CMS Wants To Make Enrollment Period Changes for 2018

The Centers for Medicare & Medicaid Services (CMS) has proposed a rule aimed at providing consumers with more health insurance choices, in addition to taking steps toward stabilizing the health insurance marketplaces.

This proposed rule for 2018 would make changes to special enrollment periods as well as shorten the annual open enrollment period. The rule also addresses guaranteed availability, essential community providers and actuarial value requirements. It also announces upcoming changes to the qualified health plan certification timeline.

The rule proposes a variety of changes to the marketplace, including:

Open enrollment period. The rule proposes to shorten the upcoming annual open enrollment period for the individual market. For the 2018 coverage year, CMS proposes an open enrollment period of Nov. 1, 2017, to Dec. 15, 2017. This proposed change will align the marketplace enrollment period with that of the employer-sponsored insurance market and Medicare.

Special enrollment period pre-enrollment verification. The rule proposes to expand pre-enrollment verification of eligibility to individuals who enroll through HealthCare.gov during special enrollment periods. This proposed change  will require individuals to submit supporting documentation, a common practice in the employer health insurance market. This will help place downward pressure on premiums, curb abuses, and encourage year-round enrollment, CMS said in a news release.

Guaranteed availability. The rule would allow  an issuer to collect premiums for prior unpaid coverage before enrolling a patient in the next year’s plan with the same issuer. This will incentivize patients to avoid coverage lapses.

Determining the level of coverage: The rule would provide greater flexibility to issuers to provide patients with more coverage options.

Network adequacy. In the review of qualified health plans, CMS would defer to the states to ensure their residents have access to high quality care networks.

Qualified health plan (QHP) certification calendar. In the rule, CMS would release a revised proposed timeline for the QHP certification and rate review process for plan year 2018. This revised timeline would provide issuers more time to implement proposed changes that are finalized prior to the 2018 coverage year. These changes will give issuers flexibility to incorporate plan changes and maximize the number of coverage options available to patients.

“Americans participating in the individual health insurance markets deserve as many health insurance options as possible,” Dr. Patrick Conway, Acting CMS Administrator, said in a news release “This proposal will take steps to stabilize the marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options. They will help protect Americans enrolled in the individual and small group health insurance markets while future reforms are being debated.”

The proposed rule can be found, here: https://www.federalregister.gov/documents/2017/02/17/2017-03027/patient-protection-and-affordable-care-act-market-stabilization

Susan Rupe is editor in chief, magazine, for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].