Regulatory Updates

We will not be soliciting Social Security numbers—and will instead rely on you to accurately update this information through FileLink or BlueLinks prior to January 1, 2019. Each account is responsible for sending the report file to your tax vendor and filing the data with the IRS.

Retroactive enrollment will be included in an incremental file that we will generate in February, 2019.

To request a Member Months Coverage Report, please notify your account executive by November 1, 2018.

Pharmacy Benefit Update for Statin Medications, Effective December 1, 2017

To comply with new United States Preventative Services Task Force (USPSTF) recommendations, we are updating our statin medications benefit beginning December 1, 2017. In this update, the following statin medications will be covered at no cost^* to eligible employees:

• Atorvastatin 10-20 mg
• Fluvastatin IR and XL 20-80 mg
• Lovastatin 10-40 mg
• Pravastatin 10-80 mg
• Rosuvastatin 5-10 mg
• Simvastatin 5-40 mg

In order to be eligible, employees must meet the conditions below:

• No history of cardiovascular disease (CVD) (i.e., symptomatic coronary artery disease or ischemic stroke)
• Meet the age requirement (40 to 75)
• Have one or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking), and
• Have a calculated 10-year risk of a cardiovascular event of 10% or greater

For more information about our prescription coverage, visit bluecrossma.com/bluelinks.

^*For qualified members. Applies only to commercial health plans that are non-grandfathered and grandfathered plans that have the preventive services benefit under the Affordable Care Act.

A recap of recent activity related to health care reform as of 03.10.17

GOP Repeal and Replace Proposal

On Friday February 24, a Republican proposal to "Repeal and Replace" the ACA was leaked to the public. Because of the unofficial nature, this version is subject to change, but offers the first concrete look at the House legislative proposal to "Repeal and Replace". It was wide-ranging and consistent with themes of the past several months. In addition to the likelihood of the legislation changing, it should also be noted that the current legislation has different timing for different provisions and also allows state flexibility in a number of areas (which is especially notable for Massachusetts). We will share details as they are confirmed.

Broadly speaking, next steps include:

• The House committee will make changes to the bill the week of March 6 (this is termed "Mark Up").
• The Congressional Budget Office (CBO) will "score" the final bill (determine its cost and impact to the budget).
• Then, the full House will vote on the bill and it will move to the Senate.
• The Senate parliamentarian will then decide if it passes procedural muster.
• If the Senate makes any changes to the bill, the House must pass the "reconciled" bill before it can be sent to the President to be signed into law.

This is expected to be complicated process, politically, substantively and procedurally.

President Addresses Congress in formal Joint Session February 28

President Trump addressed the joint session of Congress on Tuesday, February 28, and touched on topics highlighted throughout his campaign, such as controlling immigration, and health care – specifically, the repeal of the Affordable Care Act. Based on previous statements by the President and HHS Secretary Tom Price, a proposal from the White House is expected by mid-March.

March will be an intense month for activity related to health care. In addition to the Market Stabilization regulation expected to become final, the legislative process is expected to move forward at a more significant pace.

Tom Price Confirmed as Secretary of Health & Human Services

On February 10, 2017 the United States Senate confirmed Representative Tom Price (R-GA) as Secretary of the Department of Health and Human Services. While no action has been taken as yet to officially repeal and replace the ACA, Price has been vocal opponent of the law and is expected to make changes. As Secretary of HHS, he will have authority to make changes to current regulations that could have implications for our business and customers. Seema Verma, a health care consultant from Indiana and President Trump's nominee to lead the Center for Medicaid and Medicare Services (CMS) is also expected to be confirmed following Senate hearings. Verma's background is primarily Medicaid, although she will have oversight over multiple programs that CMS administers, including the ACA, Medicare and Medicaid.

CMS issues "Market Stabilization Rule"

On February 15, 2017, the U.S. Department of Health and Human Services (HHS) released a proposed Market Stabilization rule intended to stabilize the individual and small group markets that exist nationally under the Affordable Care Act (ACA). The proposed rule is intended to provide additional stability to this market as insurance companies begin planning for 2018. The exact timing of the release of a final rule from CMS is not clear.

The rule addresses a number of issues that could encourage more plans to remain in the market across the country. This includes wider variation on actuarial value, tightening of special enrollment periods and a change to the open enrollment period that would begin November 1 and end on December 15.

The Rule is not yet final, but GRA expects it to become final by April, in time for health plans to update their 2018 product filings.

ACA ("Affordable Care Act") Still Stands

Questions have arisen about the status of the ACA, for instance whether current reporting requirements are still in effect and whether CMS market rules (also known as payment parameters) for the merged market remain intact. Because no official actions have been taken to legally reverse or otherwise change the law, all current regulations stand and BCBSMA will continue to comply with the current laws until changes are made official.

Governor Baker Includes Health Care Provisions in Budget

On January 25, 2017, Governor Baker unveiled his FY2018 $40.5 billion budget proposal known as House 1. The proposal includes several measures intended to help control spending growth at MassHealth which has grown to approximately 40% of the total state budget due in part to individuals shifting out of commercial coverage. The proposals include a growth cap on provider rates and an overall provider rate cap within the Group Insurance Commission (GIC). Other provisions include a new $300M assessment on employers with 11 or more full time employees that do not provide a minimal level of insurance, an additional $13M assessment on acute hospitals, a new state transparency website, and a five year moratorium on new benefit mandates. The budget will be taken up by the House in April and the Senate in May with a final negotiated version to be submitted to the Governor in late June before the start of the FY on July 1.

MA Health Connector Moving Ahead

While various proposals are discussed and debated at the federal level, locally in Massachusetts the Connector is scheduled to proceed with plans for 2018. The Seal of Approval process will kick-off in March for health plans to be offered on the Exchange starting in January 2018. The biggest change recently announced by the Connector is to partner with the existing state Exchange in Washington DC to create a new shopping platform for small groups. The new platform will include the concept of Employee Choice where an employer selects a plan and the employees may then disaggregate and buy other coverage. Employers will still have the option to buy coverage in the Connector sole source as they do today. The Connector expects to have the new platform ready for employers to purchase plans in November for January coverage.

Health Care Reform Activity 

We are currently reviewing the bill released by House Republican leadership last night (on March 6) to assess its potential impact on Blue Cross Blue Shield of Massachusetts customers as well as the Massachusetts health care system more broadly. It is important that we protect the coverage gains made in Massachusetts, where we have the lowest rate of uninsured in the nation. We will continue to be strong advocates for measures that ensure stability and security for our customers and for all of the individuals and families who have benefited from having access to affordable health insurance.

Recent Activity in Health Care Reform

With the inauguration of President Donald Trump, the national health care landscape seems to be shifting, raising questions about the Affordable Care Act (ACA) and what it all means to our industry – and your businesses. While there is nothing definitive from policymakers in Washington, we do expect there to be changes to the law over time.

At Blue Cross Blue Shield of Massachusetts, we want to ensure that everyone in the state continues to have access to high–quality, affordable health care. We also want to ensure the marketplace remains competitive, affordable, and stable. We're committed to working in a spirit of shared responsibility to maintain what we have achieved.

Through all this uncertainty, our focus remains on our accounts, brokers, and members. As your trusted advisor on health care, Blue Cross will be prepared to help you – answering questions, navigating changes.

We're committed to keeping you updated and apprised as decisions are made in Washington, and here in Massachusetts. Below is a summary of recent activity at the state and federal levels.

• Governor Charlie Baker weighed in on "Repeal and Replace" in his response to U.S. House Majority Leader Kevin McCarthy, who had asked governors across the country to detail their state's experience with reform. Governor Baker outlined how Massachusetts was successful in expanding health care coverage to almost everyone in the state, discussed our work in the state to control the rising cost of health care, and wrote that he intends to protect the gains made in Massachusetts.
• President Trump signed an executive order generally directing the federal government to move forward in "easing the burden of the Affordable Care Act" and use their authority under the Act "to minimize the unwarranted economic and regulatory burdens" of the ACA.
• Congress has already begun to take initial steps necessary to roll back certain provisions of the ACA. Both chambers passed a budget resolution allowing "Repeal and Replace" to move forward through the reconciliation process.

Mass Connector Certifies New High Deductible Health Plans

Blue Cross Blue Shield of Massachusetts has received Minimum Creditable Coverage (MCC) certification from the Massachusetts Health Connector for several high deductible health plans for 2016 and 2017. The specific plans noted below on their own are now MCC-compliant and no longer need to be paired with a Health Reimbursement Account (HRA) or require an account attestation form confirming an HRA has been funded.

The plans referenced above are standard base plans or are available with rider options. We requested MCC certification based on $100 increments only. Any amount between $2,000 and $3,000 that is not a $100 increment will either require the use of the existing attestation process or require the account to request separate Certification to the Connector.