CMS releases proposed regulations for 2022 ACA insurance exchange issuers, including lower user fees

ACA
The Centers for Medicare & Medicaid Services proposed to lower the user fees for Affordable Care Act insurers for the 2022 coverage year. (Getty/designer491)

The Trump administration proposed lowering the user fee for Affordable Care Act (ACA) insurers from 3% to 2.25% of the premium for the 2022 coverage year.

The Centers for Medicare & Medicaid Services (CMS) released late Wednesday the proposed Notice of Benefit and Payment Parameters for the 2022 coverage year. The rule also proposes enabling states to partner with the private sector to create a website that competes with the state-run exchange website or HealthCare.gov.

“The actions we are taking today to reduce user fees will directly reduce premiums,” said CMS Administrator Seema Verma in a statement Wednesday.

The agency also proposed to reduce the user fee for insurers offering plans through state-based exchanges that use HealthCare.gov to 1.75% of the premium.

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“These reductions reflect the successful cost-saving measures CMS implemented over the past several years to strengthen program integrity and improve our technology infrastructure,” CMS said in a release.

It calls on state-run exchanges to install the same eligibility requirements for special enrollment periods, when people can sign up for coverage outside of open enrollment, as those used by HealthCare.gov.

“The rule proposes to require all exchanges to conduct special enrollment period verification for at least 75% of new enrollments for consumers not already enrolled in coverage through the relevant exchange,” the agency said. “Tightening those standards on [special enrollment period] eligibility verification is expected to protect the risk pool and, in turn, lower premiums by preventing people from waiting until they are sick to enroll.”

The decision, though, comes as more people could sign up for exchange coverage outside of the open enrollment period that ends Dec.15. Massive job losses from COVID-19 could lead to more people enrolling on the exchanges in a special enrollment period.

The rule also outlines a new option for states to partner with private entities to create a new enrollment website as an alternative to their state’s own websites.

“This design would leverage web brokers and issuers to serve as the consumer-facing means to apply and enroll in individual market [qualified health plans] offered through the exchange,” CMS said in a release. “These platforms would enable a more curated, customized consumer experience designed to target diverse populations who need coverage.”

The exchanges would still have to make sure these new private sites would meet all consumer protections.

“Exchanges would remain responsible for making all eligibility determinations, performing required verifications of consumer application information, and meeting all of the statutory and regulatory requirements for the operation of an exchange,” the release said.

The rule comes after CMS granted a waiver for Georgia to leave HealthCare.gov and rely on the private sector to sign up people for ACA coverage.