memo that includes analysis on the harmful impacts of the administration’s policy changes to the ACA. In the HHS memo, CMS Administrator Seema Verma recommended against adopting administration policy proposals including an end to silver loading, terminating automatic re-enrollment for consumers in the ACA Marketplace, and changes to the premium indexing methodology that would reduce advance premium tax credits for consumers, citing coverage losses and price increases for consumers. According to CMS’s internal analysis, these three actions would result in 1.1 million individuals losing coverage, further premium increases, and market disruption. In their letter to Azar, the Chairmen called on Azar to not finalize the proposed policy changes and requested further documents from HHS related to the memo.

Energy & Commerce Committee Holds Hearing on Surprise Medical Bills - On June 12^th, the House Energy & Commerce Committee held a hearing on ways to address the issue of surprise medical billing. Witnesses representing payers, providers, employers, hospitals and patients all testified. There was bipartisan consensus among the committee that patients should not be held responsible for unexpectedly high medical bills and that the health care industry must act, otherwise Congress would. Discussion also centered on the No Surprises Act, a draft bill that would prohibit balance billing for emergency services and non-emergency services provided by an out-of-network provider at an in-network facility. The Act is one of several legislative proposals that have been put forth in recent months that address the issue of surprise medical billing. As legislation addressing surprise medical billing looks increasingly likely to become law, a key issue will be determining whether to benchmark rates paid to providers or whether to implement some form of arbitration between payers, providers and hospitals in cases where there is a billing dispute. Payers, providers and hospitals differ on which option to implement, and there is likely to be intense debate on this issue as legislation moves forward.

States Increase Scrutiny of Health Care Sharing Ministries – As health care sharing ministries, religious organizations where members help pay each other’s medical bills, have grown dramatically in recent years, they have come under increased scrutiny from state regulators. Members of health care sharing ministries are exempt from the ACA’s individual mandate and more than one million people have joined health care sharing ministries since the ACA was enacted. Health care sharing ministries do not have the same protections as ACA plans, such as covering pre-existing conditions or preventive services and may have limits on the total amount they will pay for treatment. The Nebraska Department of Insurance in 2018 warned that health care sharing ministries are not considered insurance and cannot be forced to pay members’ medical bills. Last month, Washington’s state insurance commissioner ordered Aliera Healthcare to stop sales in the state saying that Aliera’s promotional efforts could mislead consumers into believing the products were insurance. State regulators have limited power as the ministries are not regulated by state insurance commissioners and state legislatures have passed bills guarding the ministries from state regulation on the grounds that the state should not interfere in a religious organization.