All posts by Lisa Kaplan Howe

Lisa Kaplan Howe (J.D.) is a Senior Advisor who has spent her career working in health law and policy. At PCG, she focuses on statutory and regulatory analysis and strategic advising, particularly related to health care policy. Lisa has provided subject matter expertise to support state health care reform efforts, including policy development and regulatory support for health insurance Marketplaces and state insurance plan management efforts, Medicaid expansion and Medicaid Waivers (including DSRIP Waivers) and State Innovation Waivers. Lisa led PCG’s work with the New Hampshire Insurance Department relative the state’s Section 1115 Medicaid Waiver to provide coverage to newly-eligible adults through the Marketplace and continues to support the states’ Marketplace plan management work. In those roles, Lisa has served as the chief advisor and policy expert related to Medicaid and private insurance law to the New Hampshire Insurance Department, helping to identify, analyze and lead strategic consideration of federal opportunities and requirements. Lisa is also part of the team helping to design Colorado’s Delivery System Reform Incentive Payment (DSRIP) program. Ms. Kaplan Howe also provides broad policy and regulatory support to PCG’s other health care clients across the country, analyzing policy and regulatory developments, providing strategic advice relative to regulatory questions, and drafting policy briefs and position papers. Lisa is a managing editor of PCG’s monthly health practice area newsletter, Health Policy News. Prior to joining PCG, Lisa served as Policy Director at New Hampshire Voices for Health, where she led legislative and regulatory analysis, strategic planning, and implementation of the organization’s policy agenda. Her work included drafting bills, amendments, testimony, and communications and testifying at hearings. Lisa also held the positions of Private Market Policy Manager and Consumer Health Policy Coordinator at Health Care for All of Massachusetts. While there, she managed private insurance market policy work and was a member of the organization’s internal health reform team. Lisa also practiced law in the Ropes & Gray health care department, advising health care provider and insurer clients.

CMS Proposes Changes to the Regulations Governing Medicaid and CHIP Managed Care

On November 14, 2018, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule making changes to the Medicaid and Children’s Health Insurance Program (CHIP) Managed Care regulations. CMS had notified states in March 2017 that it was doing a thorough review of Medicaid and CHIP Managed Care regulations, which were last overhauled ...

States Respond to Recent Federal Regulations

States across the country have spent the past few months reviewing and considering two significant rules promulgated at the Federal level over the summer: the final rule on Association Health Plans (AHPs) issued by the Department of Labor in June, and the final rule on Short Term Limited Duration Insurance (STLDI) issued by the Departments ...

Federal Departments Finalize Rule to Expand Access to Short Term Health Plans that are not ACA-Compliant

On August 1, 2018, the Department of the Treasury, the Department of Labor, and the Department of Health and Human Services (together, “the Departments”) jointly promulgated a final rule on Short-Term Limited-Duration Insurance (“final rule”). The final rule further amends the proposed rule released in February and seeks to carry out the directions given in ...

States Are Increasingly Turning to Uniform Prior Authorization Forms

Background Prior authorization is a common tool for utilization management and controlling health care costs. While the approach to the process is similar across payers, each insurance carrier and public program has its own forms – with variations on questions asked, how they are asked, and the order in which they are asked – and ...

States Pursue Unique Approaches to Permit Non-Compliant Health Plans

While much of the attention over the debate over the Affordable Care Act (ACA) has centered at the Federal level, states continue to act as the laboratories for innovation. Last year Health Policy News featured a series of updates on activity around Section 1332 State Innovation Waivers in the states – with a focus primarily ...

CMS Proposes Changes to Rules related to Medicaid Access to Care Requirements

On March 23rd, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would exempt states from requirements to analyze and monitor access to care in the Medicaid program under certain circumstances. The proposal seeks to amend 42 CFR 447.203(b), which sets forth the process for states to document whether Medicaid payments ...

New federal grant opportunity to support state efforts to strengthen the private health insurance market

On February 5, 2018, the Center for Consumer Information and Insurance Oversight (CCIIO) released a new Notice of Funding Opportunity to support states as they implement several of the market reforms and consumer protections under Title I of the Affordable Care Act (ACA). This grant program is a follow-up to the Health Insurance Enforcement and ...

Administration budget proposal includes health care changes

The administration released its budget proposal on February 12, 2018. As expected, the proposal includes a number of changes related to health care. The budget plan revives the Affordable Care Act (ACA) repeal, with a proposal similar to the Graham Cassidy Heller Johnson bill. Specifically, the budget plan proposes a staged repeal and replace, with ...

Federal departments put out proposed rule to expand access to short-term health plans that are not ACA-compliant

On February 20, 2018, the Department of the Treasury (Treasury), the Department of Labor (DOL), and the Department of Health and Human Services (HHS) jointly promulgated a proposed rule on Short-Term, Limited-Duration Insurance (STLDI) plans. The proposed regulatory changes seek to carry out the directions given in Executive Order 13813, “Promoting Healthcare Choice and Competition ...

CMS releases several major policy changes and expanded roles for states in its Proposed NBPP for 2019

At the end of October, the Centers for Medicare & Medicaid Services (CMS) released its annual Proposed Notice of Benefit and Payment Parameters (NBPP) for 2019 (along with accompanying guidance, including a Draft 2019 Actuarial Value Calculator). As in past years, the NBPP for 2019 addresses a breadth of issues related to health plan regulation, Exchange operations (including ...