CMS proposes ACA benefit changes for 2019: 7 things to know

CMS issued its proposed HHS Notice of Benefit and Payment Parameters for 2019.

"This proposed rule is intended to increase flexibility in the individual market, improve program integrity and reduce regulatory burdens associated with the Patient Protection and Affordable Care Act in the individual and small group markets," according to CMS.

Here are seven things to know.

1. Beginning in 2019, the proposed rule aims to give states greater flexibility when defining essential health benefit benchmark plans. Specifically, CMS proposes allowing states to choose a new essential health benefit-benchmark plan annually and extend those options beyond the ACA's 10 essential health benefits.

2. The proposed rule seeks to establish incentives supporting state-based exchanges. CMS also requests the removal of several small business health options program, or SHOP, requirements. For example, CMS wants to allow SHOP consumers to enroll through a SHOP qualified health plan insurer or a SHOP-registered broker.

3. CMS calls for the removal of the ACA's meaningful difference requirement for qualified health plans. The requirement mandates qualified health plans be materially different in one or more ways. CMS said this rule is unnecessary due to fewer insurers participating in the exchanges.

4. The rule proposes eliminating the ACA's mandate that each exchange have two navigators helping enrollees sign up for coverage. Beginning in 2019, CMS also wants to end requirements ensuring one of the navigators must be a consumer-focused entity and each navigator maintains a physical presence at the exchange area.

5. CMS aims to amend the HHS risk adjustment model. For example, the agency wants to recalibrate the 2019 risk adjustment model to give insurers more predictability and stability. CMS also looks to allow states to reduce risk adjustment transfers in the small group market.

6. Finally, the rule calls for rate review reform. The proposed rule seeks to eliminate a requirement mandating proposed and final rate increases be posted at a specific time. Instead, CMS aims to allow states to do the following:

  • Publish those rates on a rolling basis
  • Exempt student health insurance from federal review process
  • Allow states to have different submission deadlines for insurers offering only non-qualified health plan coverage
  • Reduce the advanced notice states give CMS about rate increase postings from 30 to five business days
  • Increase the threshold for rate increases subject to review from 10 percent to 15 percent.

7. CMS is seeking comments on the proposed rule through Nov. 27.

To access CMS' fact sheet on the proposed rule, click here

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