February 23, 2017

CMS proposes new insurer deadlines for 2018 exchange participation

Daily Briefing

    CMS in a draft bulletin published Friday proposed extending the deadline for health insurers to file proposed premium rates for plans they intend to sell on the Affordable Care Act's (ACA) exchanges in the 2018 coverage year.

    While some industry experts say the deadline extensions could give insurers more time to propose their premium rates, others say the amount of uncertainty facing the marketplace continues to pose a challenge. Insurers currently are determining whether to participate in the exchanges for the 2018 coverage year. Humana last week announced that it would not participate in any exchanges for the 2018 coverage year.

    Are the ACA exchanges really in a death spiral? We asked the experts.

    Draft bulletin details

    The proposed changes in the draft bulletin would apply to insurers seeking to sell health plans through the federal exchanges for the 2018 coverage year.

    Under the proposal, insurers seeking to sell 2018 plans in states that rely on the federal exchange for enrollment would have until June 21 to file suggested rates for the plans. June 21 also would be the deadline for health plans to file qualified health plan (QHP) applications signaling their intent to participate in the federal exchange. In both cases, the proposed deadline would represent an extension from a current deadline of May 3.

    In addition, CMS in the draft bulletin proposed extending the deadline by which insurers can file corrections to their original rate filings for 2018 plans from June 13 to Aug. 2. However, CMS proposed moving up the date by which insurers must petition to change their service areas from Aug. 9 to Aug. 4, as well as the final date insurers can seek to change their QHP applications from Aug. 21 to Aug. 16.

    CMS plans to send its final certification notices to QHP insurers by Oct. 12, delayed from the previous Sept. 22 deadline.

    CMS also proposed delaying rate filing deadlines for single-risk pool markets in the four states that do not have effective rate review programs. In the draft bulletin, CMS said insurers seeking to participate in those exchanges would need to file rate filings with federal regulators by June 1. The previous deadline was scheduled for May 3.

    States that have effective rate review programs would still be required to submit their rates by a date set by the state, which can be as late as July 17, Tim Jost, a law professor emeritus at Washington and Lee University, writes in Health Affairs Blog.

    CMS is accepting comments on the proposed extensions through March 7.

    Implications

    Kristine Grow, senior vice president of communications at America's Health Insurance Plans, said the delay is "a welcome move that provides more time for health plans to gain clarity on transition plans and market stabilization."

    Margaret Murray, CEO of the Association for Community Affiliated Plans, said the proposal "will likely give insurers more time to sort out some of the short-term uncertainty in the market" stemming from Republicans' efforts to repeal and replace the ACA.

    However, some stakeholders say the extensions do not address insurers' most significant concerns.

    For example, insurers say policymakers need to resolve a legal dispute over whether the Trump administration will continue to pay insurers for the ACA's cost-sharing reductions for lower-income policyholders. Ceci Connolly, CEO of the Alliance of Community Health Plans, said, "Plans are eager to get clarity regarding subsidies for next year. Without that, it is nearly impossible to develop sound pricing."

    In addition, insurers say proposals to replace the ACA if it is repealed should continue to require U.S. residents to purchase health plans.

    Cori Uccello, a senior health fellow of the American Academy of Actuaries, said, "The extended timeframe is less helpful if uncertainty about policymaking continues" (Dickson, Modern Healthcare, 2/21; CMS draft bulletin, 2/17; CMS proposed QHP certification dates, February 2017; Hansard, Bloomberg BNA, 2/21; Dickson, Crain's Chicago Business, 2/21; Court, MarketWatch, 2/22; Jost, Health Affairs Blog, 2/17)

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