Community HealthChoices Southeast Is Now Live!

Community HealthChoices (CHC) is Pennsylvania's mandatory managed care program for individuals who are dually-eligible for Medicare and Medicaid and individuals 21 years of age or older with physical disabilities. The Department of Human Services has a 35-minute online training module available to review the CHC program and how it works along with FAQs for viewing. For more information, visit www.healthchoices.pa.gov

Comments Sought on CMS Proposed Rule for 2020 Coverage

Last week, the Centers for Medicare and Medicaid Services (CMS) issued a proposed annual Notice of Benefit and Payment Parameters for the 2020 benefit year. This proposed rule sets forth: payment parameters and provisions related to risk adjustment and risk adjustment data validation programs; cost-sharing parameters; and user fees for federally-facilitated exchanges (FFEs) and state-based exchanges on the federal platform (SBE-FPs). It proposes changes that would allow greater flexibility related to the duties and training requirements for the Navigator program and that would provide greater flexibility for direct enrollment entities. It also proposes policies that are intended to reduce the costs of prescription drugs. The rule proposes to:

• Add and change training requirements for navigators 
• Allow but not require navigators to assist consumers with applying for eligibility for insurance affordability programs and qualified health plan (QHP) enrollment through web-broker websites
• Possibly end the practice of silver-loading that has allowed insurers to offer lower premiums for the 2020 plan year (currently, insurers apply the full premium increase to silver plans and the government pays the remaining costs as the subsidy to consumers) 
• Allow health insurers to make mid-year formulary changes to incentivize greater enrollee use of lower-cost generic drugs
• Allow consumers to buy QHPs outside of Healthcare.gov and require plans to provide consumers with access to "mirrored QHPs" that omit abortion services 
• Reduce the exchange user fee charged to insurers to fund exchange operations 
• Expand the types of hardship exemptions for 2018 through the tax filing process 
• Create a special enrollment period for off-exchange enrollees who experience a decrease in income and who are deemed eligible for advance premium tax credits (APTCs) 

Additionally, the rule asks for comments on:  how many hours per month navigators spend providing enrollment assistance and current workflow; elimination of the automatic re-enrollment process; different options on data collection and dissemination of that data and disclosure of cost sharing information; and changes to the risk adjustment methodology. PACHC will be commenting on these proposed rules by the deadline of Tuesday, Feb. 5. 

Join PACHC's Monthly Enrollment Assister Networking Call

PACHC hosts an interactive, collaborative Outreach and Enrollment Assister call on a monthly basis.  The next call is scheduled for Wednesday, Jan. 30 from 10:00 - 11:00 am.  Call-In Number: 1-800-220-9875; Participant Code, 15072594#.  Join us!

• 25 January 2019
• Author: Amanda Tekely
• Number of views: 43
• Comments: 0