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.
Virtual Care Post-Apex: Rethinking Telehealth Policy After the COVID-19 Surge
As COVID-19 has spread across the country, telehealth has proven to be an essential tool for maintaining access to health services while conforming with social distancing restrictions and reducing unnecessary exposure risk for health care providers and consumers. Nearly all states have, in some way, expanded coverage or reimbursement for telehealth services on a temporary basis during the COVID-19 pandemic and nationally, telehealth visits now account for 10 – 20 percent of overall outpatient utilization. As the first COVID-19 apex passes, state Medicaid programs are now grappling with how to maintain access to telehealth services in a severely budget-constrained environment. States are also considering issues related to telehealth coverage and reimbursement requirement in the commercial market, cross-state licensure flexibilities, consumer uptake of telehealth, and address technology access issues for historically underserved populations. Furthermore, by connecting underserved populations to necessary and timely health care, telehealth can be a tool to advancing health equity; as states continue to address health equity issues, it is important for states to consider ways to maintain access to telehealth services in a manner that ensures a more equitable health care system for all.
On Friday, June 12, State Health & Value Strategies hosted a webinar during which experts from Manatt Health and Georgetown reviewed the current telehealth policy landscape and considerations for states as they design their post-apex telehealth policies. This webinar also included brief remarks by state officials from Colorado and Massachusetts.