CMS final rule boosts insurer user fees and extends ACA open enrollment period for 2022 coverage year

ACA
The Centers for Medicare & Medicaid Services released a new final rule outlining regulations for the 2022 Affordable Care Act open enrollment, extending the signup period by 30 days and hiking user fees. (designer491)

The Biden administration is extending Affordable Care Act (ACA) open enrollment by another month and slightly increasing insurer user fees for participating on the exchanges to help fund greater outreach.

The Centers for Medicare & Medicaid Services (CMS) issued the third part of the 2022 Notice of Benefit and Payment Parameters that lays out standards and regulations for the ACA exchanges for the 2022 coverage year. The rule builds on prior final rules governing ACA exchange insurers and related stakeholders in January and May of this year.

CMS decided to change the user fees that ACA insurers must pay to submit their plans on the exchanges.

For 2022, insurers will face an increase in the federally run marketplace user fee rate to 2.75% of their premiums and the state-run exchanges to 2.25%. That is a change from the user fees finalized Jan. 19 under the Trump administration, which called for a user fee of 2.25% for the federal marketplace and 1.75% for the state-run exchanges.

“These rates account for funding for consumer information and outreach, including the [federally run] Navigator program,” according to a fact sheet on the rule. “These rates are still lower than the current 2021 benefit year user fee rates.”

RELATED: HHS: ACA exchange enrollment reaches 12.2M thanks to enhanced subsidies

The rule would also extend the open enrollment period by 30 days for ACA signups, with the new deadline on the federally run exchanges being Jan. 15. Open enrollment for the federal exchanges still starts Nov. 1.

CMS said the goal is to enable more customers to get help picking a plan, especially as the agency has boosted the number of navigators available for assistance. The number of navigators increased to 1,500 thanks to an $80 million grant provided by CMS earlier this year.

The regulation also will enable navigators to give consumers information and assistance on topics they may need to know after they choose a plan, such as how to make an appeal for marketplace eligibility and the components of reconciling premium tax credits.

The increased user fee funding will go toward this additional outreach.

CMS is also creating a new special enrollment period that targets low-income individuals through HealthCare.gov.

The goal is to target people who could be eligible for boosted subsidies that were included in the American Rescue Plan Act but expire after the 2022 coverage year. Congress is debating whether to extend those subsidies as part of a $3.5 trillion infrastructure package.

CMS also seeks to roll back guidance released in 2018 under the Trump administration that changed guardrails for Section 1332 waivers that enable states to make changes to individual and small group insurance markets. But the waivers have key guardrails that halt states from significantly altering major ACA coverage requirements.

The Trump administration released a guidance document in 2018 that could enable states to allow ACA exchange subsidies to purchase short-term plans. But CMS is now rescinding that guidance because it more aligns with the Biden administration’s goals of strengthening the ACA and “increase enrollment in comprehensive coverage,” according to a fact sheet on the final rule.

The final rule is the latest attempt by CMS to roll back several Trump administration policies on the ACA exchanges. The Trump administration cut the open enrollment period to Dec. 15 and reduced funding for navigators and outreach, saying it was simply making the outreach programs more efficient.