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CMS Issues Proposed Rule Released to Stabilize Health Insurance Markets

February 15, 2017

The Centers for Medicare & Medicaid Services today released a proposed rule intended to stabilize the health insurance marketplaces, through which millions of Americans have acquired health insurance coverage. Insurers and providers both have pressed the Trump Administration and Congress to address the challenges that threaten coverage options, and may cause more insurers to discontinue offering policies through the marketplace in 2018.

The proposed changes included in the rule would take effect for the 2018 insurance plan year, and include:

  • Expansion of special enrollment period pre-enrollment verification
  • Guaranteed availability protections related to non-payment of premiums
  • Adjustments to level of coverage determinations
  • Clarification of states’ roles in ensuring network adequacy
  • Implementation of a new timeline for qualified health plan certification and the rate review process
  • Shortening of the open enrollment period to align the marketplace with the employer-sponsored insurance market and Medicare

The proposed rule, the “Patient Protection and Affordable Care Act; Market Stabilization,” will be published in the February 17 Federal Register, with comments due no later than March 7, 2017.

The American Hospital Association (AHA) previously outlined specific recommendations to address the stability of the health insurance marketplaces in testimony during a recent U.S. Senate hearing. Those recommendations included:

  • Continuing payment of the cost-sharing reductions
  • Maintaining and strengthening the special enrollment periods
  • Maintaining and building on recent changes to the risk adjustment program
  • Increasing access to coverage through third-party payment of premiums
  • Supporting the development of state-level marketplace solutions

The AHA has stressed the importance of improving consumer access to coverage and maintaining important consumer protections. The hospital community will be evaluating this proposed rule issued today with those goals in mind.

Congressional leaders have called upon the Trump Administration to take steps to stabilize the 2018 health insurance marketplaces while they continue to consider next steps in repealing and replacing the Affordable Care Act (ACA).

As both the Trump Administration and Congress pursue ACA policy, Pennsylvania hospitals have stressed the importance of preserving coverage for more than 1.1 million Pennsylvanians who have benefited from coverage through the marketplace, Medicaid expansion, and dependent coverage.

HAP previously has asked federal lawmakers to focus on the following priorities as they consider next steps surrounding the health care system:

  • Ensure continuity of coverage and care through access to a robust, competitive delivery system
  • Ensure stable and sufficient funding for hospitals
  • Maintain momentum in delivery system transformation and innovation

Please contact Laura Stevens Kent, HAPs vice president, federal advocacy, with questions regarding federal advocacy on health care reform initiatives.

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