Today, CMS/CCIIO
issued a proposed
rule on Market Stabilization (CMS-9929-P) for 2018. The publish date
is February 17, 2017. Comments are due by March 7, 2017.
The proposed rule proposes new
reforms that are critical to stabilizing the individual and small group health
insurance markets to help protect patients. This proposed rule would make
changes to special enrollment periods, the annual Open Enrollment Period,
guaranteed availability, network adequacy rules, essential community providers,
and actuarial value requirements; and announces upcoming changes to the
qualified health plan certification timeline.
“Americans participating in
the individual health insurance markets deserve as many health insurance
options as possible,” said Dr. Patrick Conway, Acting Administrator of the
Centers for Medicare & Medicaid Services. “This proposal will take
steps to stabilize the Marketplace, provide more flexibility to states and
insurers, and give patients access to more coverage options. They will help
protect Americans enrolled in the individual and small group health insurance
markets while future reforms are being debated.”
The rule proposes a variety of
policy and operational changes to stabilize the Marketplace, including:
-
Special Enrollment Period Pre-Enrollment
Verification: The rule proposes to expand pre-enrollment verification of
eligibility to individuals who newly enroll through special enrollment periods
in Marketplaces using the HealthCare.gov
platform. This proposed change would help make sure that special enrollment
periods are available to all who are eligible for them, but will require
individuals to submit supporting documentation, a common practice in the
employer health insurance market. This will help place downward pressure on
premiums, curb abuses, and encourage year-round enrollment.
-
Guaranteed Availability: The rule
proposes to address potential abuses by allowing an issuer to collect premiums
for prior unpaid coverage, before enrolling a patient in the next year’s plan
with the same issuer. This will incentivize patients to avoid coverage lapses.
-
Determining the Level of Coverage: The
rule proposes to make adjustments to the de minimis range used for determining
the level of coverage by providing greater flexibility to issuers to provide
patients with more coverage options.
-
Network Adequacy: The proposed rule takes
an important step in reaffirming the traditional role of states to serve their
populations. In the review of qualified health plans, CMS proposes to defer to
the states’ reviews in states with the authority and means to assess issuer
network adequacy. States are best positioned to ensure their residents
have access to high quality care networks.
-
Qualified Health Plan (QHP) Certification
Calendar: In the rule, CMS announces its intention to release a revised
proposed timeline for the QHP certification and rate review process for plan
year 2018. The revised timeline would provide issuers with additional time to
implement proposed changes that are finalized prior to the 2018 coverage year.
These changes will give issuers flexibility to incorporate benefit changes and
maximize the number of coverage options available to patients.
-
Open Enrollment Period: The rule also
proposes to shorten the upcoming annual Open Enrollment Period for the
individual market. For the 2018 coverage year, we propose an Open Enrollment Period of November 1, 2017, to December 15, 2017. This proposed change
will align the Marketplaces with the employer-sponsored insurance market and
Medicare, and help lower prices for Americans by reducing adverse
selection.
The
proposed rule can be found here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-03027.pdf
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