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Daily Briefing

Around the nation: CMS outlines new requirements for ACA insurers


CMS  on Monday announced that insurers on the Affordable Care Act (ACA) exchanges will be required to include substance abuse and mental health providers in their plans, in today's bite-sized hospital and health industry news from Maryland, New Jersey, and Rhode Island.

 

  • Maryland: CMS on Monday issued a final rule requiring insurers on the ACA exchanges to include substance abuse and mental health providers in their plans. The rule will relax CMS' proposed limits on the number of plan options exchange insurers can offer. The rule also lowers the fees insurers are required to pay to market their product offerings on federal and state exchanges. Under the rule, state-based marketplaces will be allowed to implement a special enrollment period for enrollees who lose Medicaid or CHIP coverage. CMS also finalized plans to cut the number of insurance options available and eliminate misleading plan names. The agency will require insurers to submit their plans' marketing names for approval from federal or state officials. (Tepper/Turner, Modern Healthcare, 4/17)
  • New Jersey: Merck  recently agreed to purchase  Prometheus Biosciences — an immunology biotech company with an ulcerative colitis candidate — for roughly $10.8 billion in cash. Following the acquisition, Merck will be able to compete against a  Pfizer-Roviant partnership on anti-TL1A monoclonal antibodies. "The breadth of Prometheus' list of potential target diseases, which includes rheumatoid arthritis, atopic dermatitis, psoriasis and other blockbuster indications, is underpinned by evidence that TL1A modulates the location and severity of inflammation and fibrosis," according to FierceBiotech. (Primack, Axios, 4/17)
  • Rhode Island: CVS Health on Monday appointed Brian Kane head of its  Aetna  health insurance division. According to the announcement, Kane will step into the roles of EVP of CVS Health and president of Aetna, effective Sept. 1. He will replace Dan Finke, who will provide support throughout the transition. Most recently, Kane served as a consultant to several healthcare-focused private equity firms. In 2021, he stepped down as  Humana's CFO, where he oversaw the development of the company's  CenterWell  primary care clinics. (Tepper, Modern Healthcare, 4/17)

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