CMS NEWS
FOR IMMEDIATE RELEASE
November 20,
2015
Contact: CMS Media Relations
(202) 690-6145 | CMS
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CMS
Proposes Improvements for the 2017 Marketplace
The Centers for Medicare &
Medicaid Services (CMS) today issued the proposed annual Notice of Benefit and
Payment Parameters for 2017, governing participation in the Health Insurance
Marketplaces. The proposed rule seeks comment on proposals that will provide
continued choice and competition for consumers, and a vibrant and growing
market for affordable, quality health plans. The proposed rule seeks to
improve the consumer experience, both when individuals shop for health
insurance and when they use it.
“As we enter into our third year,
the Health Insurance Marketplace continues to grow, with millions of people
looking to the Marketplace as their source for quality, affordable health
coverage that will be there when they need it. We’re off to a good start with
tens of thousands more Americans turning to the Marketplace for health coverage
every day, and even more returning for another year,” said Kevin Counihan, CEO
of the Health Insurance Marketplaces. “We look forward to reviewing comments to
these proposed rules to make the Marketplaces work even better so that consumers
will benefit from choice and competition.”
To protect consumer access to
health care providers and delivery organizations, the proposal asks states to
establish a provider network adequacy standard for health plans in the federal
Marketplace, subject to minimum criteria that CMS will establish at a later
date, with a default time and distance standard otherwise. CMS is evaluating
additional efforts to support transparency and informed consumer
decision-making as it relates to provider network adequacy, and is requesting
comment on whether designating network strength – for instance, indicating
whether a plan has a broad number of doctors or health facilities in their
network to choose from or not -- could improve the consumer experience in
future years.
To make it easier for consumers to
compare plans based on key provisions, CMS is proposing to give issuers the
choice of offering plans with standardized options such as cost-sharing. Health
plans would not be required to issue such plans and could continue to offer
other plans with more variable plan designs, as well as the proposed optional
standardized plans, so consumers can choose the plan that’s right for them.
In an effort to reduce surprises
consumers may face after buying a policy, CMS is seeking comment on a
requirement that health plans in the federal Marketplace count certain
out-of-pocket expenses on unexpected out-of-network services towards a policy
holder’s annual out-of-pocket maximum, if the service was performed at an
in-network facility and advance notice was not provided. For instance, if a
patient who had surgery at an in-network facility finds out later that their
anesthesiologist was not part of the health plan’s network, cost-sharing
charges for that anesthesiologist’s services would count toward the
out-of-pocket maximum, protecting the patient against additional financial
liability. Currently, these types of out-of-network cost-sharing charges are
generally not counted towards the out-of-pocket maximum.
Recognizing that once consumers
enroll in coverage, many still need assistance in understanding and using their
coverage, the proposed rule seeks comment on expanding the required duties of
Navigators. The expanded duties would include specific post-enrollment
assistance activities such as Marketplace eligibility appeals, applying for
exemptions through the Marketplace, and navigating the transition from coverage
to care. This proposal is a step forward in engaging and empowering consumers
with the resources they need to understand how to use their coverage.
The proposed rule would also
increase options for employees in the federal Small Business Health Options
Program (SHOP) for plan years beginning in 2017 and beyond. Under current
regulations, employers participating in the federal SHOP Marketplace can offer
their employees either one health plan and/or one dental plan, or all health
and dental plans across one metal level (or actuarial value, for dental plans).
Under the proposal, employers would be able to offer all plans across all
levels of coverage from one insurance company. This would give employers more
choices as they look for coverage that best suits their employees.
The rule proposes changes and
solicits comments on a number of proposals as well as improvements to the
premium stabilization programs in an ongoing effort to build the Marketplace in
a way that supports a vibrant and competitive environment for issuers and
consumers. Those include:
- Streamlining direct enrollment so that customers can
more easily use websites of agents and brokers, decreasing administrative
costs for issuers;
- Keeping the federal Marketplace user fee stable for
2017, the 4th year of predictability for issuers;
- Discussing options on transitioning consumers more
smoothly from Marketplace coverage to Medicare, so that elderly, often
higher-risk consumers, move from the Marketplace risk pool to Medicare;
- Recalibrating the risk adjustment formula using most
recent data to provide greater accuracy of payments;
- Seeking comment on improvements to the child age rating
curve to reflect risk more accurately, so that premiums can be more
accurately priced; and
- Seeking comment on the Open Enrollment period for 2018
and beyond. Under the proposal the Open Enrollment period for 2017 would
remain November 1 – January 31.
For a more detailed list of
proposals in the rule, visit: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/CMS-9937-P-Fact-Sheet-final-112015.pdf
The proposed rule was placed on
display at the Federal Register today, and can be found at:
https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-29884.pdf
and on 12/02/2015 available online at http://federalregister.gov/a/2015-29884
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