Responding to insurer complaints, CMS to test pre-enrollment checks for ACA

In light of insurer pushback, CMS said Tuesday it will work to further strengthen rules for special enrollment periods established by the Affordable Care Act.

Payers have argued special enrollment periods allow recently sick individuals to join health plans and drive up costs. To regulate special enrollment periods, CMS will launch a pilot program next year to evaluate a pre-enrollment verification system. The system will require enrollees to provide documentation to prove they are eligible for special enrollment periods.

The pilot program will evaluate the impact of requiring further documentation on ACA compliance, enrollment, sustainability of coverage, risk pools and other outcomes, according to the report. CMS is still determining the scope of the pilot. 

More articles about payer issues:
BCBS of Michigan unveils value-based program, employer fee
In New Hampshire, low reimbursements may impede opioid abuse treatment
Florida residents to face on average 19% premium rate hike

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