IHA Daily Briefing: Oct. 11

CMS: Health Insurance Marketplace Premiums Drop
Congress Launches Investigation on Maternal Mortality
IDPH Issues Emergency Rules on Healthcare Flu Shot
IHA Webinar Covers New Assault Treatment Rules
Preckwinkle Releases Cook County Budget Proposal
President Signs Bills Banning Pharmacy Gag Clauses

CMS: Health Insurance Marketplace Premiums Drop
Today, the Centers for Medicare & Medicaid Services (CMS) announced that the average premium for second lowest cost silver plans (SLCSP) for the 2019 coverage year will drop by 1.5 percent, the first time average premiums have dropped since the implementation of the federally-facilitated exchange in 2014. Illinois will see a 2.7 percent decline in average premiums for those plans, after experiencing increases of 40.6 percent in 2017 and 38.5 percent in 2018.

According to a CMS press release, after the Affordable Care Act (ACA) regulations took effect in 2014, average individual market premiums more than doubled from $2,784 per year in 2013 to $5,712 on HealthCare.gov; in 2017, an increase of $2,928 or 105 percent. In the HealthCare.gov states (including Illinois), between 2017 and 2018, the average premium for the second-lowest cost silver plan increased by 37 percent. Between 2016 and 2017, the hike in average premiums was 25 percent.

CMS says that for this upcoming Open Enrollment (starting Nov. 1), Americans will, on average, experience lower premiums on health plans purchased on the federal exchange. There are 23 more medical qualified health plan (QHP) issuers for 2019 than were participating during open enrollment in 2018, and 29 current medical QHP issuers are expanding their service area into more counties. The number of counties with only one insurer has dropped from 56 percent in 2018 to 39 percent in 2019, and only four states will have only one insurer, compared to 10 in 2018.

More information on the health insurance marketplace data can be found here.

Congress Launches Investigation on Maternal Mortality
The U.S. House Ways and Means Committee announced Wednesday that it will investigate why maternal mortality morbidity rates “are rising in America and what federal agencies, states, and hospitals are doing and can do to address this issue.&rdquo

"It is absolutely unacceptable that preventable failures are the cause of avoidable, unnecessary, and absolutely tragic deaths," the committee's GOP leaders (including Rep. Peter Roskam of Illinois) said in a statement. "With this investigation, we are committed to finding out why these deaths are happening and where Congress can take action to not only prevent these deaths, but also reverse this trend."

Compared to 30 years ago, a report by the Alliance for Innovation on Maternal Health finds that women giving birth in the U.S. are more at risk of dying than their mothers were and that African American women are three to four times more likely to experience pregnancy-related deaths than Caucasian women.

IDPH Issues Emergency Rules on Healthcare Flu Shot
The Illinois Dept. of Public Health (IDPH) issued emergency rules (see pp. 17942-17953) on Oct. 5 to implement PA 100-1029, effective immediately, which eliminate a healthcare worker’s ability to refuse an influenza vaccination based on philosophical or moral reluctance.

Under current law, a healthcare employee may only decline a flu shot based on one of the following factors:

  • The vaccine is medically contraindicated;

  • The vaccination is against the employee’s religious belief, or

  • The employee has already been vaccinated.

IDPH states the necessity of these emergency rules is to help combat influenza during the 2018-2019 season.

IHA Webinar Covers New Assault Treatment Rules
To help hospitals comply with new sexual assault treatment requirements, IHA is offering a complimentary webinar, New Hospital Requirements for Sexual Assault Treatment, from 1-2:30 p.m. on Nov. 13.

The webinar will unpack the key provisions in Public Act 100-0775, a new state law that modifies the Sexual Assault Survivors Emergency Treatment Act and goes into effect Jan. 1.

Key topics covered include:

  • Revised treatment and transfer plans;

  • Ongoing training for emergency department staff;

  • Photo documentation and storage;

  • Memorandum of understanding with a rape crisis center;

  • Semi-annual reporting of statistics; and

  • 24/7 availability of qualified medical provider availability—defined as a Sexual Assault Nurse Examiner (SANE), Sexual Assault Forensic Examiner (SAFE) or child abuse pediatrician—by Jan. 1, 2022.

The law also creates a new category of treatment hospital—treatment hospital with approved pediatric transfer—requiring such hospitals to submit an area-wide treatment plan. Transfer hospitals also have new compliance requirements for approving transfer plans.

IHA is teaming up with the state to present the webinar. From the state will be Karen Senger, BSN, RN, division chief of the Dept. of Public Health's Division of Health Care Facilities and Programs. Sandy Kraiss, vice president of Health Policy and Finance is presenting from IHA.

IHA encourages CMOs, CNOs, CQOs, emergency department heads, in-house counsel, government relations personnel, compliance officers and SANE coordinators to attend. Register today.

Preckwinkle Releases Cook County Budget Proposal
Cook County Board President Toni Preckwinkle on Wednesday proposed a $5.92 billion county budget for fiscal year (FY) 2019 that does not include any new taxes, fines  or fees. Preckwinkle’s proposal reflects an increase of $712.2 million compared to FY 2018, including a $647.3 million increase in the Health Enterprise Fund, driven primarily by the projected growth of CountyCare enrollment to nearly 345,000 members per month in FY 2019.  Additional cost drivers include programmatic expansion of surgery, dialysis and health center services. Increased costs were primarily offset by an increase in CountyCare membership resulting in $611 million in revenue.

“We’ve had to make a number of difficult decisions over the last eight years that have helped put us in a position to present this balanced budget that provides essential public safety and public health services to County residents without raising taxes, fines or fees,” Preckwinkle said. “This has been possible because my administration has avoided quick fixes and one-time solutions. We have done the hard work and heavy lifting to instill sound fiscal discipline and to ensure that more than 90 percent of our annual budgetary solutions are structural in nature.

All FY 2019 budget information has been posted to the Cook County website. Public hearings will be scheduled in the coming weeks.

IHA is urging the Cook County Board of Commissioners to support the Cook County Health & Hospitals System (CCHHS) in the FY2019 budget and oppose any cuts to CCHHS as the Board considers the budget.

President Signs Bills Banning Pharmacy Gag Clauses
President Trump Wednesday signed two bills that ban pharmacy gag clauses, which prevent pharmacists from informing consumers when they can pay less out of pocket for a prescription drug, in both private insurance and Medicare prescription plans.

Health and Human Services (HHS) Secretary Alex Azar praised the President’s leadership on this issue: “This bipartisan legislative accomplishment was secured by President Trump’s historic leadership on drug pricing. The President’s drug-pricing blueprint called for ending gag clauses. Within a week of the blueprint’s release, HHS informed Medicare plans that they are unacceptable, and now Congress has responded to the President’s call by formally banning them. American patients should know: You can always ask your pharmacist whether you’re getting the best deal on the prescription drugs you need. This is just one step in the President’s plans to deliver better healthcare to Americans at lower prices, efforts that have already involved more action to bring down drug prices than any previous President has taken."