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CMS issues final rule on health insurance market for 2018

To provide some immediate relief for patients and insurers, CMS has issued the final Market Stabilization Rule, which the agency says will help lower premiums, stabilize individual and small group markets and increase health care choices.

“CMS is committed to ensuring access to high quality affordable health care for all Americans and these actions are necessary to increase patient choices and to lower premiums,” Seema Verma, MPH, CMS Administrator, said in a press release. “While these steps will help stabilize the individual and small group markets, they are not a long-term cure for the problems that the Affordable Care Act has created in our health care system.”

To provide some immediate relief for patients and insurers, CMS has issued the final Market Stabilization Rule, which the agency says will help lower premiums, stabilize individual and small group markets and increase health care choices.

Some of the other changes, according to the release, include:

• adjusting the annual open enrollment period for 2018 to run from Nov. 1 to Dec. 15, 2017, which is more in line with private market and Medicare;
• decreasing abuse, waste and fraud by mandating individuals to submit supporting documentation for special enrollment periods and ensuring only those eligible to enroll do so;
• encouraging continuous coverage by mandating individuals to pay back past due premiums before enrolling into a plan with the same issuer the following year;
• ensuring more choices by allowing issuers additional actuarial value flexibility to create more choices with lower premium options for consumers, and to continue offering existing plans; and
• returning oversight of network adequacy to states that are best positioned to perform this task, which empowers states and reduces duplication.

Last week, the AMA, AAFP and other organizations sent a letter to Congress and President Donald J. Trump asking that funding for cost sharing reductions continue, and that action be taken quickly to stabilize the insurance market.

In a statement after the final rule was issued, the AMA said these latest CMS actions do not go far enough.

“The regulations … still need to address the resulting inequity of the [Affordable Care Act’s] grace period, which allows issuers to collect unpaid premiums for months in which health care services were provided but not actually covered by insurance,” Andrew W. Gurman, MD, AMA President, said in a statement. “Moreover, we believe reducing the open enrollment period to 6 weeks will not provide enough time for consumers to enroll, and we are concerned that moving oversight of network adequacy completely to the states will not provide sufficient protection for physicians and their patients.”

Reference : CMS’ Final Rule on Market Stabilization (accessed 04-17-2017)

Disclosure: Verma is the administrator of CMS; Gurman is president of AMA.