CMS Proposes Health Insurance Exchange Changes for 2017
Proposed Rule's Network Standards
Under the rule, states would be required to implement CMS-approved quantitative measures to ensure that individuals with exchange plans have adequate access to health care providers. States could either:
- Adopt default network adequacy standards set by CMS; or
- Draft their own network adequacy standards and submit them for HHS approval.
Such standards could measure a plan's network adequacy based on policyholders' maximum travel distances and times to access providers. According to CMS, minimum adequacy standards for the plans will be determined at a later date. HHS would then notify insurers of the standards in each state (Herman/Dickson, Modern Healthcare, 11/20).
Next Year's Open Enrollment
CMS also proposed that the ACA's next open enrollment period would run from Nov. 1, 2016, to Jan. 31, 2017 (Radnofsky/Wilde Mathews, Wall Street Journal, 11/20). According to Modern Healthcare, CMS chose those dates because they more closely align with annual open enrollment periods for both Medicare and employer-sponsored health coverage.
In addition, CMS said it is seeking comments and data from stakeholders about the special open enrollment periods under the ACA, which allow consumers to enroll in exchange coverage at times outside of the annual open enrollment period if they experience qualifying life events (Modern Healthcare, 11/20).
Qualifying events include moving to another state, getting married, having a new child, losing previous coverage or becoming a U.S. citizen. Individuals who experience such events are eligible to enroll in exchange coverage within 60 days of the events' occurrence (California Healthline, 8/14). According to Modern Healthcare, some insurers have said consumers are not using the special open enrollment periods correctly and are instead enrolling in and dropping exchange coverage based on changes in health status.
Additional Elements of the Proposed Rule
Further, CMS proposed more "standardized options" for exchange plans in each of the metal plan tiers. Under the suggested change:
- All bronze-level plans sold through the exchanges in 2017 would have a $6,650 deductible;
- All silver-level plans would have a $3,500 deductible; and
- All gold-level plans would have a $1,250 deductible.
CMS also proposed changes to the Small Business Health Options program, or SHOP exchange, that would allow employers to offer a wider range of plans from one insurer beginning Jan. 1, 2017. Currently, employers using SHOP can offer workers either a single health and/or dental plan or all of such plans across a one metal tier. According to Modern Healthcare, the change is intended to draw more people into the exchange.
In addition, CMS proposed that the federal SHOP exchange send notices 90 days in advance to enrollees whose dependents will age off of their coverage when they turn 26 (Modern Healthcare, 11/20).
Other parts of the proposed rule would:
- Alter how HHS calculates payments to and from insurers with large numbers of sick enrollees (Goldstein, Washington Post, 11/20);
- Raise annual out-of-pocket spending limits from $6,850 to $7,150 for individuals and from $13,700 to $14,300 for families (Modern Healthcare, 11/20);
- Tally all medical expenditures, not just those incurred within a health plan's network, toward the ACA's limits on out-of-pocket costs (Washington Post, 11/20); and
- Stop some insurers from selling exchange plans if they failed to comply with federal rules or were financially insolvent (Wall Street Journal, 11/20).
CMS is accepting comments on the proposed rule until Dec. 21 (Modern Healthcare, 11/20).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.