Benefits and Compensation

CMS Issues Final Health Insurance Market Stabilization Rule

On April 13, the Centers for Medicare & Medicaid Services (CMS) issued a final market stabilization rule designed to improve the healthcare marketplace and promote

“CMS is committed to ensuring access to high quality affordable healthcare for all Americans and these actions are necessary to increase patient choices and to lower premiums,” said CMS Administrator Seema Verma, quoted in a press release. “While these steps will help stabilize the individual and small group markets, they are not a long-term cure for the problems that the Affordable Care Act has created in our healthcare system.”

The final rule makes several policy changes, including:

  • 2018 annual open enrollment period modified: The final rule shortens the annual open enrollment period for 2018. It will start on November 1, 2017, and run through December 15, 2017.
  • Supporting documentation required for special enrollment periods: The final rule requires individuals to submit supporting documentation for special enrollment periods and is meant to “encourage individuals to stay enrolled in coverage all year,” according to CMS.
  • Insurers may demand past-due premiums: The final rule allows issuers to require individuals to pay back past due premiums before enrolling into a plan with the same issuer the following year.
  • Provides additional actuarial value flexibility to insurers: This is meant to give insurers “flexibility to develop more choices with lower premium options for consumers, and to continue offering existing plans.”
  • Eliminates duplications: The final rule “reduces waste of taxpayer dollars by eliminating duplicative review of network adequacy by the federal government. The rule returns oversight of network adequacy to states that are best positioned to evaluate network adequacy,” says CMS.

CMS also made a number of other announcements regarding the process that issuers must follow to meet the law’s requirements for the 2018 plan year. The additional guidance includes updates that would make the guidance consistent with the final rule and information needed by issuers in order to have their plans certified for 2018, including: Key Dates for 2017; Issuer Guidance on Uniform Rate Review Timeline; Good Faith Compliance Guidance; QHP Certification Guidance for States; and Final Actuarial Value (AV) Calculator for 2018, and Methodology.

The final rule can be found here.