As CMS Sets Rules for 2020 Health Insurance Marketplaces, PA Proposes State-based Exchange > Hospital Association of Pennsylvania


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As CMS Sets Rules for 2020 Health Insurance Marketplaces, PA Proposes State-based Exchange

April 22, 2019

The Centers for Medicare & Medicaid Services (CMS) has finalized the Notice of Benefit and Payment Parameters for 2020. These parameters would set the 2020 standards for health insurance companies, services, and organizations and the health insurance marketplaces.

The rule finalizes a number of policies, including:

  • Changes to the navigator program, which has been cut back during the years
  • A change in the methodology for calculating subsidies
  • Decreases in the administrative fee that health plan issuers pay to the government for operating the exchanges

In addition, CMS finalized the key dates for qualified health plan certification on the federally facilitated exchanges. The initial deadline for plan applications is June 19, 2019, and final changes must be submitted to CMS by August 21, 2019. Open enrollment will begin on November 1, 2019.

As CMS releases its new policies, the Pennsylvania Insurance Department is proposing to create a state-based health insurance exchange with a target implementation date of 2021. A state-based health insurance exchange is an insurance marketplace in which the state provides the infrastructure, the website, and the customer support for individuals and small businesses to purchase state based plans.

Consistent with association priorities, HAP confirmed support for the proposal to Insurance Commissioner Altman. The benefits for Pennsylvanians would include:

  • Greater control over the enrollment and reenrollment processes
  • Increased flexibility to manage the operational aspects of the marketplace based on Pennsylvania consumer needs––this would include the enrollment timeframe to maximize the number of individuals who could secure coverage
  • Increased access to data, which would enable the state to identify groups for targeted outreach and education efforts

When the Affordable Care Act became law during 2010, states were allowed to choose whether to establish their own state-based health insurance exchanges or allow individuals to obtain insurance through the federal exchange. At that time, Pennsylvania opted to go through the federal exchange. The state expanded its Medicaid program during 2015.

HAP has a consistently advocated for helping as many people as possible secure and keep their health insurance coverage. 

For additional information, contact Jolene Calla, Esquire, HAP’s vice president, health care finance and insurance.

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