The CMS has sent a rule designed to stabilize the individual health insurance market to the Office of Management and Budget for final review. The Trump administration hopes to finalize the rule very soon.
The administration is rushing to publish the final rule to calm insurers, who are nervously trying to decide within the next two months whether to offer plans for 2018 and what to charge for premiums.
The rule sent to OMB, which includes the CMS' responses to more than 4,000 public comments, takes steps to limit consumers' ability to enroll in plans outside the Affordable Care Act's annual open enrollment period.
Insurers seek such limits to prevent what they see as gaming by consumers who sign up when they need expensive care and drop coverage after they receive it. That has contributed to higher premiums in the individual market by skewing the risk pool toward sicker enrollees. It's not yet known whether the CMS included a number of tougher restrictions sought by insurers.
OMB has 90 days to review the rule and send it back to the CMS for final publication. But the agency is expected to move much faster given the looming rate-filing deadlines for insurers.
The rule aims to entice insurers to stay on the Obamacare marketplaces next year despite uncertainty over whether Republicans will try again to repeal and replace the ACA. Insurers also are jittery about whether the Trump administration and congressional Republicans will continue to enforce the law's individual mandate and fund payments to carriers for the law's cost-sharing reductions for low-income enrollees.
The proposed market stabilization rule, issued in February, contained provisions that would shorten the open-enrollment period for the federal marketplace from three months to six weeks; shift authority to states to determine whether health plans have adequate provider networks; and let insurers design plans that pay for a somewhat lower percentage of consumers' medical costs. It does not apply to state-run exchanges in states such as California and New York.
Anthem, which sells plans on the ACA exchanges in 14 states, largely supported the proposed rule but wanted the CMS to further limit opportunities for individuals to buy coverage during so-called special enrollment periods based on changes in life circumstances such as moving, job loss or divorce.
Plans have complained that consumers buying plans during special enrollments are sicker and more expensive to cover than those who come in during open enrollment.
The CMS proposed to require special enrollment applicants to demonstrate they had coverage for one or more days during the 60 days preceding the date of the qualifying event that would make them eligible for special enrollment, or else demonstrate they lived outside of the U.S.
In a March 7 letter, Anthem suggested tougher conditions. The insurer proposed that beginning in 2018 these individuals be required to demonstrate 12 months of continuous coverage with no more than a 63-day gap in coverage to qualify for a special enrollment period. Those individuals who could not demonstrate continuous coverage would be required to wait until the next open enrollment to sign up.
Anthem also wanted the more rigorous verification standards the CMS is proposing for special enrollment periods to also apply to state-run exchanges.
Cigna, in its comment letter, asked that the CMS impose a late enrollment penalty, similar to one now imposed on Medicare beneficiaries, for people signing up through special enrollment periods.
Other suggestions included reducing premium tax credits for people who do not enroll during regular open enrollment, imposing a waiting period for coverage or limiting access to certain benefits.
It's not yet known whether the CMS included these tougher conditions in the proposed rule sent to the OMB.
Consumer advocates oppose many of these measures, with some warning they would discourage healthier people from signing up. In addition, it's not clear whether some of these measures would be consistent with the ACA's statutory provisions.
