Health Care News, Health Center Regulatory Issues

CMS Issues Proposed Rule on “Market Stabilization” for the ACA Marketplaces

On February 15, 2017, CMS issued its proposed rule on “market stabilization” in the Affordable Care Act’s Marketplaces.  This proposed rule is one of the first issued by the Trump Administration.  Below you will find a summary of the major provisions of the proposed rule and can read NACHC’s comments on the proposed rule here.  We will continue to follow this and other actions from the Administration and encourage you to check back for further updates.

Summary of Proposed Rule on ACA Marketplace Stabilization 

  • Stated goal is to “stabilize” the ACA Marketplaces by making them more attractive (aka less risky) for insurers, so they’ll be less likely to withdraw.
  • Development of this proposed rule began under the Obama Administration, although it is not entirely clear which provisions resulted from which Administration.
  • Major provisions include:
    • Cutting the length of the Open Enrollment Period by half (from 3 months to 6 weeks), which aligns with Medicare and most private sector Open Enrollment periods.
    • Tightening up on Special Enrollment Periods (SEPs) by strengthening the requirements that people applying during a SEP prove that they qualify (e.g., they really did get married, have a baby, get laid off).
    • Lowering the requirement that Qualified Health Plans (QHPs) contract with 30% of the Essential Community Providers in their service area to 20%. (Note that the NPRM does not propose to eliminate the requirement that QHPs contract with at least one FQHC in each county in their services areas.)
    • Requiring individuals who dropped out of a plan and later choose to re-enroll in the same plan to pay any back premiums before they can re-enroll.
    • Slightly loosening the actuarial requirements on QHPs.
    • CMS will defer entirely to States’ reviews of QHPs for network adequacy. (In states without adequate capacity to conduct such reviews, CMS will defer to outside accrediting bodies.) For the 2016 and 2017 plan years, CMS had applied minimum time-and-distance standards when evaluating network adequacy.
  • Contrary to some expectations, the proposed rule did not include any provisions to:
    • Increase the spread between how much the youngest and oldest enrollees can be charged.
    • Further restrict the ability of third-parties to pay individuals’ premiums
    • Increase flexibility around the required Essential Health Benefits.