ALERT: USA: Proposed Affordable Care Act (ACA) Rule
February 20, 2017:
The following update regarding the Affordable Care Act (ACA) was provided to us by Alliant, Asinta’s Partner in the United States. You can read the original article here.
Trump Administration Issues Proposed ACA Rule
Today the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for 2018, intended to implement reforms to stabilize the individual and small group health insurance markets.
The proposed rule is not necessarily remarkable in its content. It proposes common sense changes to special enrollment periods and annual open enrollment periods, among other issues described below, in an effort to minimize continued adverse selection and increasing costs.
It is remarkable in that the Trump administration is working within the ACA regulatory framework for the first time, another significant signal that ACA repeal and replace could take several years—at least until 2019. The rule proposes:
- Special Enrollment Period Pre-Enrollment Verification: Expand pre-enrollment verification of eligibility to individuals who newly enroll through special enrollment periods using the HealthCare.gov platform. This proposed change will require individuals to submit supporting documentation, a common practice in the employer health insurance market.
- Open Enrollment Period: Shorten the upcoming annual open enrollment period for the individual market. For the 2018 coverage year, the proposed rule would shorten the open enrollment period to November 1, 2017, to December 15, 2017. This change is intended to better align the Marketplaces with the Employer-Sponsored Insurance Market and Medicare, and reduce adverse selection.
- Guaranteed Availability: Address potential abuses by allowing an issuer to collect premiums for prior unpaid coverage before enrolling a patient in the next year’s plan with the same issuer. This is intended to discourage coverage lapses.
- Determining the Level of Coverage: Provide greater flexibility to issuers to provide patients with more coverage options.
- Network Adequacy: CMS proposes to defer to the states to assess issuer network adequacy. States are best positioned to ensure their residents have access to high quality care networks.
- Qualified Health Plan (QHP) Certification Calendar: Release a revised proposed timeline for the QHP certification and rate review process for plan year 2018. The revised timeline would provide issuers with additional time to implement proposed changes that are finalized prior to the 2018 coverage year.
While the proposed rule does not directly impact employer group health plans, the individual and employer health insurance markets are necessarily interconnected. As discussed in our recent podcast on this topic, changes within the individual market impact cost, employee choice, and employer plan administration. Most significantly, the proposed rule indicates that change will take longer than anticipated, likely at least until 2019.
In the meantime, recall that no changes have been made to the ACA provisions that impact employer group health plans.
We will continue to monitor developments and will provide this update to clients. We will also discuss the proposed rule and the impact on employer plans on our next weekly podcast.
Alliant’s podcasts can be found on their Hot Topics page.
Do you have questions regarding potential changes to the Affordable Care Act or about doing business in the United States? You can get in contact with Asinta’s Partner, Alliant, to get all of your questions answered via their contact page here.