CMS finalizes changes to ACA plans for 2021, pushes back deadlines due to COVID-19

A signpost with the words Affordable Care Act
The Centers for Medicare & Medicaid Services released a slew of regulatory changes to Affordable Care Act plans for the 2021 coverage year, giving insurers more time to develop their rates. (Getty/kroach)

The Trump administration finalized a slew of regulatory changes for the Affordable Care Act’s (ACA's) exchanges, including a key change that insurers do not have to count copay assistance from drug companies toward out-of-pocket cost-sharing and deductibles.

But the administration backed down from any changes to automatic enrollment, after flirting with the idea in a proposed rule back in January.

The Centers for Medicare & Medicaid Services (CMS) released late Thursday the final Notice of Benefit and Payment Parameters rule that outlines the regulations for ACA plans for 2021.

The agency gave insurers another week extension for the certification of a qualified health plan and the rate review timeline to give insurers more time to assess the impact of COVID-19. Insurers have said that it is hard to set prices and give outlooks on membership due to the changes in healthcare utilization spurred by the pandemic.

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The initial deadline for applications for qualified health plans is June 17, and the deadline to change any applications is Aug. 26. Open enrollment is still set for Nov. 1.

The final rule pegs the 2021 user fees at the same rate as this year: 3% of a premium and the state-based exchange rate of 2.5%.

One of the biggest changes is on drug manufacturer coupons, which was proposed back in January. The final rules said that coupons and other support can count toward the annual limit for cost-sharing such as deductibles, even if a generic is available.

But the controversial change drew immediate blowback from patient advocacy groups that worry patients will be forced to pay higher costs for drugs.

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“It is just unimaginable that the Trump administration moved forward with this regulation at a time when people throughout the country are facing financial hardships like they have never experienced before,” said Carl Schmid, executive director of the HIV and Hepatitis Policy Institute, in a statement.

Other key changes in the rule include:

  • New rules on special enrollment periods. The rule allows exchange enrollees in silver plans that become newly eligible for a cost-sharing reduction to change to a plan on a higher or lower tier. The rule also shortens the time between a consumer selecting a plan through certain special enrollment periods and the effective date of the plan.
  • Finalizing changes to improve tax credit allocation. The rule finalizes a proposal that updates the data matching standards that prevent an ACA tax credit from going to an enrollee that either died or was also enrolled in Medicare. The rule also “strengthens a policy around the annual reporting of state-required benefits that are mandated in addition to Essential Health Benefits,” according to the agency release. States must now annually notify CMS of any additional benefit mandates to ensure taxpayers aren’t “inappropriately paying the cost for these state mandates.”
  • New provisions intended to allow value-based plan designs. The rule includes a blueprint for insurers to include innovative healthcare plan designs. CMS gave an example of an insurer offering a plan that provides “high-value services like blood pressure monitoring or cardiac rehabilitation with zero cost-sharing,” the release said.