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March 05, 2014 at 01:04 PM
Only the commercial health plans sold through the new public exchanges — and some very similar plans — will be able to participate in a new underwriting profit protection program.
The Centers for Medicare & Medicaid Services today ruled that only “qualified health plans” — and plans that are “substantially the same as a QHP” — can either make payments to or get cash from the federal “risk corridors” program.
The drafters of the Patient Protection and Affordable Care Act created the risk corridors program to protect QHP issuers against the possibility that all of the underwriting rules and benefits mandates PPACA is imposing could flood some insurers with claims.
Carriers with high operating profits are supposed to reimburse carriers with profit margins of less than 3 percent. If all health insurers do poorly, PPACA calls for the federal government to chip in.
CMS talks about the risk corridors program and many other PPACA provisions in the same 335-page anthology of PPACA final regulations that lets consumers keep non-PPACA-compliant individual policies for two extra years, if insurers and state regulators permit that, and that keeps the current March 31 PPACA individual QHP enrollment deadline.
Commenters on a draft of the regulations asked CMS to let all health plans that comply with PPACA rules, including non-exchange health plans, participate in the risk corridors program.
Limiting the program to QHPs and very similar plans will preserve the intent of the program, which is to stabilize QHP premiums, officials say.
Other sections of the new CMS regulations deal with everything from whether agents and brokers can use their own websites to enroll employers in small-group exchanges’ QHPs to whether short-term medical plans have to pay for another PPACA risk-management program, a temporary reinsurance program.
CMS officials say they are comfortable with the idea of a state-based exchange letting brokers enroll businesses in exchange plans, but it’s probably not going to make that feature available through the public exchanges it runs for HHS in 2015.
