HHS Proposes Rule to Stabilize Health Insurance Marketplace

This week, the Department of Health and Human Services issued a proposed rule intended to stabilize the individual and small group health insurance markets.

The proposed rule would change special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community providers and actuarial value requirements. It also announces upcoming changes to the qualified health plan certification timeline.

The rule proposes the following key provisions that may impact independent insurance agents and brokers:

  • Expanding pre-enrollment verification of eligibility to individuals who newly enroll through special enrollment periods in marketplaces using the HealthCare.gov platform. This proposed change would help ensure that special enrollment periods are available to all who are eligible, but would require individuals to submit supporting documentation—a common practice in the employer health insurance market. This would help place downward pressure on premiums, curb abuses and encourage year-round enrollment.
  • Addressing potential abuses by allowing an issuer to collect premiums for prior unpaid coverage before enrolling a patient in the next year’s plan with the same issuer. This would incentivize patients to avoid coverage lapses.
  • Making adjustments to the de minimis range used to determine the level of coverage by offering issuers greater flexibility to provide patients with more coverage options.
  • Reaffirming the traditional role of states to serve their populations. In the review of qualified health plans, the Centers for Medicare/Medicaid (CMS) proposes to defer to state reviews in states with the authority and means to assess issuer network adequacy. States are best positioned to ensure their residents have access to high-quality care networks.
  • Releasing a revised proposed timeline for qualified health plan certification and rate review process for plan year 2018. The revised timeline would give issuers additional time to implement proposed changes that are finalized prior to the 2018 coverage year. This would give issuers flexibility to incorporate benefit changes and maximize the number of coverage options available to patients.
  • Shortening the upcoming annual open enrollment period for the individual market. For the 2018 coverage year, CMS proposes an open enrollment period of Nov. 1, 2017 to Dec. 15, 2017—which would align the Marketplaces with the employer-sponsored insurance market and Medicare, and help lower prices for Americans by reducing adverse selection. 

Wyatt Stewart is Big “I” senior director of federal government affairs.