The Centers for Medicare & Medicaid Services (CMS) has finalized a number of proposals in its rule governing the Affordable Care Act (ACA) exchanges in 2022, including lower user fees.
In the final rule, the CMS set user fees for qualified health plans at 2.25% of the premium, down from 3%. The agency said that steadily cutting down user fees since 2018 has allowed it to decrease premiums by 8%.
The rule would also set fees for state-based exchanges that use HealthCare.gov to 1.75%, down from 2.25%.
CMS said in an announcement that the final rule aims to enshrine priority provisions included in the annual Notice of Benefit and Payment Parameters proposed in November, based on feedback from submitted comments.
“Since 2017, premiums are down, coverage options are up, and we have stabilized the individual market with better care at lower costs,” said CMS Administrator Seema Verma in a statement. “The actions we’re taking today to ensure these improvements can continue tomorrow because we must never be satisfied when too many Americans still cannot afford coverage in the individual market.”
The final rule also includes a provision that aims to encourage states to partner with private firms to create "next generation exchanges." These platforms would harness web brokers and insurers to serve as the main consumer-facing elements to assist them in securing qualified health plans.
States would still be required to ensure any participating brokers or insurers meet consumer protections and would also be responsible for eligibility decisions.
Also in the rule, CMS enshrined prior guidance on section 1332 innovation waivers to provide states with more clarity on how the feds will evaluate and offer such waivers in the future.
The waivers allow states to test new options for their exchange populations, such as a reinsurance program.