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CMS proposes 2018 rule to increase patients’ health insurance options
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CMS issued a proposed rule for 2018 to mandate new reforms that will stabilize the individual and small group health insurance markets to protect patients, according to a recent press release.
The proposal will amend a variety of policies and operations including special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community providers and actuarial value requirements.
“Americans participating in the individual health insurance markets deserve as many health insurance options as possible,” Patrick Conway, MD, MSc, acting administrator of CMS. “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.”
CMS is proposing a special pre-enrollment verification eligibility expansion to include individuals who recently enrolled in marketplaces through the HealthCare.gov platform. This would ensure that all individuals who are eligible for special enrollment periods have access, but will also require a submission of supporting documentation, thus decreasing pressure on premiums, curb abuses and encourage year-round enrollment, according to CMS.
To address potential misuses and incentivize patients to avoid coverage lapses, CMS is suggesting that before enrolling a patient in the next year’s plan with the same issuer, an issuer be allowed to collect premiums for prior unpaid coverage. The change is also offering greater flexibility to issuers and more coverage options to patients by suggesting to amend the de minimis range that determines the level of coverage.
CMS is reaffirming the traditional role of states to serve their populations by proposing to defer to the states’ reviews in states with the authority and ability to evaluate issuer network adequacy. According to the CMS, this will ensure that high quality care networks are accessible to residents.
In its proposal, CMS announced that it will release a revised proposed timeline for the 2018 Qualified Health Plan certification and rate review processes to offer additional time to insurers to employ proposed changes that are confirmed before 2018. Changes to the timeline will allow insurers to integrate benefit modifications and maximize the number of health insurance choices available to patients, according to CMS.
In addition, CMS is proposing to shorten the upcoming annual open enrollment period for the individual market to run from Nov. 1, 2017, to Dec. 15, 2017. This will align the marketplaces with the Employer-Sponsored Insurance Market and Medicare and assist in lowering prices for Americans through moderating adverse selection, according to CMS.
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Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.