ALLIANCE OF COMMUNITY HEALTH PLANS, INC.

MMM · Medicare/Medicaid

Medicare & Medicaid Issues: Medicare Advantage (Part C) and Prescription Drug (Part D): Advocated on quality measures and Star Ratings; third-party marketing practices and broker compensation; risk adjustment reform; modernization of network adequacy standards; reforms to Medicare Advantage benchmarks; and Medicare Part C and Part D reporting requirements. Medicaid: Advocated on implementation of Medicaid provisions in the One Big Beautiful Bill Act, including community engagement and eligibility requirements; advocated for states to use available data to verify eligibility, compliance and exemptions before requiring additional documentation from enrollees. Dual Eligibles: Advocated for greater integration of Medicare and Medicaid coverage for dual-eligible beneficiaries, including expanded access to and streamlined enrollment in integrated D-SNP models such as FIDE-SNPs and HIDE-SNPs. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on prescription drug models and initiatives being developed by the Center for Medicare & Medicaid Innovation; advocated for affordable access to cell and gene therapies, including creation of a national risk-pool model; advocated for patent reform to reduce barriers that delay lower-cost biosimilars and generics from entering the market; advocated for PBM transparency and reforms that increase visibility into fees, rebates and other compensation; advocated for restrictions on direct-to-consumer drug advertising, including ending tax deductions associated with such advertising; advocated for requirements that pharmaceutical manufacturers disclose wholesale acquisition costs in drug advertisements; and advocated for expanded FDA oversight of direct-to-consumer drug advertising. Prior Authorization: Advocated for electronic prior authorization policies that reduce administrative burden, improve timely access to appropriate care and support patient safety; advocated for reciprocal requirements and accountability for health plans and providers to support effective adoption of electronic prior authorization; advocated for implementation timelines, technical standards and reporting requirements that recognize the operational and resource constraints of smaller, community-based health plans. Telehealth: Advocated for permanent extension of Medicare telehealth flexibilities and continued access to virtual care; advocated for extension of the Acute Hospital Care at Home waiver program; advocated for removal of unnecessary in-person requirements that limit Medicare beneficiaries access to telehealth services, including behavioral health care. Provider Directories: Advocated for improved accuracy of provider directories, greater provider accountability for maintaining accurate information and development of a national provider directory at CMS.

HCR · Health Issues

General Health Care Issues: Prescription Drug Pricing: Advocated on prescription drug costs, including PBM transparency; advocated in support of the Fair Accountability and Innovative Research (FAIR) Act; advocated for patent reform and on access to and utilization of GLP-1 drugs; and advocated for elimination of the separate interchangeability designation for biosimilars. Mental and Behavioral Health: Advocated for improved access to mental and behavioral health services, including integrated care and tele-mental health; advocated on federal mental health parity requirements. Prior Authorization: Advocated for electronic prior authorization policies that reduce administrative burden, improve timely access to appropriate care and support patient safety; advocated for reciprocal requirements and accountability for health plans and providers to support effective adoption of electronic prior authorization; advocated for implementation timelines, technical standards and reporting requirements that recognize the operational and resource constraints of smaller, community-based health plans.