GPAHU Pulse – January 2023

GPAHU - Monthly State and Legislative Updates

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year.

A new survey shows just how much Americans with private health insurance coverage value their telehealth benefits. Key findings include:
• Over 40% of the 498 respondents with private insurance used a telehealth benefit in the past year.
• The majority (65%) used these benefits because it was more convenient than an in-person appointment.
• Nearly 4 in 5 (78%) said telehealth made it easier to seek out care when they need it.
• Eighty-five percent of respondents said there were an adequate number of telehealth providers available for their health needs.
• More than half (53%) of respondents used telehealth services between 2-5 times in the past year.
• Nearly 3 in 4 people (73%) want Congress to make the provisions that allow telehealth services to be paid for before the application of the deductible in High Deductible Health Plans permanent.

Source: https://www.ahip.org/documents/AHIP-Telehealth-Survey-Results-12012022.pdf

The Big Three

Each month GPAHU identifies three top public policy or legal developments that could impact our members and clients.  Here are this month’s big three!

PA House of Representatives Elects Independent Speaker

After two months of debate over which party will control the Pennsylvania House of Representatives in January, and who will be elected Speaker of the House, the chamber is attempting bipartisan government. On January 3, 2023, Representative Mark Rossi (D-Berks) was elected and sworn in as an “independent” Speaker. He was chosen by all House Democrats and 16 House Republicans, and he has pledged to hire both Democratic and Republican staff.

The reason why control of the PA House was under dispute is that even though Democrats won more seats than Republicans during the November elections for the 2023-2024 legislative session, they only won majority with a one-seat margin. It became clear following the election that Pennsylvania needs to hold three special elections to replace Democratic House members who have moved on to higher offices or are recently deceased. With three open seats, Republicans have more voting members than Democrats right now, but since the open seats are all in heavily Democratic areas, it is very unlikely the GOP will maintain control when the special elections occur in February.

Over the past two months, Democratic and Republic leaders engaged in various power moves, including secret swearing-in ceremonies and lawsuits, related to both control of the chamber and scheduling of the special elections. Debate in both caucuses was fierce, and while Republicans have 101 voting members versus the Democrat’s 99, the House GOP could have elected a Republican speaker. However, they could not find a candidate that could garner all 101 votes they needed.

In the end, the result was some GOP House members approaching and working with all House Democrats to find a unity candidate in Rossi. While registered and elected as a Democrat, Rossi now says he will caucus with neither party to maintain complete independence. Given the tight margins in the Chamber, as well as divided government between the GOP-controlled Senate and Democratic Governor Josh Shapiro, we expect Rossi will be casting a lot of tie-breaking votes. Currently the chamber is struggling to formalize a rules package, and cannot consider any legislation until that task is finished.

Biden Administration Issues RxDC Deadline Extension and Limited Reporting Relief

The first two rounds of the new data for the new federal health plan reporting requirement, known as the Prescription Drug Data Collection (RxDC), were supposed to be due on December 27, 2022. However, on December 23, 2022, the Biden Administration issued Affordable Care Act FAQ #56 which specifies that groups have up until January 31, 2023 to submit their 2020 and 2021 data reports without penalty. The FAQ also creates a compliance safe harbor for entities that use a good faith, reasonable interpretation of the regulations and reporting instructions when making data submissions and attempts to make the submission process easier. For example, entities that only need to submit a plan list, premium and life-years data and narrative response because other entities are submitting other required on behalf of the plan, will now be allowed to email the plan’s submission to RxDCsubmissions@cms.hhs.gov instead of submitting in the Centers for Medicare and Medicaid Services’ Health Insurance Oversight System (HIOS). This is welcome relief because creating a HIOS account and obtaining the necessary ID is a complicated process that can take up to two weeks.  

This deadline and enforcement relief is transitional and only applies to the 2020 and 2021 calendar year submissions that were originally due on December 27, 2022. It does not apply to 2022 calendar year RxDC reporting, which must be completed on or before June 1, 2023. The Administration indicated in the FAQ it will monitor stakeholder efforts to comply with the 2020 and 2021 reporting requirements and then determine whether additional guidance is needed in advance of the next reporting deadline.

Omnibus Legislation Includes Telehealth Protections with A Twist

The Consolidated Appropriations Act, 2023 (CAA23) includes important relief for telehealth coverage offered through qualified High Deductible Health Plans (HDHPs) that pair with Health Savings Accounts (HSAs). The law allows people with an HDHP to receive telehealth care without meeting their deductible first and still contribute to an HSA. A previous HSA/HDHP telehealth protection was supposed to expire on December 31, 2022, but the new law creates safe harbor for first-dollar telehealth coverage offered through an HDHP for plan years beginning after December 31, 2022, through December 31, 2024.

However, due to a quirk in the way the measure is written, there is an unwelcome twist for non-calendar year health plans. The safe harbor applies to plans that start after December 31, 2022, but the old relief expired on that date. So, if a group plan does not renew on January 1, 2023, then it cannot begin offering the telehealth relief again until the group’s new plan year begins. Any HDHP plan with first-dollar telehealth coverage that renews after January 1, 2023, will have to stop offering the benefit pre-deductible until the start of the next plan year. HDHPs do not have to offer telehealth coverage pre-deductible, but if a group does, they should check their plan renewal dates and plan documents to make sure they maintain compliance.

Check This Out!

If you want to expand your health policy knowledge beyond this newsletter, here is a resource to check out!

The National Health Expenditure Accounts (NHEA) are the official estimates of total health care spending in the United States. Dating back to 1960, the NHEA measures annual U.S. expenditures for health care goods and services, public health activities, government administration, the net cost of health insurance, and investment related to health care. The data are presented by type of service, sources of funding, and type of sponsor.


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