The Centers for Medicare & Medicaid Services on Monday issued a proposed rule that would set the standards governing health insurance issuers and the state- and federally-run Health Insurance Marketplaces for 2018.
CMS’ proposed rule sets forth payment parameters and provisions related to the risk-adjustment program, cost-sharing parameters and cost-sharing reductions and user fees.
The American Hospital Association (AHA) says it is pleased that CMS proposed several changes the association believes will improve the risk-adjustment program, including one which the agency proposes to implement in the 2017 benefit year.
CMS proposes to refine the risk-adjustment program to better reflect enrollee risk, clarify the use of several special enrollment periods, and increase the number of standardized plan options available. The proposal would maintain the federally-facilitated Marketplace user fee rate of 3.5 percent and the state-based Marketplace on the federal platform user fee rate of 3 percent, and it would set the maximum annual limit on cost sharing for 2018 at $7,350 for individual coverage and $14,700 for family coverage.
The AHA says the changes are consistent with recommendations the AHA has made to the agency (see more here) and are an important step in stabilizing the marketplaces.
Last week, in response to recent decisions by some insurers to stop selling plans on the Affordable Care Act marketplaces, the AHA wrote U.S. Department of Health and Human Service Secretary Sylvia Burwell about the stability of the marketplaces.