CMS final rule aims to stabilize Health Insurance Marketplaces

The Centers for Medicare & Medicaid Services (CMS) April 13 issued a final rule designed to help stabilize the Health Insurance Marketplaces.

The rule finalizes changes related to special enrollment periods; guaranteed issue; actuarial value; network adequacy; and open enrollment periods.

The new policies are intended to reduce the administrative burden on plans, reduce adverse selection to improve the risk pools, and facilitate consistency in plan structure and pricing from one year to the next.

 “The AHA is committed to ensuring that all Americans have affordable coverage, and we commend the Administration today for finalizing several policies that will help keep the marketplaces as a source of coverage for millions of Americans,” said AHA Executive Vice President Tom Nickels. “At a more fundamental level, we remain deeply concerned that the most critical challenge facing the marketplaces today is unresolved: assurance that funding for cost-sharing reductions will be available to insurers.”

The AHA earlier this week expressed its concern to the administration and Congress and urged them to work together to ensure such funding is available..

The AHA and seven other organizations representing providers of health care or coverage, including America’s Health Insurance Plans, April 12 urged Congress and the administration to take quick action to ensure cost sharing reductions for the individual health insurance market are funded.

“The window is quickly closely to properly price individual insurance products for 2018,” the organizations said in a letter to President Trump and congressional leaders. “The most critical action to help stabilize the individual market for 2017 and 2018 is to remove uncertainty about continued funding for cost sharing reductions. Nearly 60% of all individuals who purchase coverage via the marketplace – 7 million people – receive assistance to reduce deductibles, co-payments and/or out-of-pocket limits through CSR payments. This funding helps those who need it the most access quality care: low- and modest-income consumers earning less than 250% of the federal poverty level. If CSRs are not funded, Americans will be dramatically impacted.”

Also signing the letter were the American Academy of Family Physicians, American Benefits Council, American Medical Association, Blue Cross Blue Shield Association, Federation of American Hospitals, and U.S. Chamber of Commerce.