The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on February 17, 2017 targeted at reforming and stabilizing the individual and small group health insurance markets. When (or if) finalized, the proposed rule would make modifications and changes to special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community providers, and actuarial value requirements. Centers for Medicare and Medicaid Services (CMS) explains its belief that the proposed regulations would give more flexibility to insurers and states, offer patients access to more coverage options, and stabilize individual and small group health insurance markets while future reforms are being debated.
The significant modifications and changes proposed in the regulations are as follow:
Addressing the potential abuses by permitting an issuer to accumulate premiums for prior unpaid coverage, before enrolling a sufferer in the plan of next year with the same issuer. This will incentivize patients to ignore coverage lapses.
Expansion of pre-enrollment verification of eligibility to people who newly enroll via special enrollment periods in Marketplaces by utilizing the HealthCare.gov platform. This proposed change has been intended by CMS to help make definite that special enrollment periods are available to all who are eligible while requiring people to submit supporting documentation, a common practice in the employer health insurance market. The purpose is to help place downward pressure on premiums, curb abuses, and boost year-round enrollment.
Reaffirming the states’ traditional role to serve their populations by moving network adequacy reviews to the states. During the analysis of QHPs, Centers for Medicare and Medicaid Services (CMS) would defer network adequacy reviews in states with the authority and means to assess issuer network adequacy.
Statement of CMS’ purpose to issue a revised proposed timeline for the QHP certification and rate review process for plan year 2018. Issuers will be provided with additional time through the revised timeline to implement proposed changes that are finalized prior to the 2018 coverage year. These modifications will give issuers flexibility to incorporate benefit changes and increase the number of coverage options available to sufferers.
Adjustments to the de minimis range utilized for evaluating the level of coverage by giving higher flexibility to issuers to offer patients with more coverage options.
Upcoming annual open enrollment period’s shortening for the individual market. CMS proposes an open enrollment period of November 1, 2017, to December 15, 2017 for the 2018 coverage year. The stated intent is to align the Marketplaces with the Employer-Sponsored Insurance Market and Medicare. This might assist to lower prices for Americans by decreasing adverse selection.
All of the regulations, clearly, pertaining to the Affordable Care Act (ACA) are up in the air pending potential Congressional action on the underlying statutes. Due to the current uncertainty, CMS seems to be moving forward with revisions to the health care program that it proposes to add stability to operation and costs. March 7, 2017 will be the last day for public comments to be received on the proposed regulations.