On March 10, the Centers for Medicare and Medicaid Services (CMS) issued a proposed new rule, CMS-9884-P/RIN 0938-AV61, that would, among other things, shorten the Affordable Care Act (ACA) enrollment period by a month and reduce ACA subsidies by $5/month until those claiming the subsidies confirm information about their income. Under the new rule, the enrollment period would end on December 15 rather than January 15.
CMS describes their proposed rule as follows: “CMS issued the “Marketplace Integrity and Affordability Proposed Rule” that proposes standards for the Health Insurance Marketplaces, as well as for health insurance issuers, brokers, and agents who connect millions of consumers to Affordable Care Act (ACA) coverage. The rule proposes additional safeguards to protect consumers from improper enrollments and changes to their health care coverage, as well as establish standards to ensure the integrity of the Marketplaces.
“Key proposals include revised standards relating to strengthening income verification processes; modifying eligibility redetermination procedures; removing Deferred Action for Childhood Arrivals (DACA) recipients from the definition of “lawfully present” for eligibility and enrollment in Marketplace and Basic Health Program (BHP) coverage; and adopting pre-enrollment verification for special enrollment periods (SEPs), aimed at reducing improper enrollments and improving the risk pool. Additionally, the rule proposes to adopt in regulation the evidentiary standard CMS uses to assess whether to terminate an agent’s, broker’s, or web-broker’s Marketplace Agreements for cause; prohibit issuers from providing coverage of sex-trait modifications as an essential health benefit (EHB); revise actuarial value standards for health plans; require Marketplaces to deny eligibility for advance payments of the premium tax credit (APTC) upon a tax filer’s failure to reconcile APTC for one year; revise the automatic reenrollment hierarchy; change the annual Open Enrollment Period (OEP); eliminate the SEP for persons with annual household incomes below 150% of the federal poverty level (FPL); and revise the premium adjustment percentage methodology.
“These and other policies in the proposed rule are designed to stabilize the risk pool, lower premiums, and reduce improper enrollments with a goal of improving health care affordability and access while maintaining fiscal responsibility.”
Prospects: The proposed rule is open for a short 30-day comment period, starting from the March 10 “exposure date,” even though the proposed rule was not published in the Federal Register until March 19.
NAIFA Staff Contacts: Mike Hedge – Senior Director – Government Relations, at mhedge@naifa.org or Jayne Fitzgerald – Director – Government Relations, at jfitzgerald@naifa.org.