The Senate voted Wednesday to pass the 21st Century Cures Act, a wide-ranging legislation package that touches multiple sectors of the healthcare industry—including public and private payers.
Health insurance industry trade group America’s Health Insurance Plans already weighed in on the act when it passed the House last week.
“We share the commitment of Cures to improving brain health, defeating cancer and combating opioid addiction,” the organization said in a statement. “We look forward to working with policymakers on implementation of the law, especially changes to the Medicare Advantage program.”
Here’s a look at some of the payer-related topics included in the legislation:
More muscle in mental health parity oversight
In keeping with the Obama administration’s mission to increase enforcement of laws that require insurers to cover behavioral health treatments as adequately as they cover medical treatments, the act says that government agencies will issue guidance to help health plans improve their compliance.
In addition, if the secretary of the Department of Health and Human Services, the secretary of labor or the secretary of the Treasury determines that a group health plan or health insurance issuer has violated the existing mental health parity law at least five times, one of those officials will audit the plan’s documents to improve its compliance.
Selected agencies also will submit a report to committees in the House and Senate summarizing the results of all closed federal investigations completed during the prior year that found any serious compliance violations.
Tweaks to Medicare Advantage quality-rating rules
The act says that through the end of the plan year 2018, the HHS secretary cannot terminate an organization’s Medicare Advantage contract “solely because the MA plan has failed to achieve a minimum quality rating under the 5-star rating system.” This temporary delay, the legislation says, is intended to give officials time to reform the star-rating system after studying and collecting feedback about the effects of socioeconomic status and dual-eligible populations on the ratings.
While that represents a reprieve for poor-performing plans, many plans routinely score high marks on the ranking system as they vie for lucrative government bonus payments. In the Centers for Medicare & Medicaid Services’ most recent rankings, about 49% of MA and prescription drug plans earned four stars or higher.
Other Medicare regulation adjustments
The act also will require the HHS secretary submit a report on Medicare enrollment data to two House committees and the Senate Finance Committee every year. That data must be presented by congressional district and state and should include information on fee-for-service and Medicare Advantage enrollment.
Further, the legislation says the HHS secretary must request information from stakeholders such as patient advocates, issuers and employers on what information to include in beneficiaries’ “Welcome to Medicare” package, then update the package so that it provides information about benefits options under Medicare Parts A, B, C and D that is “presented in a clear and simple manner.”