The Centers for Medicare and Medicaid Services this week issued a proposed rule for 2018 that would make changes to special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community providers and actuarial value requirements.
In addition, CMS announced upcoming changes to the qualified health plan certification timeline.
According to CMS Acting Administrator Dr. Patrick Conway, “This proposal will take steps to stabilize the Marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options.”
The rule proposes changes to provisions from several existing regulations including those concerning:
- Special Enrollment Period Pre-Enrollment Verification: The rule proposes to expand pre-enrollment verification requirements, which already is in place requiring pre-enrollment verification of 50 percent of newly enrolled individuals through special enrollment periods in Marketplaces. The proposal would require pre-enrollment verification to apply to all newly enrolled individuals.
- Guaranteed Availability: The rule proposal would allow insurers to apply premiums to the previous year’s unpaid coverage before enrolling a patient in the next year’s plan with the same issuer. This is a change in a previous interpretation that restricted this practice.
- Determining the Level of Coverage: The rule proposes to make adjustments to the de minimis range used for determining the level of coverage, except for silver level plans.
- Network Adequacy: The proposed rule would eliminate the Department of Health and Human Service’s oversight activities regarding network adequacy and defer to states’ reviews in states with the authority and means to assess issuer network adequacy.
- Qualified Health Plan (QHP) Certification Calendar: In the rule, CMS announces its intention to release a revised proposed timeline for the QHP certification and rate review process for plan year 2018. This would afford insurers additional time to implement proposed changes that are finalized prior to the 2018 coverage year.
- Open Enrollment Period: The rule proposes to shorten the upcoming annual open enrollment period for the individual market. For the 2018 coverage year, the open enrollment period would end on Dec. 15, 2017, instead of the currently mandated end date of Jan. 31, 2018.
The proposed rule can be found on the Federal Register. Comments are due by March 7.