CMS proposes expansion of ACA enrollment period
CMS' proposal would also create a new special enrollment period opportunity for low-income consumers.
Photo: Tempura/Getty Images
The Centers for Medicare and Medicaid Services has proposed changes to regulations governing the Affordable Care Act's exchanges in 2022, including a proposal to lengthen the annual open enrollment period by an additional 30 days.
CMS' proposal would also create a new special enrollment period opportunity for low-income consumers, and expand the duties of Federally-facilitated Exchange Navigators to offer additional help to consumers enrolling in plans.
These provisions are the third installment of the payment notice for 2022, and revisit several of the policies in the Notice of Benefit and Payment Parameters for 2022, which was finalized in two phases.
WHAT'S THE IMPACT?
The proposed rule would give exchanges the option of offering a new special enrollment period to provide additional opportunities for certain low-income consumers to access premium-free or low-cost coverage, available to them because of the enhanced advanced premium tax credit provisions included in the American Rescue Plan Act of 2021.
The proposed monthly special enrollment period would align with President Biden's Executive Order 14009, issued January 28, which requires federal agencies to identify and appropriately address policies that create barriers to accessing ACA coverage.
Several other provisions in the proposed rule would seek to streamline operations for the federally-facilitated exchanges, health insurance issuers and other stakeholders who facilitate access to coverage. For example, the proposed rule would repeal certain requirements that could have resulted in burdensome and costly changes to issuer billing systems, CMS said. It also proposes to lengthen the annual open enrollment period for 2022 and future coverage years by an additional 30 days.
The rule also proposes modifications to policies related to State Innovation Waivers (sometimes called "section 1332 waivers"), which allow states to pursue new strategies for providing residents with access to coverage. This includes proposals related to the interpretation of the statutory guardrails and flexibilities in public notice and post-award public participation requirements under future emergent circumstances, if certain criteria are met. The rule also includes proposals regarding the process for amending or extending approved section 1332 waivers.
In addition, the rule would enable CMS to collect and dedicate additional revenue to fund consumer outreach and education through modest increases in user fee rates for issuers in federally-facilitated exchange states and state-based exchanges on the federal platform. The proposed user fee rates, which are levied on issuers each year, are still lower than the current 2021 benefit year rates.
The rate change for issuers on the federally-facilitated exchange would also make additional revenue available that can be used to fund Navigators, who help consumers – particularly the uninsured – understand their options and enroll in health insurance plans.
The proposed rule would also re-institute expanded duties applicable to Navigators in the federally-facilitated exchanges to ensure that consumers have access to assistance beyond applying for and enrolling in health insurance coverage. These include, for example, assistance with the process of filing exchange eligibility appeals, understanding basic information about reconciliation of premium tax credits, and understanding basic concepts and rights related to health coverage and how to use it, such as locating providers and accessing care.
THE LARGER TREND
According to CMS data, about 8.3 million people selected individual market plans through the marketplaces using the federal platform during the 2021 open enrollment period.
This total enrollment is nearly the same as enrollments during the 2020 open enrollment period, despite the fact that New Jersey and Pennsylvania transitioned to state-based exchange platforms starting with the 2021 open enrollment period.
After removing these states from the total plan selection totals in the 2020 open enrollment period and comparing year-over-year trends, the results show plan selections this year increased by 7% from 2020, despite a decline in new consumers. Also, for the fourth straight year, the consumer satisfaction rate at the call center remained high – averaging over 90% – throughout the entire stretch.
The data indicates enrollment remained stable, and, with the investments over recent years to improve the stability and experience on the HealthCare.gov platform, more consumers were able to actively enroll or re-enroll in coverage this year without the need for waiting rooms, CMS said.
ON THE RECORD
"With the ACA and American Rescue Plan, the Biden-Harris Administration is expanding access to affordable health insurance coverage for millions – for many, perhaps for the first time," said CMS Administrator Chiquita Brooks-LaSure.
"The success of the special enrollment period opportunity clearly shows the demand for quality, affordable coverage. These latest steps aim to better fund outreach efforts and eliminate barriers to coverage. We're making high-quality, low-cost coverage more accessible than ever."
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
