What Are the COVID-19 and Inflation Legislative Updates for 2023?

American Rescue Plan Act (ARPA) and the Inflation Reduction Act (IRA)

ARPA was enacted in 2021 to assist mostly low-income and middle-class Americans through a pandemic-crippled economy.?

Also known as the COVID-19 Stimulus Package, it offered enhanced premium subsidies for Consolidated Omnibus Budget Reconciliation Act (COBRA) recipients, changed aspects of the? Affordable Care Act (ACA), expanded Medicaid, and other changes.

In August 2022, ARPA was extended through 2025 when President Joe Biden signed the IRA into law.

The IRA aims to curb inflation and lower prescription drug costs. It raised and authorized billions, including three years of ACA subsidies and prescription drug and tax reform. Specific provisions, such as caps on drug costs for seniors, won’t come into effect until 2025.

Public Health Emergency (PHE) Declaration

The HHS announced that the country's Public Health Emergency (PHE) declaration would expire on May 11, 2023, and published a roadmap to assist in the transition. With the end of the PHE, COVID test kits, treatments, and vaccines may no longer be free.

Families First Coronavirus Response Act (FFCRA)

The FFCRA prohibited states from terminating Medicaid coverage during the pandemic, serving as an essential protective measure prohibiting states from removing coverage. This Medicaid protection provision, known as “continuous enrollment,” is set to end on March 31, 2023, with federal Medicaid matching funds phasing down until the end of the year.

Medicaid

Expanded Medicaid through the ACA broadened the qualifications for low-income individuals.?

Resumption of Medicaid eligibility redeterminations will shift enrollees from Medicaid to other sources of insurance, like individual or employer-sponsored, or leave them uninsured.?

The Consolidated Appropriations Act, 2023 (CAA, 2023) mandates that beginning April 1, 2023, states can terminate Medicaid enrollment for many currently eligible individuals who might not be after redeterminations have concluded.

Affordable Care Act (ACA)

ACA changes allowed workers to purchase an individual market ACA plan and qualify for subsidies when an affordable health plan is unavailable through their employer. The Internal Revenue Service (IRS) finalized the rule change in October 2022, a few weeks before the open enrollment period for 2023.

Furthermore, premiums across ACA marketplace plans increased. However, IRA subsidies reduced premium costs for low-income enrollees, leaving many with a zero-dollar or nearly-free premium.

No Surprises Act

The No Surprises Act took effect January 1, 2022, and protects insured patients from receiving unexpected bills for healthcare from out-of-network hospitals, doctors, or providers they did not select. Essentially, it controls costs for out-of-network care for insured patients, and these consumer billing protections remain in effect for 2023.

Centers for Medicare & Medicaid Services (CMS) 2023 Final Regulations

CMS 2023 final regulations limit the extent to which plans can have actuarial values (AV) below the statutory value. This regulation makes the benchmark plan more generous than in the past, increasing access to zero-premium plans and potentially growing enrollment.

Navigate Legislative Changes With Alaffia’s Technology-Enabled Solutions

The Year 2023 will see the undoing of many pandemic-related public policies and the continuation of others. Third-party administrators and payers should only attempt to navigate these choppy waters with help. Sail smoothly with Alaffia’s payment integrity solutions.

Alaffia’s artificial intelligence (AI) solutions provide a reliable and efficient way to ensure payments issued to healthcare providers are precise and unbiased by human subjectivity or error.?

So, eliminate opportunities risk for fraud, waste, and abuse—and avoid getting caught in a riptide of legislative changes by implementing our AI-powered bill reviews and other innovative technological solutions.

After all, you’re at the helm of your organization's direction in this ever-shifting environment. So, take the next step in steering your organization into calm waters by scheduling a call with us today!