CMS Issues Proposed Rule Outlining Insurance Exchange Guidelines

On Friday, CMS issued a proposed rule that outlined a series of guidelines for the health insurance exchanges under the Affordable Care Act that would clarify oversight of premium assistance programs and provide other technical details, Modern Healthcare reports (Daly, Modern Healthcare, 6/14).

Background

CMS in a press release and fact sheet said the proposal provides "program integrity" guidelines for the online marketplaces and "premium stabilization" programs under the ACA, which were designed to protect insurers from unusually large losses in the competitive environment of the exchanges (Reichard, CQ HealthBeat, 6/14).

Proposed Rule Details

Under the proposed rule:

• Providers of qualified health plans in all states would be required to accept various payment methods by individuals without bank accounts -- such as prepaid debit cards -- for insurance premiums beyond the default bank account deduction;
• States that operate risk adjustment or reinsurance programs would have new oversight standards to follow that require them to report their operations plans to HHS and the public and adopt strategies that would "ensure the soundness and transparency of the programs";
• Insurers would be required to issue refunds to consumers and providers if they erroneously apply an advance payment of the premium tax credit or cost-sharing reductions, or incorrectly assign consumers to a standard plan without cost-sharing reductions; and
• States that run their own exchanges would have to determine whether enrollees receive advance payments of the premium tax credit or cost-sharing reductions, and if their marketplaces are compliant with federal transparency standards.

According to Modern Healthcare, HHS would play a role in enforcing compliance with the exchanges' standards (Modern Healthcare, 6/14).