CMS proposes new rules to encourage insurers to stay in ACA marketplace

Despite numerous insurers pulling out of the Affordable Care Act business and the promise by President Donald Trump to repeal the ACA, the Centers for Medicare and Medicaid Services on Wednesday issued proposed reforms to stabilize the individual and small group health insurance market.

[Also: Humana to exit exchange business in 2018]

Marilyn Tavenner, president and CEO of America's Health Insurance Plans, commended the administration's efforts in proposing policies she said are intended to address stability, affordability, and choice for consumers get the coverage they need.

The proposed rule gives states greater authority, CMS said. States with the means to do so will review qualified health plans to assess issuer network adequacy, according to CMS Acting Administrator Patrick Conway, MD.

The proposed rule, effective 2018, would expand verification requirements to enroll during special enrollment periods, shorten the annual open enrollment period, and make changes to guaranteed availability, network adequacy rules, essential community providers, and actuarial value requirements, according to Conway.

The changes will help protect Americans enrolled in the individual and small group health insurance markets while future reforms are being debated, he said.

CMS is also releasing a revised proposed timeline for the qualified health plan certification and rate review process for plan year 2018.

The revised timeline would provide insurers with additional time to implement proposed changes for the 2018 coverage year, allowing them to incorporate benefit changes and maximize the number of coverage options.

"This proposal will take steps to stabilize the marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options," Conway said.

CMS proposes expanding pre-enrollment verification of eligibility to individuals who newly enroll through special enrollment periods using the Healthcare.gov platform.

This proposed change would require individuals to submit supporting documentation, a common practice in the employer health insurance market, CMS said. This is aimed at keeping premiums from rising, curbing abuses, and encouraging year-round enrollment.

To help curb any abuse of the system, the proposed rule would allow an issuer to collect premiums for prior unpaid coverage, before enrolling a patient in the next year's plan. This will incentivize patients to avoid coverage lapses, CMS said.

[Also: Conservatives pushing for speedy Obamacare repeal as process crawls along]

The rule provides insurers with greater flexibility by making adjustments to the minimal range used for determining the level of coverage, which gives patients more coverage options.
 
The rule also proposes to shorten the upcoming annual open enrollment period for the individual market. For the 2018 coverage year, CMS proposes an open enrollment period of November 1 to December 15.

This aligns the marketplaces with the employer-sponsored insurance market and Medicare, which should help lower prices for Americans by reducing adverse selection, CMS said.

Leading Democrats blasted the new rule, saying it shifts costs to consumers.

"The first action of Trumpcare rolls back consumer protections and tips the scales in favor of insurance companies. These changes will do nothing to fix the damage and uncertainty caused by Republicans' actions to sabotage the law. If Republicans in Congress and President Trump want to work to stabilize the market, they must end their reckless attempts to repeal the law with no plan to replace it," said Ways and Means Committee Ranking Member Richard Neal of Massachusetts, Energy and Commerce Committee Ranking Member Frank Pallone, Jr. of New Jersey and Education and the Workforce Committee Ranking Member Bobby Scott of Virginia. 

Tavenner said the proposal is commendable as Congress considers other critical actions necessary to help stabilize and improve the individual market for 2018.

"Our commitment is to ensure short-term stability and long-term improvements," Tavenner said. "While we are reviewing the details, we support solutions that address key challenges in the individual market, promote affordability for consumers, and give states and the private sector additional flexibility to meet the needs of consumers"

Recent analysis by Avalere has found that exchange enrollment has fallen below initial projections, that for one out of three regions in 2017, there is no competition among plans, and that premiums and out-of-pocket costs for consumers has increased while there's been a decrease in preferred provider organization plan options.

[Also: Open enrollment 400,000 lower this year than last]

"Today's proposed rule is an effort to stabilize the exchange markets until an ACA replacement plan is approved and implemented," said Caroline Pearson, senior vice president at Avalere Health. "Many health plans have expressed uncertainty about their plans for 2018 exchange markets, and this rule is meant to encourage plan participation. It is unclear, however,  whether these changes will be sufficient to ensure all regions of the country have an exchange operating in 2018."

Twitter: @SusanJMorse