New CMS rule wants to increase ACA exchange participation — 4 insights

CMS issued a final rule aimed at stabilizing the individual and small group insurance markets for the 2018 coverage year.

Here's what you need to know:

1. The rule will change the following:

  • CMS is reducing the open enrollment period from Nov. 1, 2017 to Jan. 1, 2018 to Nov. 1 to Dec. 15, 2017.
  • CMS is increasing pre-enrollment verification for all individual market special enrollment periods from 50 percent to 100 percent
  • CMS is revising how it interprets the federal guaranteed availability requirement to allow insurers to "apply a premium payment to an individual's debt owed for coverage from the same issuer or a different issuer in the same controlled group within the prior 12 months before applying the payment towards a new enrollment.
  • CMS is increasing de minimis variation in actuarial values to determine metal levels of coverage.

2. CMS issued the rule in response to several payers withdrawing from the exchanges.

3. The final rule aims to increase incentives for people staying in the ACA exchanges while decreasing incentives for people seeking coverage once they require medical service.

4. CMS concluded the rule saying, "We believe these changes are critical to improving the risk pool, and will together promote more competitive markets with increased choice for consumers."

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