Healthcare Association of New York State Issues Public Comment on Centers for Medicare & Medicaid Services Proposed Rule

WASHINGTON, Aug. 4 -- Jeffrey Gold, senior vice president and special counsel for managed care and insurance at the Healthcare Association of New York State, Rensselaer, has issued a public comment on the Centers for Medicare and Medicaid Services proposed rule entitled "Patient Protection and Affordable Care Act: Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond Proposed Rule". The comment was written and posted on July 28, 2021:

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The Healthcare Association of New York State, on behalf of our member nonprofit and public hospitals, nursing homes, home health agencies and other healthcare providers, appreciates the opportunity to comment on the Department of Health and Human Services' proposed rule listed above.

HANYS remains committed to ensuring that consumers have access to affordable, high quality and comprehensive coverage through the federal and state marketplaces.

HANYS supports the proposed changes in this rule, recognizing that they will increase patient access to care and reduce burdens, provide more information to consumers and expand health equity.

Direct enrollment

HANYS supports CMS' proposal to repeal the provision from part one of the final notice of benefit and payment parameters that established an Exchange Direct Enrollment option. This option would have moved away from state-based exchanges and allowed private sector entities to market to and enroll consumers directly.

HANYS advocated against this proposal, because it would confuse consumers by creating multiple private entities that would compete for enrollment, incentivized by commissions. These entities would be allowed to market insurance options that are not ACA-compliant qualified health plans, exposing consumers to the risk of enrolling in "alternative" products like short-term limited duration insurance plans or incomplete insurance that does not cover the essential health benefits.

HANYS strongly believes that the one-stop shop feature of the SBEs is critical to ensuring that all consumers have the necessary information to make decisions without the undue influence of for-profit companies. New York's own one-stop SBE, the New York State of Health, has helped reduce the total of uninsured New Yorkers to about 5% of the total population.

Section 1332 waivers

HANYS supports CMS' plan to rescind the proposal to codify the Trump administration's sub-regulatory guidance interpreting Section 1332 of the ACA. Section 1332 allows states, with federal approval, to waive certain ACA requirements if a state demonstrates that its proposal meets certain statutory procedural and substantive "guardrails" to ensure state and federal patient protections. The 2018 guidance allowed CMS to approve a wavier designed to boost enrollment in short-term plans and other less-comprehensive kinds of coverage, skirting around the ACA's patient protections, such as essential health benefits.

Having advocated against codifying the 2018 interpretation, HANYS supports the agency's use of guidance from 2015. This guidance includes guardrails around comprehensiveness, affordability and coverage that would help increase the number of people with comprehensive and functional healthcare coverage. HANYS and our members share CMS' focus on ensuring that any allowed waivers do not negatively affect vulnerable populations.

Special enrollment periods

HANYS supports CMS' proposal to extend the federally facilitated exchange open enrollment period by 30 days, ending on Jan. 15 of the applicable year. This would provide consumers significantly more time to obtain coverage. However, HANYS requests that CMS continue to allow SBEs the flexibility to determine their own open enrollment dates. As an example of the importance of SBE flexibility, due to the ongoing public health emergency and the availability of significantly enhanced federal tax credits through the American Rescue Plan, New York extended its 2021 open enrollment period through Dec. 31, 2021.

In addition, HANYS supports the creation of new special enrollment periods for Advance Premium Tax Credit-eligible individuals at or below 150% of the Federal Poverty Level. HANYS has consistently advocated for policies that decrease the uninsured population. Offering more opportunities to enroll in coverage, especially for populations that experience high enrollment instability, would support the goal of protecting patients and increasing insurance coverage.

We thank the agency and the administration for continuing to implement changes that support state exchange autonomy, expand coverage opportunities and protection to patients, and maintain affordable options for patients.

HANYS appreciates the opportunity to provide feedback on the proposed rule. If you have questions regarding our comments, please contact me at (518) 431-7730 or at [email protected] or Victoria Aufiero, senior director, insurance, managed care and behavioral health, at (518) 431-7889 or at [email protected].

Sincerely,

Jeffrey Gold

Senior Vice President and Special Counsel, Managed Care and Insurance

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The proposed rule can be viewed at: https://www.regulations.gov/document/CMS-2021-0113-0002

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