CMS Issues New Rule to Stabilize the ACA Market

CMS/CCIIO issued a proposed rule on Market Stabilization (CMS-9929-P) for 2018, published February 17, 2017. Comments are due by March 7, 2017.

The regulation proposes new reforms¬†intended to stabilize the individual and small group health insurance markets which in turn should help consumers. “This proposal will take steps to stabilize the Marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options,” said Dr. Patrick Conway, Acting Administrator of the Centers for Medicare & Medicaid Services.¬†“They will help protect Americans enrolled in the individual and small group health insurance markets while future reforms are being debated.”

The new rule can be found here. It proposes a variety of policy and operational changes to stabilize the Marketplace, including:

Special Enrollment Period Pre-Enrollment Verification

The ruling wants to ensure special enrollment periods are available to those that qualify. However, it will require individuals to submit supporting documentation; this is common within the employer health insurance market. By implementing this rule, it should lower premiums, help stop abuses, and encourage year-round enrollment.

Guaranteed Availability

Under this rule, insurers can collect back payments on unpaid premiums¬†from clients¬†before enrolling them in the next year’s plan. By enforcing payments, the rule¬†will incentivize patients to always have insurance.

Determining the Level of Coverage

To increase insurer’s flexibility so as to provide patients with more coverage options, the rule¬†intends to adjust¬†the de minimis range. This will change¬†the requirements that qualify for each¬†level of coverage – bronze, silver, gold, platinum.

Network Adequacy

CMS claims that states are “best positioned to ensure their residents have access to high quality care networks.” Therefore, the ruling defers the authority to decide if the networks of providers is sufficient or not to the states.

Qualified Health Plan (QHP) Certification Calendar

In addition to giving insurers the flexibility to determine plan benefits, the rule also promotes flexibility by revising the timeline for the Qualified Health Plan (QHP) certification and rate review process for plan year 2018. This will give insurers more time to propose benefit changes to coverage options for the next open enrollment period (OEP).

Open Enrollment Period

Lastly, the rule changes the timeline of the next OEP for the 2018 coverage year. Instead of November 1 to January 31, the enrollment timeframe for this year will¬†be shortened to¬†November 1, 2017, to December 15, 2017. This new enrollment period aligns with the employer-sponsored insurance market and Medicare. This should help lower prices for consumers “by reducing adverse selection,” according to CMS.


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