NYS of Health Issues Public Comment on Centers for Medicare & Medicaid Services Proposed Rule
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NY State of Health, the State's
NY State of Health notes that the compressed timeline to provide comments on the Payment Notice for 2022 limits the ability of States, Exchanges, and other key stakeholders to engage in a comprehensive review of the various changes set forth in the proposed rule.
III. Provisions of the Proposed HHS Notice of Benefit and Payment Parameters for 2022
4. Ability of States to Permit Agents and Brokers to Assist Qualified Individuals, Qualified Employers, or Qualified Employees Enrolling in QHPs (Sec. 155.220)
a. Navigator and Certified Application Counselor Use of Web-broker Websites
* Proposed Rule
The proposed rule seeks to make significant changes to sections 155.220 and 155.221 to allow states to permit issuers, web-brokers, agents and brokers to assist consumers in enrolling in QHPs. Additionally, the rule seeks to modify current policy that prohibits Navigators and CACs ("assisters") from using web-broker websites to assist with QHP selection and enrollment. The proposal would permit, but not require, assisters in FFEs and SBE-FPs, to the extent permitted by state law, to use web-broker websites to assist consumers with QHP selection and enrollment. This proposal is optional for State-based Marketplaces.
* NY State of Health Comments
NY State of Health supports allowing States and State-based Marketplaces to choose to preserve the prohibition on assisters using web-broker websites.
5. Standards for Direct Enrollment Entities and for Third Parties to Perform Audits of Direct Enrollment Entities (Sec. 155.221)
c. FFE, SBE-FP, and State Exchange Direct Enrollment Options
* Proposed Rule
The proposed rule seeks to add Sec. 155.221(j) to establish a process for states to elect an Exchange Direct Enrollment (DE) option where states could engage approved private-sector entities (including QHP issuers, web-brokers, agents and brokers) as the pathway for consumers to shop, apply for, and enroll in coverage through the Exchange.
* NY State of Health Comments
NY State of Health supports State flexibility for State-based Marketplaces to determine whether to permit private-sector entities to assist consumers in enrolling in QHPs. NY State of Health also encourages CMS to strengthen the oversight of these private sector direct enrollment entities.
When individual consumers apply for coverage, they often do not know whether they are eligible for insurance affordability programs or QHPs, particularly if their employment situation or their household composition has changed. Direct enrollment entities would complicate and could hinder the ability of consumers who may be eligible for programs such as Medicaid or the
8. Special Enrollment Periods (Sec. 155.420)
d. Special Enrollment Period Verification
* Proposed Rule
The proposed rule seeks to amend Sec. 155.420 to add paragraph (f) to require Exchanges to conduct eligibility verification for at least 75 percent of new enrollments through special enrollment periods for consumers who are not yet enrolled in exchange coverage.
* NY State of Health Comments
Given the unique nature of each state Marketplace,
3. Premium Adjustment Percentage (Sec. 156.130(e))
* Proposed Rule
CMS proposes to maintain the same methodology [updated in 2020] to calculate the premium adjustment percentage.
* NY State of Health Comments
CMS' proposed premium adjustment percentage increases consumers' "applicable percentage" used to determine Premium Tax Credit (PTC) amounts, which will result in higher post-tax credit premiums for consumers. The result of maintaining the same methodology would be higher consumer premium contributions and lower federal tax credits.
This methodology was revised in plan year 2020 to account for increases in individual market premiums, which resulted in higher annual limits on out-of-pocket costs and higher required contribution from subsidized enrollees.
11. Quality Rating System (Sec. 156.1120) and Enrollee Satisfaction Survey System (Sec. 156.1125)
* Proposed Rule
CMS seeks comment on which level or levels of the QRS hierarchy should be removed.
* NY State of Health Comments
* Proposed Rule
CMS proposes to make the full
* NY State of Health Comments
IV. Provisions of the Proposed Rule for State Innovation Waivers -
A. 31 CFR Part 33 and 45 CFR Part 155 - State Innovation Waivers
1. Section 1332 Application Procedures (31 CFR 33.108 and 45 CFR 155.1308), Monitoring and Compliance (31 CFR 33.120 and 45 CFR 155.1320), and Periodic Evaluation Requirements (31 CFR 33.128 and 45 CFR 155.1328)
* Proposed Rule
CMS proposes to incorporate by reference its 2018 published Guidance regarding the guidelines for 1332 waivers, known as "innovation" waivers. [See, "State Relief and Empowerment Waivers," 83 FR 53575 (
NY State of Health Comments
The guidelines for section 1332 waivers affect insurance markets and important consumer protections. For example, increased flexibility regarding short-term health insurance plans that are less comprehensive than ACA-compliant plans has the potential to draw enrollees and risk from the more comprehensive plans. This may increase premium for consumers with pre-existing conditions and other health needs who rely on comprehensive plans.
The proposed wholesale incorporation of 2018 guidance on an accelerated timetable does not provide sufficient opportunity to address the impact of these requirements to date and the potential prospective impact, including the potential negative consequences for consumers seeking affordable coverage to meet their health needs.
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The proposed rule can be viewed at: https://www.regulations.gov/document?D=CMS-2020-0151-0005
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