Benefits Insights, Winter 2018
The Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) issued a proposed rule concerning benefits and payment parameters for the Affordable Care Act (ACA). The proposed rule is intended to increase flexibility in the individual market, improve program integrity, and reduce regulatory burdens associated with the ACA in the individual and small group markets.
In the proposed rule, CMS recommends standards for issuers and health care exchanges, generally for plan years beginning on or after January 1, 2019. The proposals looks to enhance the role of states regarding essential health benefits (EHB) and qualified health plan (QHP) certification. It also includes cost-sharing parameters and cost-sharing reductions, as well as user fees for federally-facilitated exchanges and state-based exchanges available on the federal platform.
Specifically, changes would include standards related to exchanges; the required functions of the Small Business Health Options Program (SHOP) Exchanges; actuarial value for stand-alone dental plans; the rate review program; the medical loss ratio program; eligibility and enrollment; exemptions; and other related topics. The changes are intended to provide states with more variety of adaptable choices in the operation and establishment of exchanges, including SHOPs.
The actions in this proposed rule seem to build on other steps CMS has taken to encourage the health insurance markets in recent months. Currently, there is an RFI seeking public comment on ways to stabilize the individual and small group health insurance markets, promote consumer choice, enhance affordability, and return regulatory authority to the states.
A fact sheet with more details is available at https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/Proposed-2019-HHS-Fact-Sheet.pdf.