With final rule, feds seek to shore up ACA marketplaces

Document titled "Patient Protection and Affordable Care Act"
With its newly finalized regulations, the Obama administration aims to leave the ACA marketplaces "on a stable path." (Getty/designer491)

The federal government on Friday finalized a slew of new regulations to improve how the Affordable Care Act marketplaces function—even as their future remains uncertain amid a change in political power.

The 2018 Notice of Benefit and Payment Parameters final rule (PDF) includes not only changes to the risk adjustment model, but also provisions that the Centers for Medicare & Medicaid Services says will “streamline the marketplace consumer experience” and strengthen the ACA marketplaces as a whole.

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Congressional Republicans have said that repealing the ACA will be an early priority once President-elect Donald Trump takes office, though they are expected to delay implementing a repeal in order to leave time to design a suitable replacement.

Thus, with its latest regulations, the Obama administration seeks to “leave the marketplaces on a stable path that, when fully implemented, will ensure quality coverage is available for all Americans well into the future,” CMS Acting Administrator Andy Slavitt said in an announcement.

As outlined in a CMS fact sheet, some of the key provisions in the final rule include:

  • It updates standardized plan options for all six metal levels on the exchanges—also known as Simple Choice plans—based on an analysis of individual market data from 2016. The final rule also creates three sets of standardized options, selecting one at each level of coverage for each state based on that state’s cost-sharing requirements.
  • Starting in 2018, the four states involved in a CMS pilot to display information about plans’ network breadth on Healthcare.gov will also identify whether a particular plan is offered as part of an integrated provider delivery system.
  • The final rule adds new consumer protections surrounding direct enrollment for marketplace plans, specifying that insurer or broker websites must display standardized options and information about advance premium tax credits. They also must demonstrate “operational readiness” before their sites are approved to complete plan selection.
  • It allows insurers to extend the deadlines for binder payments—or the first premiums paid on a plan—if they are experiencing billing or enrollment problems due to high volume or technical errors.
  • In reference to special enrollment periods, the final rule codifies several already existing SEPs “to ensure the rules are clear and to limit misuse.” Insurers have argued SEPs are vulnerable to abuse by consumers, but the final rule notes that an examination of enrollment data suggests that any such gaming of the system “it is occurring, does not appear to be occurring at sufficient scale to produce statistically measurable effects.”

CMS also released other key documents Friday, including the final actuarial value calculator for 2018; guidance regarding age curves and state reporting; and key dates for 2017, among others.