As a firm plan for the future of the Affordable Care Act (ACA) remains in limbo, the Centers for Medicare & Medicaid Services (CMS) have responded by issuing a proposed rule for 2018 that outlines reforms “critical to stabilizing the individual and small group health insurance markets to help protect patients,” says CMS.
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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. It also 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, quoted in a press release. “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, including:
- Special Enrollment Period Preenrollment Verification: The rule proposes to expand preenrollment verification of eligibility to individuals who newly enroll through special enrollment periods in Marketplaces using the HealthCare.gov platform. This proposed change, says CMS, “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. The rule is designed to 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,” says CMS. “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, “giv[ing] issuers flexibility to incorporate benefit changes and maximize the number of coverage options available to patients,” says CMS.
- Open Enrollment Period: The rule also proposes to shorten the upcoming annual open enrollment period for the individual market. For the 2018 coverage year, CMS proposes 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,” says CMS.
The proposed rule can be found here.