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The Biden administration has issued a final rule to protect consumers from low-quality "junk" health insurance plans, in today's bite-sized hospital and health industry news from the District of Columbia and Maryland.
- District of Columbia: The Biden administration on Thursday finalized new regulations that limit the use of short-term health insurance plans that are not in compliance with the Affordable Care Act (ACA). In 2018, the Trump administration issued a rule allowing short-term plans to last for just under a year, with an option to renew them for up to three years. The new rule reverses this limit, reducing it to 90 days, with an option to extend the plan for one month. Although supporters of short-term health plans say they are beneficial for workers who are in-between jobs or people who cannot afford a marketplace plan, critics say that the plans may mislead consumers, particularly those who may be eligible for free coverage through ACA marketplaces. "HHS is cracking down on junk insurance plans to help consumers make informed choices and avoid mistakenly paying for a plan that does not provide them the coverage or protection they expect," said HHS Xavier Secretary Becerra. "Over the past three years, we have helped more people gain access to high-quality, affordable coverage — and more than 300 million Americans are covered for the first time ever. We want everyone to have the peace of mind that comes with having coverage that includes the protections and benefits they expect." (Weiland, New York Times, 3/28; HHS press release, 3/28; CMS fact sheet, 3/28)
- Maryland: FDA recently granted emergency use authorization for a new monoclonal antibody to protect immunocompromised individuals against COVID-19. The drug, which is called Pemgarda and manufactured by Invivyd, is the first monoclonal antibody to be available for COVID-19 since FDA pulled AstraZeneca's Evusheld from the market in January 2023. Pemgarda is intended for immunocompromised individuals ages 12 and older who may not develop an adequate immune response after vaccination. According to Invivyd, there are an estimated 9 million immunocompromised Americans, but the company will initially target those who have the greatest need, including stem cell transplant recipients, organ transplant recipients, and blood cancer patients. "For people who are immunocompromised and literally defenseless because their immune system doesn’t really work, this is really an important development," said Ziyad Al-Aly, the chief of research and development at the Veterans Affairs St. Louis Healthcare System. (Blum, New York Times, 3/25; Mast, STAT, 3/22)
- Maryland: CMS recently released the proposed rule for inpatient rehabilitation facilities (IRFs) for fiscal year (FY) 2025. The proposed rule includes a 2.8% payment update, which is equal to an increase of $280 million minus a $25 million cut to the proposed outlier threshold. Overall, IRFs would see a $255 million payment increase in FY 2025. In addition, CMS has asked for feedback on developing a five-star rating system for IRFs. According to the agency, a star rating system for IRFs would help consumers compare facilities more easily and promote competition in the sector. The proposed rule was published in the Federal Register on March 29, and comments will be accepted for 60 days. (Eastabrook, Modern Healthcare, 3/27; AHA News, 3/27; CMS fact sheet, 3/27)
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