Obama administration adjusts ACA exchange program for 2018

HealthCare.gov managers are keeping a requirement designed to weed out consumers who move solely to get a special enrollment period. (Image: Thinkstock)
HealthCare.gov managers are keeping a requirement designed to weed out consumers who move solely to get a special enrollment period. (Image: Thinkstock)

If the Trump administration sticks to the current Affordable Care Act exchange system framework, applications from would-be 2018 HealthCare.gov issuers could arrive from April 5 through May 3.

Proposed 2018 health plan rates could hit the web Aug. 1.

Open enrollment for 2018 coverage run from Nov. 1, and last until Jan. 31, 2018.

Seema Verma, the Trump administration’s pick to be the next Centers for Medicare & Medicaid Services (CMS) administrator, might oversee efforts in March to let health insurers know how much they should expect to get from or pay into the ACA risk-adjustment program for 2016.

The officials now running CMS have put those dates on a list of key HealthCare.gov and Affordable Care Act commercial health insurance regulation dates for 2017. The date list is part of a new packet of documents showing how CMS expects HealthCare.gov, the ACA exchange plan rate review system, and the ACA insurer risk management programs to work in the coming year.

Related: 3 darts for agents in the new ACA 2018 draft rules

In addition to releasing the key date list, CMS officials have posted a letter to would-be 2018 HealthCare.gov plan issuers, and final version of the Notice of Benefit and Payment Parameters for 2018.

The new ACA parameters regulation shows how CMS expects to adjust ACA rules and benchmark numbers in 2018. For 2018, for example, CMS expects to charge exchange plan issuers a user fee equal to 3.5 percent of premiums in states that rely solely on HealthCare.gov to handle ACA exchange plan enrollment, marketing and account administration services.

In states that help with marketing but use the HealthCare.gov enrollment system, CMS will charge a 3 percent user fee, according to the ACA package.

In the packet, CMS also has:

  • Started creating an independent compliance and data security audit vendor program for agents and brokers that enroll consumers directly in HealthCare.gov plans.

  • Fleshed out the rules for validating the enrollee health score data health insurers feed into the ACA risk-adjusting program. The program is supposed to shift cash from insurers with higher-risk enrollees to issuers with lower-risk enrollees. Regulators have decided, for example, that issuers with more than $15 million in premiums should have their risk score data validated every year. Smaller issuers would go through a random audit target selection process.

  • Tightened the rules for special enrollment period applicants, or applicants who apply outside the ordinary open enrollment period.

Special enrollments

The ACA now blocks insurers from using health-related information other than location when deciding whether to sell coverage to an applicant, and it blocks them from using health information other than location, age and tobacco use when deciding how much the coverage should cost.

Insurers, regulators and exchange managers came up with the open enrollment system to try to keep people from waiting until they get sick to apply for coverage. The system puts limits on when people can apply for coverage without showing they have what the government sees as a good excuse,

One reason consumers can use to apply for special enrollment periods is moving to a new community.

HealthCare.gov only recently began requiring the consumers who applied for relocation special enrollments to show they had really moved.

CMS officials say in the introduction to the new final rules that insurers believe some people with health problems are relocating purely to qualify for special enrollments.

Insurers have feared that relocations for the sake of getting special enrollments “will lead to adverse selection and immediate, unexpected losses in the remaining months of this year, which could lead to significant premium increases or issuers exiting the market,” officials say.

Officials note that, in May, they began immediately require applicants for relocation special enrollments to show they had had major medical coverage in place for at least one of the 60 days before they moved.

In the new final rule, CMS makes the relocation special enrollment period eligibility requirement permanent.

Officials say some commenters said CMS had imposed the requirement without showing any hard evidence of abuse.

Officials say they will monitor the relocation special enrollment period to make sure the new eligibility rule is not shutting out consumers who should qualify for relocation special enrollments.

Related:

HealthCare.gov plans systemwide eligibility-proofing test

CMS posts 2017 PPACA World rules

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