CMS Issues Final Rule on Market Stabilization

The Centers for Medicare & Medicaid Services (CMS) released a final rule, Patient Protection and Affordable Care Act Market Stabilization, to help stabilize individual and small group markets and affirm the traditional role of State regulators.

The final rule makes the following changes to improve the risk pool and promote market stability:

  • The dates for the annual open enrollment period are adjusted to more closely align with Medicare and the private market. The next open enrollment period will start on November 1, 2017, and run through December 15, 2017, encouraging individuals to enroll in coverage prior to the beginning of the year.
  • Requires individuals to submit supporting documentation for special enrollment periods and ensures that only those who are eligible are able to enroll. It will encourage individuals to stay enrolled in coverage all year, reducing gaps in coverage and resulting in fewer individual mandate penalties and help to lower premiums.
  • Promotes personal responsibility by allowing issuers to require individuals to pay back past due premiums before enrolling into a plan with the same issuer the following year. This is intended to address gaming and encourage individuals to maintain continuous coverage throughout the year, which will have a positive impact on the risk pool.
  • Allows issuers additional actuarial value flexibility to develop more choices with lower premium options for consumers, and to continue offering existing plans for the 2018 plan year and beyond.
  • Reduces waste of taxpayer dollars by eliminating duplicative review of network adequacy by the federal government.  The rule returns oversight of network adequacy to states that are best positioned to evaluate network adequacy.

The rule is effective June 19, 2017.

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Key Dates Calendar for 2017