HHS tweaks rules for short-term marketplace plans, risk adjustment

U.S. Capitol building

The federal government has announced six new changes to the Affordable Care Act marketplace designed to strengthen the program's risk pool. 

Among the new changes, the Department of Health and Human Services (HHS) plans to make improvements to the risk adjustment program, building off of previous discussions the Centers for Medicare & Medicaid Services (CMS) had with insurers in March. Beginning in 2017, the risk adjustment model will include partial-year enrollees, and beginning in 2018, the model will incorporate prescription drug utilization data. Both changes were requested by America's Health Insurance Plans in April.

HHS is also tightening its rules around short-term limited duration plans, issuing a proposed rule that stipulates short-term policies can only be offered for three months or fewer and cannot be renewed at the end of the term. Sales for short-term policies had surged recently, as consumers saw them as a cheaper alternative to marketplace plans. Similarly, HHS continued tightening rules around special enrollment periods (SEPs). Beginning June 17, those enrolling through SEPs will be required to submit additional eligibility documents.

"ACHP members have emphasized repeatedly that a broad, stable risk pool is critical for health plans to maintain and expand coverage," Alliance of Community Health Plans President and CEO Ceci Connolly said in a statement emailed to FierceHealthPayer. "We are very pleased that the administration has responded to the needs of plans who remain committed to coverage. These steps will encourage people to enroll and stay enrolled in health plans that provide essential benefits."

Additionally, HHS announced new education and outreach initiatives targeting individuals faced with data-matching issues and seniors making the transition to Medicare, an initiative that was commended by the Medicare Rights Center.

"We applaud CMS for today's announcement," Joe Baker, president of the Medicare Rights Center, said in a statement. "Advance notice and adequate education is fundamental to ensuring that people with Marketplace plans are prepared to enroll in Medicare."

To learn more:
- here's the HHS announcement
- see the Medicare Rights Center statement