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  • Washington Highlights

    CMS Releases Affordable Care Act Market Stabilization Proposed Rule

    Len Marquez, Senior Director, Government Relations

    The Centers for Medicare and Medicaid Services (CMS) Feb. 15 released the Patient Protection and Affordable Care Act Market Stabilization proposed rule, which proposes reforms to stabilize the individual and small group health insurance markets. Most of the policies will be effective for the 2018 plan year, but some could be implemented in 2017. 

    The proposed rule makes policy and operational changes to network adequacy rules, special enrollment periods, guaranteed availability, and annual enrollment periods. Specifically, the proposals:

    • Loosen federal oversight of network adequacy and defer to the states’ network adequacy reviews in states with federally facilitated exchanges and the means to assess issuer network adequacy;

    • Expand pre-enrollment verification by requiring individuals to submit supporting documentation of eligibility to enroll through a special enrollment period;

    • Shorten the annual open enrollment period to 45 days (Nov. 1 - Dec. 15), as opposed to the current 90 days; and

    • Allow an issuer to collect premiums for all past due premiums owed to the insurer before resuming coverage with the same insurer.

    Finally, CMS intends to release a revised proposed timeline for the Qualified Health Plan (QHP) certification and rate review process for plan year 2018 to accommodate implementation of the proposed changes.

    Comments on the proposed rule are due March 7. The AAMC is currently reviewing the rule.