CMS proposes rule for 2015 insurance market standards

The CMS on Friday issued its final rule for exchange and insurance market standards for 2015 and beyond, a potpourri of policies that address consumer notices, quality reporting and enrollee satisfaction surveys, the Small Business Health Options Program (SHOP), standards for navigators and other consumer assisters, and policies regarding the premium stabilization programs, among others.

Its navigator standards are likely to anger state officials who have tried to regulate navigators in their jurisdictions, but it may bring smiles to insurers, who will have more protections against losses.

The agency is sticking by its plans to lessen state control over navigators by pre-empting state laws, or portions of them, if they “prevent the application of the provisions of Title I of the Affordable Care Act,” the CMS said.

Throughout 2013, numerous, mostly GOP-led states passed laws limiting navigator activities. Such measures included stringent restrictions on the advice navigators could offer consumers. Pre-empting such state laws is its prerogative, the CMS contends, because of an HHS interpretation of the Patient Protection and Affordable Care Act.

The CMS also made clear it's not pre-empting all state laws, such as those that don't stop navigators from doing their federal duties. It is sticking by its decision to strike state laws that require navigators to refer consumers to agents or brokers when they request help in choosing an exchange plan because navigators are required by the ACA to provide consumers with impartial advice, while other entities such as brokers are not.

The CMS also indicated it intends to lower the threshold for reinsurance payments in 2015. Those payments are designed to subsidize insurers that end up with disproportionately expensive enrollees. The agency had originally proposed that such payments would kick in when a customer had made $70,000 in claims. The federal government would then pay 50% of claims up to $250,000.

But the CMS indicated that it now intends to lower that threshold to $45,000, the same level as for 2014, to provide more protection to insurers. In addition, the CMS finalized changes to the risk corridor program intended to shield insurers from some of the turbulence associated with implementation of the ACA.

Follow Paul Demko on Twitter: @MHPDemko

Follow Virgil Dickson on Twitter: @MHVDickson