CMS Issues Final Rule for Insurers in ACA Market

April 2017 ~

CMS has published a final rule(pdf) intended to help improve the risk pool and stabilize the Affordable Care Act (ACA) Insurance Exchanges for 2018,

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.

Major provisions of the final rule include:

  • Adjusting the annual open enrollment period for 2018 to more closely align with Medicare and the private market. The next open enrollment period will start on November 1, 2017, and run through December 15, 2017, encouraging individuals to enroll in coverage prior to the beginning of the year.
  • Promoting program integrity by requiring individuals to submit supporting documentation for special enrollment periods and ensures that only those who are eligible are able to enroll. It will encourage individuals to stay enrolled in coverage all year, reducing gaps in coverage and resulting in fewer individual mandate penalties and help to lower premiums.
  • Promoting personal responsibility by allowing issuers to require individuals to pay back past due premiums before enrolling into a plan with the same issuer the following year. This is intended to address gaming and encourage individuals to maintain continuous coverage throughout the year, which will have a positive impact on the risk pool.
  • Allow issuers additional actuarial value flexibility to develop more choices with lower premium options for consumers, and to continue offering existing plans.
  • Reducing 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.

CMS also made a number of other announcements regarding the process that issuers must follow to meet the requirements of the Market Stabilization Final Rule and have their plans certified for the 2018 plan year, including:

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


Source(s): CMS; HealthcareFinance News; HealthAffairs;