CMS Releases “Market Stablization Rule” for the ACA

Written by Jessica Adkins

April 17, 2017

According to an immediate release dated, April 13, 2017, from CMS Media Relations, the Centers for Medicare & Medicaid Services has issued the final Market Stabilization rule.

This rule is to help lower premiums and stabilize the individual and small group markets and increase choices for your clients. Individuals obtaining coverage in the Marketplace created by the Affordable Care Act have faced double-digit premium increases, fewer plans to choose from, and a market that continues to experience multiple carriers participating only “off market.”

“CMS is committed to ensuring access to high-quality, affordable healthcare for all Americans, and these actions are necessary to increase patient choices and to lower premiums,” said CMS Administrator Seema Verma.  “While these steps will help stabilize the individual and small group markets, they are not a long-term cure for the problems that the Affordable Care Act has created in our healthcare system.”

The final rule makes several policy changes to improve the market and promote stability, including:

  • 2018 Annual Open Enrollment Period: The final rule adjusts the annual open enrollment period for 2018 to more closely align with Medicare and the private market. The next open enrollment period will start on November 1, 2017, and run through December 15, 2017, encouraging individuals to enroll in coverage before the beginning of the year. 
  • Reduce Fraud, Waste, and Abuse: The final rule promotes program integrity by requiring individuals to submit supporting documentation for special enrollment periods and ensures that only those who are eligible can enroll. It will encourage individuals to stay enrolled in coverage all year, reducing gaps in coverage and resulting in fewer individual mandate penalties and help to lower premiums.
  • Promote Continuous Coverage: The final rule promotes personal responsibility by allowing issuers to require individuals to pay back past due premiums before enrolling into a plan with the same issuer the following year. This is intended to address gaming and encourage individuals to maintain continuous coverage throughout the year, which will have a positive impact on the risk pool.
  • Ensure More Choices for Consumers:  For the 2018 plan year and beyond, the final rule allows issuers additional actuarial value flexibility to develop more choices with lower premium options for consumers and to continue offering existing plans.
  • Empower States & Reduce Duplication: The final rule reduces waste of taxpayer dollars by eliminating duplicative review of network adequacy by the federal government.  The rule returns oversight of network adequacy to states that are best positioned to evaluate network adequacy.

CMS also made some other announcements today regarding the process that issuers must follow to meet the law’s requirements for the 2018 plan year. The additional guidance released includes updates that would make the guidance consistent with today’s final rule and information needed by issuers in order to have their plans certified for 2018, including  Key Dates for 2017; Issuer Guidance on Uniform Rate Review Timeline; Good Faith Compliance Guidance; QHP Certification Guidance for States; and Final Actuarial Value (AV) Calculator for 2018 and Methodology.

The final rule can be found, here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-07712.pdf 

For more information on carriers available in your market, please contact our ACA Experts at 800-962-4693.

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