CMS Issues Final Rule and Related Guidance to Promote Marketplace Stability

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Last week, the Centers for Medicare & Medicaid Services (CMS) issued the final rule (Final Rule) on Market Stabilization under the Affordable Care Act (ACA). The Final Rule aims to lower insurance premiums, stabilize individual and small group markets, reduce fraud, waste and abuse, promote continuous coverage, empower states, reduce duplication of efforts between the states and federal government and increase the number of health insurance plans and plan choices available to consumers in the Marketplace. To accomplish these goals, the Final Rule makes several policy changes, including:

  • Amending the annual open enrollment period to November 1, 2017 to December 15, 2017 for the 2018 plan year;
  • Requiring individuals to submit supporting documentation if they want to sign up for Marketplace coverage during special enrollment periods;
  • Allowing issuers the ability to require individuals to pay back past-due premiums before enrolling in a plan with the same issuer the following year;
  • Allowing issuers additional actuarial value flexibility to enable them to develop more plan choices with lower premium options for consumers; and
  • Providing states with the ability to evaluate and oversee the adequacy of health care networks within their borders and eliminating duplicative review of network adequacy by the federal government.

In addition to the Final Rule, CMS issued guidance regarding the process that issuers must follow to meet the requirements of the Final Rule and have their plans certified for the 2018 plan year. CMS’s guidance includes:

  • Key dates and deadlines for 2017 related to plan certification, rate review, risk adjustment, reinsurance and risk corridors for the 2018 plan year.
  • Guidance regarding Uniform Rate Review Timelines in 2017 for the 2018 plan year;
  • FAQ on CMS’s “good faith policy” approach to compliance for issuers participating in the Marketplace during the 2018 plan year;
  • Guidance for states pertaining to the review of qualified health plan certification standards for the 2018 plan year; and
  • Final Actuarial Value (AV) Calculator for 2018, which is designed to provide an estimate of the network liability for a given plan design and show changes between 2017 and 2018.

The Final Rule will become effective on June 19, 2017.

Categories: Health Care Reform, Compliance, Health Care in General | Tags: CMS , Market Stability , ACA , Affordable Care Act , AV Calculator , qualified health plan , stabilization , health insurance , Marketplace | Return