The Centers for Medicare & Medicaid Services focuses more on creating a line of easy-to-compare health insurance products in a major new batch of draft insurance rules, and punishing rogue agents and brokers, then on offering insurers new reasons to put plans on exchange shelves.
CMS, an arm of the U.S. Department of Health and Human Services (HHS), has included the standard options plan proposal, new producer disciplinary provisions, and many tweaks to PPACA exchange system rules and commercial health insurance rules in a 381-page PDF file, “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017.”
CMS is preparing to publish the draft regulations in the Federal Register Dec. 2. Comments will be due Dec. 21.
The contacts listed include Melissa Jaffe, for risk corridors matters, Lisa Cuozzo, for the rate review process; Jennifer Stolbach, for state-based exchange matters; and Briana Levine, for matters related to agents and brokers.
What’s in there for insurers?
Executives at UnitedHealth Group Inc. (NYSE:UNH) pointed out Thursday that they are seeing people with health problems acting as “free riders,” and enrolling in exchange coverage, through the special enrollment period (SEP) process, only when they are sick. On page 163 of the PDF, CMS suggests that it might rewrite the SEP rules to let an exchange cancel fraudulent enrollments retroactively.
CMS has also proposed making complicated changes to the PPACA “three R’s” risk management program reporting procedures that might have mixed effects on insurers.
Some insurers and others have complained about the PPACA individual major medical open enrollment period overlapping with the Medicare plan open enrollment period.
CMS officials have proposed having the open enrollment period for 2017 coverage run from Nov. 1, 2016, through Jan. 31, 2017, and continue to overlap with the Medicare open enrollment, because, they say, that may help some consumers switch between major medical coverage and Medicare coverage. (Page 162)
CMS has suggested that the 2017 out-of-pocket maximum might be $7,150 for an individual and $14,300 for a family. (Page 171)
See also: States gear up for the PPACA reboot year