Supporting Children and Youth with Special Health Care Needs During COVID-19
On Tuesday, December 15 State Health and Value Strategies hosted a webinar on how states can support children and youth with special health care needs during COVID-19. The COVID-19 pandemic has created significant health and economic hardships for many children and families—particularly children and youth with special health care needs. Children who receive health services in school settings to support their education are losing access to those services as schools limit—or eliminate altogether—in-person instruction. In addition, a pre-COVID-19 shortage of home health providers has worsened due to the pandemic, placing a significant burden on families who rely on home health services or who choose, for safety, not to have home health providers come into their homes. The result can lead to gaps in care and caregiver burnout, putting children and youth with special health care needs at risk of regression and long-term negative health outcomes. Recognizing these risks, states and the federal government have broadly expanded telehealth coverage, established continuous coverage requirements and eased regulatory requirements for delivery of services.
The webinar, produced by Manatt Health with the American Academy of Pediatrics, Family Voices, and the Georgetown Center for Children and Families with funding from the Robert Wood Johnson Foundation and the Lucile Packard Foundation for Children’s Health, explored strategies for state Medicaid agencies to enforce coverage requirements and make permanent the temporary regulatory flexibilities that have expanded access to services during the pandemic.
On October 7, the U.S. Departments of Health and Human Services (HHS), Treasury, and Labor (DOL) and the Office of Personnel Management (OPM) published a third rule implementing the No Surprises Act (NSA), the comprehensive federal law banning balance bills in emergency and certain non-emergency settings beginning January 1, 2022. This third rule, an interim final rule, provides details on the independent dispute resolution process (IDR), good faith estimates for enrollees on the cost of services, the dispute resolution process for uninsured patients, and external review. This expert perspective summarizes the provisions of the IFR and notes particular implications for state regulators.
With the Patient Protection and Affordable Care Act’s (ACA’s) ninth open enrollment period (OEP) set to launch in less than a month, the ACA Marketplaces are seeing record enrollment numbers with more generous subsidies, new carrier competition, and a relatively stable rating environment. At the same time, there is uncertainty with the trajectory of the COVID-19 pandemic and medical costs trending upward as the economy recovers, albeit at an uneven pace. These trends have made for a challenging rate review process in the 47 states plus the District of Columbia (D.C.) that conduct their own ACA rate reviews of carrier-proposed rates using federal review standards. State announcements of 2022 rates have trickled out at a slower pace than in prior years, and it is likely that many states will not publish their approved rates until the beginning of open enrollment. As always, state rate results vary widely and, even within states, there often are substantial variations among carriers and across different regions in geographically diverse states. With these caveats, this expert perspective highlights some observations about the factors that are impacting rate changes this year and the kind of variations that exist among states.