Health insurers in the Affordable Care Act exchanges will see changes from the CMS this year to strengthen the market, including eliminating special enrollment periods and an early look at plans' risk-adjustment data, the top CMS official said on Monday.
“We are committed to make sure that risk adjustment works as it intended to allow coverage of individuals with pre-existing conditions,” acting CMS Administrator Andrew Slavitt said during the JP Morgan Healthcare Conference in San Francisco.
Insurers this year will receive early estimates of health plans risk-adjustment calculations—intended to reflect how sick health plan members may be, and therefore how costly—and with other changes, insurers may have more timely information to set premiums, he said.
CMS will also host a conference in March to get comment on risk-adjustment methods, Slavitt said.
“We have the tools to make certain that the proper incentives exist to insure sicker populations,” he said.
Health plans have struggled with surprises among the newly insured. Sicker-than-expected members in UnitedHealth Group's health plans led to losses and an announcement in November the insurer may exit exchanges in 2017.
The CMS is expected to announce as early as this week that it will eliminate some special-enrollment periods and clarify rules for others to prevent enrollment abuse, he said.
Slavitt also announced new information technology initiatives.
New regulations to be released shortly will succeed meaningful-use requirements as the industry shifts its focus toward developing new technology uses and away from adopting IT, he said.
New regulations will require open application programming interfaces, he said, to encourage private sector innovation. “Technology must be user-centered and support physicians, not distract them,” Slavitt said. “One way to aid this is by leveling the technology playing field for startups and new entrants.”
The CMS will work with doctors and consumers to target technology development where there are gaps, such as patient engagement, and will promote technology designed to work with any other device or system. “We are deadly serious about interoperability,” he said. “Technology companies that look for ways to practice data-blocking in opposition to new regulations will find that it will not be tolerated.”
The CMS will also issue a request for information on how to “break out of the same old solutions,” a blog post announcing the new website said.