This week's hearing came after state officials delayed their rollout of the new requirements and as federal officials continue to defend work requirements in other states on appeal.
U.S. District Judge James Boasberg, who previously blocked Medicaid work requirements in Kentucky and Arkansas, heard arguments Tuesday on whether he should similarly toss out the federal government's approval of such requirements in New Hampshire.
Since the current case is practically identical to the prior two, the plaintiffs are "hopeful" that Boasberg will again issue a decision in their favor, National Health Law Program legal director Jane Perkins told HealthLeaders in an email after Tuesday's hearing.
Perkins and her organization are working with New Hampshire Legal Assistance and the National Center for Law and Economic Justice to represent the four Granite State plaintiffs. They accuse Health and Human Services of shoehorning the administration's own objectives into a Medicaid program that was established for the limited purpose of providing healthcare to people in poverty or living with disabilities.
Court records indicate that Boasberg took the matter under advisement Tuesday. It's unclear whether a decision could come quickly or be delayed.
The hearing came two weeks after New Hampshire officials delayed their rollout of the new work requirements. Two-thirds of the beneficiaries to whom the work requirements apply—that's nearly 16,900 people—had failed to demonstrate compliance by the deadline, so state officials have launched a ramped-up campaign to raise public awareness.
Perkins said her team's legal arguments are unaffected by the state's recent actions because the plaintiffs are challenging the HHS secretary's approval of the requirements.
"The state actions are directed at implementation of that approval and do nothing to fix the errors in what the secretary did," she wrote in her email.
But it's possible the state's work requirements will go back to the federal government for another review after state lawmakers and Gov. Chris Sununu expanded the Medicaid work requirement exemptions and authorized a delay.
Supporters of these work requirements have said the policies help beneficiaries climb out of poverty by giving them stronger incentives to work. Opponents have expressed concerns, however, that the added hurdles will simply result in more poor people being barred from Medicaid coverage over technicalities.
Boasberg blocking work requirements in New Hampshire would almost certainly prompt an appeal, as federal officials are continuing to defend their actions on the Kentucky and Arkansas programs before the U.S. Circuit Court of Appeals for the District of Columbia.
In a brief filed in the appellate case last week, attorneys for the federal defendants argued that the states' demonstration projects are reasonable and modeled after similar requirements that have been part of the Temporary Assistance for Needy Families (TANF) program and Supplemental Nutrition Assistance Program (SNAP) for more than 20 years.
The brief argued, furthermore, that the federal government's approval of the work requirements under Section 1115 of the Affordable Care Act were made appropriately, based on the HHS secretary's determination that the added requirements were "likely to assist" in promoting the program's objectives.
Both the HHS secretary and CMS administrator cited the competition among Medicare Advantage plans as a model of success.
The keys to solving the U.S. healthcare system's pervasive cost problem include competitive market forces and a commitment to a value-based approach to payment, two senior Trump administration healthcare officials said during speeches this week at the Better Medicare Alliance in Washington, D.C.
Health and Human Services Secretary Alex Azar said Tuesday that social determinants of health—the solutions for which are generally considered to fall outside the purview of traditional healthcare service providers—can drive a lot of the nation's healthcare spending. So it makes sense for government-sponsored health plans to expand the scope of what they are willing to cover, he said.
"Our system can often be penny-wise and pound-foolish, spending generously on healthcare without considering how health could be improved by addressing non-health needs," Azar said, according to his prepared remarks.
"You've already seen one effort to address this through new supplemental benefits in Medicare Advantage, like home-delivered meals, transportation, and home modifications," he added. "We want to go further, and we look forward to working with all of you to think about how best to do that."
There are currently about 60 million seniors on Medicare, and they are increasingly migrating from traditional plans to Medicare Advantage options—offering a model for how policymakers might be able to "keep what works and fix what's broken" throughout the rest of our system, Azar said.
Centers for Medicare & Medicaid Services Administrator Seema Verma, who spoke Monday, said so called "Medicare-for-All," single-payer, and "public option" proposals from the left are doubling down on the Affordable Care Act's fundamental failure to curb spending.
"While the discussion over the future of healthcare has focused on who should pay for it, the real focus needs to be the cost of healthcare in our country," Verma said, according to her prepared remarks.
"We believe that our role in government should be to promote a healthy and competitive free market where providers and insurers compete on the basis of cost and quality, and patients are incentivized to seek high value providers," Verma added later.
"By unleashing the power of the American consumer, market forces—the same forces that deliver better cars, better phones, and better restaurants year after year—will address the underlying cost drivers in our healthcare system," she said.
Verma, like Azar, cited Medicare Advantage as among the administration's successes, noting that MA plans compete on the basis of cost and quality. With the added flexibility granted to MA plans, the program has gained 600 new plans, premiums have fallen to their lowest level in six years, and enrollment as risen 10 percent to an all-time high of nearly 23 million MA beneficiaries, she said.
Verma likened the administration's work on MA competition to its push for greater flexibility around the ACA, including the expansion of access to short-term limited-duration insurance, association health plans, and individual market coverage paid for through employer-funded health reimbursement accounts.
"Unlike those who want healthcare prices set in Washington by bureaucrats, the Trump Administration believes the key to unlocking innovation and quality in healthcare is to empower patients as consumers," she said.
An HHS OIG review listed frequent leadership changes and poor transition planning among the major causes of the Indian Health Service hospital's ER closure and repeated findings of immediate jeopardy.
Instability in leadership ranked among the major reasons why an Indian Health Service (IHS) hospital in Rosebud, South Dakota, shuttered its emergency department for more than seven months, according to a Health and Human Services (HHS) Office of Inspector General (OIG) report.
Rosebud Hospital's emergency department was temporarily closed in December 2015 after the Centers for Medicare & Medicaid Services (CMS) cited immediate jeopardy concerns related to patient health and safety. The deficiencies entailed a failure to offer adequate and timely treatment to four patients, including a child with a possible head injury from a car wreck and a woman who delivered a pre-term baby unattended on the emergency department's bathroom floor, according to the HHS OIG report.
Officials and staff from IHS attributed the hospital's deficiencies to long-running problems with staffing, senior leadership, and equipment:
Staffing woes: Officials and staff interviewed said Rosebud Hospital has long had a tough time recruiting and retaining enough doctors, nurses, and other clinical staff because the facility is located in a remote area, so the facility often relied on contracted providers who didn't always meet the hospital's needs or standards, according to the HHS OIG report.
Leadership turnover: The hospital had a whopping 27 CEOs over the course of nine years—that's an average tenure of four months—according to an IHS official cited in the report. "Many of these CEOs served in an acting capacity and lasted only a few months before they left voluntarily, were fired by IHS, or were removed by a tribal resolution," the report states. "Although many of these CEOs may have initially appeared to be a good fit, several IHS officials indicated that the CEOs often lacked experience and were ill-equipped to fulfill that role."
Equipment issues: Surveyors also found serious problems with the emergency department's equipment, including an oxygen leak, troubles with the telephone and call-light systems, and more. Staffers complained that even suction tubes and heart monitors were often broken or insufficient.
With additional help from IHS, Rosebud Hospital instituted a plan of correction and reopened its emergency department in July 2016, fully satisfying CMS in September 2017. But the hospital was again cited with immediate jeopardy deficiencies related to its emergency department in July 2018. The factors contributing to the latest round of problems again included high leadership turnover and insufficient transition planning, according to the HHS OIG report.
To correct the problems at issue in this case, the HHS OIG report recommends that IHS develop and implement a program to recruit, train, and keep clinical and leadership staff at remote hospitals; take steps to ensure that IHS intervenes quickly enough when problems arise; and develop procedures for any future temporary closures of IHS emergency departments.
The ACA didn't take a narrow definition of short-term health insurance and make it 'sacrosanct,' the judge ruled.
A federal judge sided with the Trump administration Friday, affirming a final rule that expanded access to short-term limited-duration insurance (STLDI).
The decision effectively greenlights an effort that some had warned could contribute to instability in the individual market for health plans that provide what the Affordable Care Act defines as minimum essential benefits. Short-term health plans are often cheaper options, but they may provide less coverage because they are not required to cover preexisting conditions or meet the ACA's other requirements.
Under the Obama administration, in 2016, access to STLDI was restricted to three months, due to concerns that rising premiums for ACA-compliant plans could prompt healthy consumers to choose cheaper, skimpier short-term coverage options instead. Under the Trump administration, in 2018, the permissible duration for STLDI was expanded to 12 months, with renewals allowed up to three years.
That reversal was a reasonable interpretation of the statutory language, according to U.S. District Judge Richard Leon in the District of Columbia.
The plaintiffs had effectively argued that the ACA took a narrow definition of STLDI and made it "sacrosanct," Leon wrote in his ruling Friday. But that's not the case, he reasoned.
"It is not my role to interfere with or disrupt the balance struck by policymakers where, as here, there is no indication that those charged with implementing the balance have failed to observe it," Leon wrote.
"To be sure, the ACA's various reforms are interdependent and were designed to work together as features of the individual Exchange markets," he wrote. "However, Congress clearly did not intend for the law to apply to all species of individual health insurance. In addition to maintaining the STLDI exemption, Congress exempted multiple forms of individual health insurance from the ACA's reforms and the State-specific risk pools.
"In other words, lawmakers were not rigidly pursuing the ACA-compliant market at all costs, e.g., at the risk of individuals going without insurance altogether," Leon added. "Moreover, while Congress certainly sought to foster a robust ACA-compliant market, its chosen methods for doing so were embodied by the individual mandate and tax penalty, not the definition of STLDI !"
"We remain firm in our contention that the Trump administration's decision to expand dramatically the sale of junk insurance violates the Affordable Care Act and is arbitrary and capricious," ACAP CEO Margaret A. Murray said in a statement released to HealthLeaders.
"Indeed, the district court itself recognized that administration's decision allows junk insurance to compete directly with comprehensive, Affordable Care Act-compliant insurance plans," Murray added. "That result subverts the health care protections of the ACA. Junk insurance, no matter what it’s called, is an inferior and hazardous substitute for comprehensive coverage.
"We are confident that the appellate court will see this differently," she said.
The National Alliance on Mental Illness (NAMI), which joined ACAP and several other organizations as plaintiffs, expressed disappointment in Leon's ruling, noting that short-term plans can deny coverage and care for mental health conditions.
NAMI Acting CEO Angela Kimball said in a statement the organization will continue its decades-long fight for fair and equal coverage for mental healthcare.
"We have no intention of stopping until we end discriminatory coverage," Kimball said. "This ruling is a step in the wrong direction. It lets junk plans compete with comprehensive health insurance, even though they don't have to provide the same level of mental health coverage—or any mental health coverage at all."
"We will join an appeal of this decision because the health of our nation includes its mental health," she added. "It is imperative that insurance plans provide essential mental health benefits for all Americans, plain and simple."
If the plaintiffs do file an appeal, the dispute over STLDI will proceed to the D.C. Circuit Court, where a parallel dispute over Association Health Plans (AHP) is already pending. A different federal judge ruled in March that the Trump administration's AHP rule was an impermissible end-run around the ACA.
The STLDI and AHP rules were introduced last year as side-by-side prongs in the administration's push to expand access to cheaper insurance despite the ACA.
Health and Human Services Secretary Alex Azar issued a statement hailing Friday's decision as "a clear victory for American patients who saw their costs rise and choices disappear" under the ACA.
"President Trump has shown that we can open up dramatically more affordable options for Americans who buy their own insurance while still always protecting patients with preexisting conditions," Azar said. "The President and HHS will continue taking action to provide all Americans with ways to finance their care that provide the affordability they need, the options and control they want, and the quality they deserve."
This story was updated to include statements from NAMI Acting CEO Angela Kimball and from HHS Secretary Alex Azar.
Twenty-seven recipient organizations were awarded up to $750,000 apiece. They include rural hospitals, community health centers, schools of medicine, native American tribal organizations, and health centers run by the Indiana Health Service.
The Health Resources and Services Administration (HRSA) awarded about $20 million Thursday in Rural Residency Planning and Development Program (RRPD) grants, with the goal of boosting the number of doctors serving rural America.
The 27 recipients were allotted up to $750,000 apiece over a three-year period to establish new rural residency programs. The idea is to alleviate the rural physician shortage by developing programs in family medicine, internal medicine, and psychiatry near the geographic areas in which the need is especially pressing.
"We know that clinicians who train in rural settings are more likely to continue to practice there after they complete their residencies," said HRSA Associate Administrator for the Bureau of Health Workforce Luis Padilla, MD, FAAFP, in a statement. "Rural communities are more likely to have a shortage of health professionals."
The grant recipients include rural hospitals, community health centers, schools of medicine, native American tribal organizations, and health centers run by the Indiana Health Service across 21 states. Their programs are expected to achieve accreditation through the Accreditation Council for Graduate Medical Education.
Health and Human Services Secretary Alex Azar said promoting rural health is among the Trump administration's healthcare priorities.
"Supporting the training of healthcare providers in rural areas through grants like these is a key way to help expand rural access to care, and is part of an overall effort to support rural healthcare in sustainable, innovative, and flexible ways," Azar said in the statement.
David Callender, who was selected to lead Memorial Hermann into the future, has been working as a health system president in the Greater Houston area for more than a decade.
Houston-based Memorial Hermann Health System announced Thursday afternoon that it has named David L. Callender, MD, MBA, FACS, as its next top executive.
Callender, who has been president of the nearby University of Texas Medical Branch (UTMB Health) since 2007, will take over as Memorial Hermann president and CEO in September. His predecessor, current President and CEO Charles "Chuck" D. Stokes, previously announced that he will retire this year.
Memorial Hermann Board Chair Deborah M. Cannon called Callender "a natural choice," given his experience in the Greater Houston area.
"It's clear that Dr. Callender cares deeply for this community and, through his leadership at UTMB Health, he has demonstrated an unwavering commitment to foster a healthier environment for all," Cannon said in a statement. "We are thrilled to welcome a leader who will preserve and strengthen Memorial Hermann's legacy of serving Greater Houston with pride and distinction, making him the ideal successor to Chuck, whose leadership has been instrumental in helping Memorial Hermann thrive and flourish during an era of change in the healthcare industry."
Before his time at UTMB Health, Callender was associate vice chancellor and CEO for UCLA Health. He had several earlier leadership roles with MD Anderson Cancer Center, including executive vice president and chief operating officer.
Callender said in the statement that Memorial Hermann and its physician partners have been making strides toward greater healthcare affordability and accessibility.
"I have been inspired by Memorial Hermann's efforts to bring value-based, more personalized care to our communities, and I'm excited and honored to now help lead the way as we work to extend those efforts by delivering exceptional patient experiences and improving outcomes for all," he said.
Stokes will officially retire at the end of this year, giving him time to work alongside Callender for a smooth transition, according to the annoucement.
"I believe Dr. Callender is the right person to help guide Memorial Hermann into the future," Stokes said in the statement.
The drop comes in the first enrollment start-date since CMS overhauled the program to hasten ACOs' downside risk.
Sixty-six accountable care organizations (ACO) joined the Medicare Shared Savings Program (MSSP) this month, their first opportunity to do so since the Centers for Medicare & Medicaid Services overhauled the value-based payment program to require downside risk sooner.
The number of new ACOs, which includes 41 first-time participants and 25 that returned after a period of nonparticipation, is significantly lower than new enrollment numbers in previous years. The program had 124 new participants in 2018 and 99 new participants in 2017, according to the National Association of ACOs (NAACOS), which has raised concerns the MSSP overhaul could spur an exodus.
Counting new and returning participants, a total of 518 ACOs are currently in the program. That's 43 fewer than the 561 participants MSSP had last year.
"We hope this smaller class is only a reflection of an off-cycle start date and not an indication that the program and transition to value are slowing down," said NAACOS President and CEO Clif Gaus, ScD, in a statement.
This year's July 1 start date was a special one-time event. In future years, new participants will be able to join in January.
CMS Administrator Seema Verma said in a Health Affairsblog post Wednesday that current participation rates are in line with the agency's projections, which means the program is on track to generate the expected $2.9 billion in savings over the coming decade.
"I am especially encouraged to see that an increasing fraction of ACOs are taking on real accountability," Verma wrote.
Nearly half (48%) of the ACOs with start dates on July 1, 2019—that includes the 66 newbies, plus another 140 ACOs that renewed their agreements—are taking on downside risk, Verma said. If they miss their cost targets, they will be required to repay CMS a small percentage of their revenue or cost target. Nearly one-third (29%) of all current MSSP ACOs are taking on risk, an increase of 10 percentage points, she said.
"This is projected to lead to more savings for beneficiaries and taxpayers, and provide stronger incentives for ACOs to coordinate care and improve quality for patients," Verma wrote.
When CMS launched its overhaul, which the agency dubbed "Pathways to Success," some industry groups raised concerns the changes could hamper participation, as Verma acknowledged in her blog post.
"However," she wrote, "today's results show that American providers are ready for the value-based transformation and are willing to accept greater accountability in exchange for more flexibility."
The nonprofit health system has been looking for a way to kickstart its own growth despite the relatively stagnant Akron area.
Summa Health CEO Cliff Deveny, MD, says he and the board have been "looking for a dose of Miracle-Gro" to fuel their strategic vision for the nonprofit health system. And they think they found precisely what they have been after.
The Akron, Ohio–based organization announced last week that it intends to become a wholly owned subsidiary of Beaumont Health, based in Southfield, Michigan. Although it would be part of a larger operation that straddles a state line, Summa Health would maintain its own local leadership and board. The tie-up could open doors, Deveny says, to growth opportunities well beyond the local market in which Summa Health currently operates—an attractive option in light of challenging market circumstances.
"Even though we are substantial in size, we have seen continued pressure on revenue by the expansion of Medicare and Medicaid in our population," Deveny says. "Our community is getting older, poorer, and smaller."
About 73% of Summa Health's payer mix now relies on government reimbursement, he says.
The population of Akron and the two-county area in which it is situated, just south of Cleveland, have remained largely stagnant in recent years, according to U.S. Census Bureau estimates. Unlike the health systems that serve metro areas experiencing annual population growth of 3% or more, where provider organizations can grow alongside their communities, health systems in sleepier markets often have an uphill battle.
"Since our community is not growing and we really didn't have the opportunity to enjoy some of what other communities are seeing, we really have to focus on forcing the growth, either through inorganic or organic ways and then taking the assets we have and maximizing those," Deveny tells HealthLeaders.
"With that, we knew if we didn't find a partner—if we didn't get an organization that scored high enough in our search—that we were going to go it alone and just incrementally grow and eke it out every year," Deveny says.
Going it alone, however, would have come with some tough choices, and Summa Health's leaders wanted to steer clear of any situation in which they would have to shutter certain services, he says. So the system sent a request for proposals last fall to about 30 organizations within 250–300 miles, with revenues of more than $3 billion, plus all the local organizations in northeastern Ohio, he says. The organization reasoned at the time that, although it was already "on a path of growth, its progress may be stymied without a partner that can help address market pressures."
Summa Health's team was pleased to find so many viable options, Deveny says.
Why Pick Beaumont?
Although there were multiple workable proposals to choose from, Summa Health's leaders identified Beaumont Health as the best option for several reasons, Deveny says, including the following:
Financial stability: Faced with big operating losses in 2017, Summa Health eliminated about 300 positions, shortly after Deveny was named interim CEO following his predecessor's resignation amid conflict with the system's physicians, as The Plain Dealerreported. The system finished 2017 with a $28 million operating loss then posted a $24 operating profit in 2018, according to its audited financial statements. Despite the improvement and the expectation that 2019 will be another strong year, Summa Health was drawn to the stability of Beaumont Health's financial position, Deveny says. Beaumont had total net revenues of more than $4.8 billion in 2018, up from $4.4 billion in 2017, according to the system's unaudited financial statement.
Growth potential: Pairing with Beaumont also gives Summa the ability to serve more than its immediate geographic area. Deveny says the partnership will enable his organization's insurance product, SummaCare, to expand to new markets in Ohio and to support risk-based health insurance contracts and services in Michigan, too.
Commitment to clinical services: Summa wanted a partner who would commit to clinical services in the local community where Summa already operates, including maternity services, behavioral health, and opioid treatment, Deveny says. Beyond simply making such a commitment, Beaumont is already demonstrating its leadership by partnering with Universal Health Services (UHS) to build a new behavioral health hospital, he adds.
Ability to fill gaps in specialty care: Beaumont is also positioned to feed Summa's coverage area with greater access to specialty care services, Deveny says. "With all of their training programs, they really rose to the top," he says. Beaumont hosts medical students in their third and fourth yearsof study, has more than 900 physicians-in-training across more than 100 programs, and offerscontinuing medical education opportunities.
Cultural fit: Deveny says he and the Summa Health board work well with Beaumont's team, including CEO John Fox. It's clear, he says, that the two teams share a similar vision and sensibility for the road ahead. (A spokesperson for Fox did not respond to an interview request to expound on his earlier statement.)
Summa had viable options within Ohio but decided to reach across Lake Erie because Beaumont checked every box on Summa's list, Deveny says.
"We really got everything we were looking for," he says.
Why Be Acquired?
Rather than becoming a wholly owned subsidiary of a larger system, Summa Health could have simply struck a partnership—but Summa had already tried that approach.
Cincinnati-based Mercy Health owns 30% of Summa and holds 16 seats on its board as part of a 10-year partnership agreement, as The Plain Dealer reported. Summa negotiated with Mercy before issuing its RFP last fall; if the planned deal is finalized, then Beaumont will redeem Mercy's equity at closing, Deveny says.
"We got a significant amount of value out of the Mercy relationship," he says, citing about $75 million in bottom-line improvement. But there were also limitations in a partnership arrangement.
"When there's not full all-in integration and commitment to each other, you don't really extract all the value and you continue to be somewhat defensive of what you have and your ways of doing things," Deveny says. "It's more 'we'/'they' than it is 'us.'"
Allan Baumgarten, a consultant and long-term observer of healthcare industry trends, says the Beaumont-Summa combination—much like the possible merger of Sanford Health, based in Sioux Falls, South Dakota, and UnityPoint Health, based in Des Moines, Iowa, announced last month—shows how health systems are increasingly willing to strike deals across state lines to form significant multi-state systems.
"I think it is a new example of a trend we're seeing more broadly, and that is the regional boundaries of a local market getting much more expansive," Baumgarten says.
Considering the feedback healthcare provider organizations have received from the Federal Trade Commission and other antitrust regulators, who have indicated a willingness to challenge consolidation in local geographic markets, the prospect that more systems will strike deals across state lines like this seems likely, Baumgarten adds.
"Some of the major systems have basically topped out in terms of how much they could continue to acquire locally as part of their growth strategy … so those health systems that are looking to expand are casting their nets over a much wider geographic territory and looking to expand across different states," he says.
Deveny says healthcare strategy leaders should seek out partners who value developing these super-regional-type organizations.
"In a lot of communities," he says, "you don't want to necessarily be pulled into a proxy war with two large organizations that may be going at it."
The nonprofit health system based in Providence, Rhode Island, has tried thrice since the 1990s to reach a deal with Lifespan and Brown University. Separate discussions with Boston-based Partners HealthCare ended last month.
The board of directors for Care New England (CNE), based in Providence, Rhode Island, decided this week to quit flirting with the idea of reaching a deal with Lifespan and Brown University, at least for now.
The decision, which CNE President and CEO James E. Fanale, MD, and board chair Charles R. Reppucci announced Tuesday, comes less than six weeks after the latest round of three-party negotiations began. Rhode Island Gov. Gina M. Raimondo pushed for the parties to keep management control within her state, prompting Boston-based Partners HealthCare to abandon its efforts to acquire CNE last month.
Although the discussions among CNE, Lifespan, and Brown University were collaborative and respectful, the CNE leadership determined it would be in the organization's best interests to walk away, Fanale and Reppucci said in a statement, citing concerns over capital requirements, the expected financial stability of the combined system, antitrust considerations, the community's needs, and other factors.
The potential Partners-CNE combination had been nearing the finish line after two years of discussion when Partners withdrew its application last month, Fanale said.
"We spent so much time and energy doing that," Fanale said, as the Providence Journal's G. Wayne Miller reported. "We're kind of tired. When we earnestly tried to work on this [potential deal with Lifespan and Brown University], which we did, it just wasn't the right time to enter into another relationship."
Although the timing may not be right at the moment, CNE's leaders still see a merger in their future.
"Consolidation will continue to occur," Fanale told the Journal. "We have to continue to look for the right opportunity to do that. We're very strong for the time being. At some point we're going to have to do something. Going it alone is not a long-term strategy."
As recently as two years ago, CNE was losing $50 million per year, but not anymore, Fanale told an NBC News affiliate in Providence.
"We improved our performance dramatically. We've been in black for the last 18 months," he said.
"Do we need a partner at some point? We do. But we've improved our position remarkably in the last 18 months," he added. "We're not going to go down the drain, our cash position is better, so we're pretty optimistic about the future, absolutely."
When asked whether CNE expects to return to its talks with Partners, Fanale said there is "nothing imminent" planned, as The Boston Globe's Dan McGowan reported.
A spokesperson for Partners told the Globe that the organization values its clinical affiliation with CNE and remains committed to patients in Rhode Island, without answering whether the Boston-based health system will reinitiate merger talks.
The tools offer greater detail on how states might make the most of four waiver concepts the administration released last fall.
After urging states to explore new potential ways to bypass provisions of the Affordable Care Act, the Centers for Medicare & Medicaid Services released more details Monday on how states might do so.
The details include a template for each of the four waiver concepts CMS released last fall and a checklist for states putting together waiver applications under the ACA's Section 1332. The tools highlight specific areas in which the Trump administration has given states greater flexibility than the Obama administration had.
States aren't required to use these tools, and following the checklist and templates doesn't guarantee that an application will be approved, since states must meet a variety of statutory and regulatory requirements, CMS said.
"While states have tremendous opportunities to strengthen their health insurance markets through a State Relief and Empowerment Waiver, we've also heard from states that they need more help and detail from CMS in putting together their waiver applications," CMS Administrator Seema Verma said in a statement. "This new package of resources should reduce some of the guesswork and burden on states as they craft their waiver applications."
The four waiver concepts are based on a revised guidance document CMS released in October to give states greater flexibility. Some have questioned the legality of that revised guidance since it avoided formal notice-and-comment rulemaking.