On February 15, 2017, the Centers for Medicare and Medicaid Services (CMS) issued draft proposed regulations intended to stabilize the individual and small group health insurance markets under the Affordable Care Act (ACA). The proposed rules would shorten the open enrollment period for 2018, amend standards on special enrollment periods, increase pre-enrollment verification of eligibility on the HealthCare.gov website, allow health insurance issuers to apply consumers’ payments to past unpaid debts for coverage, increase allowable variations in the actuarial value (AV) calculations, offer more flexibility in substantiating provider network adequacy, and facilitate insurers’ compliance with essential community provider (ECP) standards.
CMS indicates that the viability of the Exchanges and the individual/small group health insurance markets in general have been threatened by the attrition of health insurance issuers and increased health insurance premiums associated with unstable risk pools in many geographic areas. Some insurers have cited consumers’ improper use of special enrollment periods (e.g., by-passing open enrollment and purchasing coverage only in special enrollment periods if an illness strikes) as a key actuarial concern that may influence insurers’ rapidly approaching decisions about premium rates and participation in Exchanges in 2018.
The proposed regulations are scheduled to be published officially in the Federal Register on February 17, 2017. The draft indicates that public comments will be due no later than March 7, 2017, an unusually short comment period.