Federal Regulatory Update, Including Acupuncture Approval to Fight Addiction

For more information about this blog post, please contact Khaled J. KleleLatoya Caprice Dawkins, Ryan M. Magee, or Labinot Alexander Berlajolli.

On January 30, 2020, CMS issued a new initiative to allow states to carry out demonstrations under Section 1115 waivers converting some of their federal Medicaid funding to block grants.  Under the initiative, states that apply can provide Medicaid coverage using flexible benefit designs under either an aggregate or per-capita cap financing model for certain populations without being required to comply with a list of Medicaid provisions, CMS said.

In an effort to fight opioid abuse, CMS announced on January 21, 2020, it will cover up to 12 acupuncture sessions in any 90-day period with a possible additional eight sessions for those with chronic lower back pain. CMS has not historically considered acupuncture reasonable and necessary, but a recent review and analysis of the evidence concerning the clinical effectiveness of acupuncture for chronic low back pain presented CMS with sufficient evidence to conclude that acupuncture does improve health outcomes for Medicare beneficiaries with chronic lower back pain.

85 FR 7088 – Proposed – The Department of Health and Human Services issued its annual proposed rule to update payment and policy parameters for the Affordable Care Act (ACA) marketplace. The proposed rule would apply to plan years beginning on or after January 1, 2020. For 2021, the rule proposes to maintain user fees for the federal facilitated and state-based exchanges at the current 2020 plan year rates, which stand at 3% and 2.5% of total monthly premiums, respectively. The proposed rule also seeks comments on modifying the automatic re-enrollment process for enrollees who would be automatically re-enrolled with advance payments of the premium tax credit (APTC) to cover the enrollee's entire premium. Last year, the agency considered ending automatic re-enrollment but decided not to make the change at that time.  The proposed rule would change benefits related to essential health benefits and would provide states with additional flexibility in the operation and establishment of the exchanges, changes related to cost-sharing for prescription drugs.  It also proposes to repeal regulations relating to the Early Retiree Reinsurance Program. Comments are due by March 2, 2020.