CMS this morning released the following statement:
The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule for 2018, which 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:
- Open Enrollment Period: The rule 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.
- 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.
The proposed rule can be found, here: https://www.federalregister.gov/documents/2017/02/17/2017-03027/patient-protection-and-affordable-care-act-market-stabilization
Categories: Uncategorized
Closing loopholes is one thing, and I concur with that, and it’s pretty much a done deal. CMS was planning to do anyway, pre-Trump. But scope and how it’s done are critical. Under these rules as proposed, it’s entirely plausible that enrollment would fall by 1 million or more fro 2018 and that untold thousands would pay more or get less generous coverage. Is that what we want. What about all those statements by Trump and Rs that it would be better coverage and more affordable. Of course, that was/is rhetoric. But the proverbial rubber now meets the road.
All the carriers in Minnesota have been vigorously demanding written proof of SEP events for the last two years.
Big deal. These carriers came within an eyelash of totally leaving the marketplace last summer.
Several sensible fixes in the OMB draft rule — particularly around closing enrollment loopholes and allowing states to handle essential benefits. But policymakers have yet to provide necessary clarity on funding, especially 2 types of ACA subsidies. Consumers need that money in order to have affordable coverage. Clock for 2018 is ticking.
http://www.achp.org/achp-news/stablization17/
“That’ll be especially true if the Trump admin decides not to enforce the mandate.”
Trump did this today. IRS said it’s still the law but it won’t cross check the returns. Can this be done without legislative change?
I wonder who these changes are targeted at. Those with no subsidy who already pay high premiums and are not much interested in ACA except for the pre-exist group, and/or the young invincibles who cannot plan ahead anyway and will not be scared much by the threat of paying back several years of premiums. I do favor the premium penalty, just don’t think it’ll make much difference with the targeted group.
The dropping of the weak mandate is not going to help offset the sick with the healthy.
Maybe Repugs just want this to die on the vine, then claim non-interest when no insurance company can make any money on it.
I’ll look for more comments.
These proposed rules are clearly impactful. They sound technical but are not minor. The actuarial changes could mean that consumers will pay more for less generous coverage, or be compelled to choose less generous coverage to maintain their premium and subsidy level. And the pre-enrollment verification rules would almost certainly translate to fewer young and healthy people covered as they get asked for more verification and decide not to bother with the hassle. That’ll be especially true if the Trump admin decides not to enforce the mandate. In any event, the market will NOT be further stabilized, quite the opposite. More later as I and others digest these first concrete steps under the new administration pertaining to the exchanges.
I’m cautiously optimistic. We know something has to be done about the gaming of the system and the essential health benefits. These seem to be reasonable first steps, and also signals that this might be the Administration’s way of “fixing” the ACA rather than simply scrapping it. We’ve got to stop the losses and stabilize the insurance function first and then make it better–sort like emergency room care. I realize that many out there will see nothing done by this administration as positive.
What remains is what are they to do about the individual mandate, which in my opinion must be strengthened. Republicans way back used to favor such a thing; maybe a history lesson might help them see their way to do that again.
Just remember that insurance is not about tailoring benefits to just what people need. We require a lot of people with coverage they don’t use to cover those who do use it; so while some tailoring (just enough to keep them in the program) is needed, beyond that, you gotta spread the risk over large numbers.
Just a few quick reactions to this:
(1) The proposed changes will have the impact of reducing the number of people in QHPs and the exchanges, and reducing the benefits (actuarial value) of the plans on the exchange. In other words, one way or another, there will be less insurance coverage.
(2) The “de minimus” provision boils down to letting plans decrease their actuarial value by 2% at each metal level. The original idea was to allow for a reasonable range of +/-2% from the 60/70/80/90 percent actuarial values at each metal level. The new rule now allows for -4% but still only plus 2%. Plans will have a major incentive to cluster near the low end of the range, meaning a drop of 1-2% in what is covered. That will also mean a drop of 1-2% in premium compared to what would have been, other things being equal, but other things are not equal and if a death spiral really gets going here those savings will be drowned out.
(3) The special enrollment period verification expansion on healthcare.gov and the restriction on the open enrollment period are both reasonable. They will suppress gaming and free riding a little, but also suppress enrollment of people who just didn’t get their act together during (the reduced) open enrollment. The shorter open enrollment period was always part of the long term plan, and matches Medicare Advantage.
(4) Of all of these, perhaps the only unambiguously good change is the increased flexibility and shortened timeframe in QHP certification. With so much in flux, plans need the extra time to submit.