CMS Proposes New Rule to Stabilize Health Insurance Exchanges

February 2017 ~

CMS has released a new proposed rule aimed at stabilizing Affordable Care Act (ACA) individual and small group insurance markets and encourage more insurers to stay on the exchanges through promoting more coverage options, and improving the risk pool for insurers.

If finalized, the new rule would:

  • Shorten the enrollment period in the individual market for the 2018 plan year to Nov. 1, 2017 through Dec.15, 2017 (instead of Nov. 1, 2017 through Jan. 31, 2018);
  • Expand the number of health insurance exchange consumers required to submit eligibility documentation during special enrollment periods from 50% to 100% (beginning June 2017);
  • Modify the official interpretation of guaranteed availability of coverage provisions to allow payers to collect past due coverage costs before enrolling an individual in the next year’s health plan;
  • Increase the de minimis variation in plan actuarial values to a range of negative 4 to positive 2 percentage points;
  • “Affirm the traditional role of States in overseeing their health insurance markets while reducing the regulatory burden of participating in Exchanges for issuers.”

“This proposal will take steps to stabilize the Marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options,” CMS Acting Administrator, Patrick Conway, stated the accompanying press release. “They will help protect Americans enrolled in the individual and small group health insurance markets while future reforms are being debated.”


Source(s): Department of Health and Human Services, February 2017; Centers for Medicare & Medicaid Services, February 2017; HealthPayerIntelligence, February 2017; HealthcareDIVE, February 2017;