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CMS: Just use the old PPACA value calculator

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The Centers for Medicare & Medicaid Services (CMS) has come up with a quick solution to updating its health plan actuarial valuator: The agency won’t really update it.

CMS officials say they will just increase the old calculator’s annual limits on how much enrollees can pay out of their own pockets and have plans stick with that slightly tweaked version of the old calculator.

Officials describe the “stick with the old calculator” solution on page 218 of a 335-page batch of Patient Protection and Affordable Care Act (PPACA) implementation regulations that CMS released Wednesday.

CMS is preparing to publish the regulations in the Federal Register March 11.

PPACA now requires insurers selling PPACA-compliant individual and small-group health insurance to cover a standardized package of “essential health benefits” (EHB).

Insurers can offer individual and small-group coverage at five different “metal levels” — bronze, silver, gold, platinum and catastrophic — and they’re supposed to base the metal levels on the percentage of actuarial value that the plan covers.

A bare-bones bronze plan is supposed to cover about 60 percent of the actuarial value of the EHB package, and a deluxe platinum plan is supposed to cover about 90 percent of the actuarial value of the EHB package.

CMS — an arm of the U.S. Department of Health and Human Services (HHS) — posted the first version of the actuarial value calculator in 2012, then proposed a 2015 update last year.

Commenters said they wanted CMS and HHS to keep the 2015 calculator as much like the 2014 calculator as possible, to hold down the number of plan changes insurers would have to make in 2015.

Given how minor most of the proposed 2015 changes were, CMS decided to scrap the idea of making the changes, officials say in the preamble to the final PPACA implementation regulations.

Because CMS has not adopted the proposed version of the 2015 calculator, just changing a few numbers in the 2014 calculator, the agency will not be addressing the comments on the 2015 calculator proposal.

“We will take them under consideration if we propose updates to the AV calculator in the future,” officials promise. 

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