Colorado

Four Colorado Community Hospitals on 2018 Top 100 – according to Becker’s
Hospital Review

Annually, Becker’s Hospital Review analyzes several national hospital rankings to come up with their
version of “100 Great Community Hospitals”. In the 2018 edition, Colorado is represented by four
community hospitals judged as industry leaders in operational excellence, quality patient care, and
economic impact on their communities.

For purposes of this survey, a community hospital is defined as a facility with fewer than 550 beds, in a
rural setting or small community outside of a metro-area.

The four Colorado hospitals are: 1. Mercy Regional Medical Center in Durango, 2. Montrose Memorial
Hospital in Montrose, 3. Valley View Hospital in Glenwood Springs, and 4. UCHealth Yampa Valley
Medical Center in Steamboat Springs.i

Read the full list at Becker’s Hospital Review.

Kaiser to Step Back from Providing Medicaid Services to Some Colorado Areas

Kaiser Permanente Colorado has announced that it no longer provides Medicaid services to several
areas along the front range in Colorado. The decision impacts close to 2,500 current Kaiser Medicaid
patients.
The stoppage began as of the first of July and mainly affects patients in Colorado Springs, Frisco, Fort
Collins, Loveland and Pueblo. Services to Medicaid patients in Boulder and Denver will not change. The
State is responsible for reassigning individuals to new Medicaid providers and communicating that
change to each recipient, according to a Kaiser Permanente statement.ii

Read more at Becker’s Hospital Review.
Read more at HealthLeaders.

National

Trump Administration to Resume ACA Risk-Adjustment Payments

CMS issued a final rule to resume risk-adjustment payments to insurance companies with plans on the individual market this week. The agency will now disburse $10 billion in 2017 risk-adjustment payments. CMS had halted payments for 2017 several weeks ago, citing a federal judge’s ruling in New Mexico Health Connections v. United States Department of Health and Human Services et al earlier this year. U.S. District Judge James Browning concluded that HHS did not adequately explain its decision to adopt a payment methodology that used the statewide average premium as the cost-scaling factor and that it needed to do so via rulemaking to ensure that the methodology was indeed budget neutral. 

To comply with this initial outcome in the New Mexico lawsuit, the new final rule issued by CMS on July 24 expands upon the reason behind the payment methodology. Ultimately, the agency reiterated that its algorithm was appropriate. The final rule explains that “HHS chose to use statewide average premium and normalize the risk adjustment transfer formula to reflect state average factors so that each plan’s enrollment characteristics are compared to the state average and the total calculated payment amounts equal total calculated charges in each state market risk pool. Thus, each plan in the risk pool receives a risk adjustment payment or charge designed to compensate for risk for a plan with average risk in a budget neutral manner.”

CMS calculates payments for the program using a statewide average premium to provide budget neutral payments and to spread the cost of covering high-risk enrollees. In addition, the risk-adjustment program is designed to reduce the chance insurance companies will engage in adverse selection to attract healthier enrollees. This is done by financially rewarding participating insurers who do not avoid high-risk beneficiaries with higher medical loss ratios (MLRs). The agency concluded that rulemaking would allow for the continued operation of the risk-adjustment program which is imperative to maintain stability in the individual and small group health insurance markets. The final rule explains insurers will receive invoices between September 11-13, 2018 and payments will begin to be sent out around October 22, 2018. This will come as welcome news to insurers that were about to lose significant amounts of money. A summary report of the 2017 risk-adjustment program shows that insurers in the individual market would have missed out on $7 billion in payments without the program, while small group plans would have lost close to $2 billion. “Issuers that had expressed concerns about having to withdraw from markets or becoming insolvent should be assured by our actions today,” CMS Administrator Seema Verma said. The continuation of the risk-adjustment program will clear up some uncertainty for insurers who are looking to stabilize their costs and spending for the current year. iii

Short-term plans (STPs) Final Rule

This morning the Trump Administration released a final rule and fact sheet regarding short-term limited duration insurance (STLDI), often referred to as short-term plans (STPs), which will go into effect 60 days from today. The rule was in response to an executive order issued by President Trump on October 12 directing federal agencies to expand the availability of Association Health Plans, STLDI policies and Health Reimbursement Arrangements. The final rule effectively ends the policy established by the Obama Administration in 2016 restricting the length of time for STPs and instead extends eligibility for the plans from a maximum of three months to less than 12 months, with the ability to renew coverage at the end of that period. The proposed rule was released in February and NAHU submitted comments on the proposal.

The final rule restores the maximum duration of STPs to up to 364 days as previously permitted, with the ability to renew for up to 36 months at the carrier’s discretion. The Administration was sure to note that the final rule increased consumer protections (which NAHU requested in our comments), specifically requiring insurers to clearly disclose the type of policy the individual is choosing and that these plans do not offer the same coverage as individual plans under the ACA. Although the Administration expects these plans to be 50% to 80% cheaper than plans in the individual market, they do not satisfy the requirement for minimum essential coverage. However, individuals who enroll in STPs for 2019 will not face a penalty due to the tax-reform bill that passed in December 2017, effectively zeroing out the individual mandate penalties effective January 1, 2019.

HHS Deputy Secretary Eric Hargan hosted a call for stakeholders shortly after the release of the final rule. The Administration believes these plans will be welcomed by individuals who either do not currently have access to choices in the individual market or are left without employer-based coverage for a period of time. Hargan repeatedly noted that STPs will still be regulated by the states, and that state insurance commissioners have the ability to enforce rules that are stricter than the federal regulation. NAHU emphasized state control in our comments to this rule and will be monitoring actions by the states and any efforts taken to adopt rules that may differ from the final rule released today.iv


i Colorado Managed Care

ii Colorado Managed Care

iii www.nahu.org

iv www.nahu.org