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CMS proposes rules to stabilize the individual marketplace for 2018

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CMS issued proposed regulations Wednesday to stabilize the individual and small group health insurance markets.

“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,” said Patrick Conway, MD, acting administrator of CMS.

Here are six proposed rules.

1. Constrict the annual enrollment period to between Nov. 1, 2017 and Dec. 15, 2017. The 2017 annual open enrollment period ran for three months, from Nov. 1, 2016 through Jan. 31. CMS said the change for the 2018 open enrollment would align the individual marketplaces with the employer-sponsored insurance market and Medicare.

2. Adjust the minimum standards used to determine levels of coverage. Officials said this would give payers flexibility to provide patients with more coverage options.

According to a filing with the Federal Registry, the “proposed change in [actuarial value]could reduce the value of coverage for consumers, which could lead to more consumers facing increases in out-of pocket expenses, thus increasing their exposure to financial risks associated with high medical costs. However, in the longer run, providing issuers with additional flexibility could help stabilize premiums, increase issuer participation and ultimately provide some offsetting benefit to consumers.”

3. Provide payers additional time to change plans before they are finalized for 2018. CMS proposed to revise the timeline for the qualified health plan certification calendar to give insurers more time to integrate benefit changes and maximize the number of coverage options available. At this time, 2018 plans must be submitted to state and federal governments beginning in April.

4. Defer review of provider network adequacy to states. Officials propose states, if they are able to, review qualified health plans to assess payer network adequacy.

5. Expand special enrollment pre-enrollment verification. CMS proposed requiring additional documentation for first-time individuals enrolling in special enrollment periods via the HealthCare.gov platform.

6. Allow insurers to collect premiums for previously unpaid coverage prior to enrolling an individual in next year’s coverage. CMS said this will “incentivize patients to avoid coverage lapses.”

Marilyn Tavenner, president and CEO of America’s Health Insurance Plans, said the national association “commend[s]the Administration for proposing these regulatory actions as Congress considers other critical actions necessary to help stabilize and improve the individual market for 2018.”

Additionally, Ceci Connolly, president and CEO of the Alliance of Community Health Plans, said the “new rule begins to address concerns about the stability of the individual market, but does not resolve all of the uncertainty for plans and patients alike. Without adequate funding it will be extremely difficult to provide high-quality, affordable coverage and care to millions of Americans. This is a promising first step.”

The proposed rules will be open for public comment until March 7. 

More articles on payer issues:
Humana to exit ACA exchanges for 2018
BCBS of North Carolina CEO retires: 4 things to know
Cigna ends merger agreement, sues Anthem for $14.85B: 3 things to know

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