The Obama administration wants to modify policies for automatic health insurance re-enrollments and strengthen rules for provider directories for the 2016 open enrollment period.
The CMS released proposed marketplace rules (PDF) on Friday for the next exchange sign-up period, which is scheduled to run from Oct. 1 to Dec. 15, 2015.
One of the most substantial proposed changes involves re-enrollment. Under current regulations, consumers who don't switch to a new health plan are automatically re-enrolled in their same plan, much like the employer-sponsored enrollment process. However, HHS wants to place consumers who take no action into plans that have lower monthly premiums.
“Default enrollment in the same or similar plan may sometimes encourage consumers to remain in plans that are significantly more expensive than the lowest-cost plans in the market,” HHS wrote. “Because we believe that many consumers place a high value on low premiums when selecting a plan, we believe that consumers could benefit from alternative re-enrollment hierarchies.”
State-based exchanges would be able to try the new default re-enrollment in 2016, while the federally run marketplaces would try the approach in 2017.
The proposed marketplace rules for 2016 also stress that HHS continues to take “great interest in ensuring strong network access.” The agency indicated that it is monitoring efforts by the National Association of Insurance Commissioners to draft a model state law dealing with network adequacy and that it won't prescribe any “significant changes” to requirements until that process is completed.
HHS is requesting that health plans allow for a transition period for new enrollees in the midst of treatment from a doctor that isn't included in the provider network of their new plan. The agency suggests that insurers permit a transition period of 30 days before charging customers for using an out-of-network provider.
“We encourage issuers to adopt this policy to accommodate the immediate needs of enrollees, while allowing the enrollee sufficient time to go through the process of selecting an in-network provider in their new plan,” HHS wrote. “We are considering whether requirements may be needed in this area.”
Controversies over provider networks have erupted across the country as insurers have moved to narrow-network plans, which have been particularly popular in the new marketplaces. Providers have sued over being excluded from plans, and consumers have complained about lack of access to particular hospitals and doctors. There also have been widespread complaints about plans disseminating inaccurate directories of the providers participating in their networks.
HHS wants to strengthen rules for provider directories. The agency proposes requiring that insurers selling plans on the exchanges update their directories at least monthly, and that they include detailed information about providers, including whether they are accepting new patients. The CMS is seeking input from stakeholders on how often health plans should be required to update this information.
The rule also indicates that HHS is considering requiring health plans to post provider directories to their websites in a “machine-readable file.” That would enable third parties to capture the data and create tools that help consumers make informed decisions about which plans will best meet their needs.
Another proposed change involves rate review. Health insurers that want to raise individual or small-group premiums by 10% must currently justify those rates to HHS. However, the stipulation only applies within a general product category, such as an individual-market PPO. HHS has recommended expanding that rate review process to include all metal tiers (which indicate actuarial value) within each health coverage product.
A summary of the proposed rules can be found on the CMS website (PDF). Comments for the proposed rules are due by Dec. 26.
Follow Bob Herman on Twitter: @MHbherman
Follow Paul Demko on Twitter: @MHpdemko
