CMS Releases ACA Market Stabilization Proposed Rule

CMS Releases ACA Market Stabilization Proposed Rule

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 proposed rule would make the following policy changes:

  • Guaranteed availability of coverage: allow insurers to require customers to pay overdue bills before enrolling in new coverage.
  • Enrollment periods: tighten the next open enrollment period to November 1 to December 15, and require pre-enrollment verification before enrolling through a special enrollment period.
  • Actuarial value (AV): increase the de minimis variation in the actuarial values used to determine metal levels; this would not apply to Silver plans.
  • Network adequacy: defer to the State’s review of network adequacy in States with the authority and means to assess this.
  • Essential community providers (ECP): lower the ECP threshold to 20 percent, and allow issuers to use a write-in process to identify ECPs who are not on the HHS list of available ECPs for the 2018 plan year.

The proposed rule can be found, here. The Academy is working to assess the impact of this rule on audiologists.

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