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PPACA World 2017: How it's supposed to work

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A key federal health insurance regulatory agency is forging ahead based on the assumption that insurers will continue to sell individual and small-group health insurance in 2017.

The agency, the Center for Consumer Information & Insurance Oversight (CCIIO), has celebrated the holidays by issuing a draft of the official letter to the insurers that will be issuing coverage through the public exchange enrollment system in 2017.

In the draft letter, CCIIO officials:

  • Say will not offer stand-alone vision products or other ancillary products in 2017.
  • Summarize new exchange agent and exchange broker compliance policies, which they announced in November. The gist is: They have concerns about producers misusing exchange users’ personal information and do not want producers to do that.
  • Echo the advice, given in a webinar held in November, that plan issuers can use reasonable means to pay commissions to agents and brokers even if the producers’ National Producer Numbers (NPNs) have somehow fallen out of enrollees’ application records.

CCIIO has also posted a preliminary list of key program dates for 2016 for insurers that will be selling plans through in 2017; for insurers that will be filing 2017 coverage rates in any of the states in which CCIIO oversees the health rate review process; and for the Patient Protection and Affordable Care Act (PPACA) risk adjustment and reinsurance programs.

The risk adjustment program pulls money from individual and small-group issuers with relatively low-risk enrollees and pushes the money to issuers with relatively high-risk enrollees. The reinsurance program, which is on track to expire after 2016, collects cash from all coverage issuers and uses the cash to cover part of the cost of insuring individual policyholders with catastrophic claims.

CCIIO says, for example, that it would like to get applications for 2017 qualified health plan (QHP) products by May 11.

The agency wants rate increase filings to be ready for consumer review by May 25, and it wants any rate filings that include QHPs to be in a final status by Aug. 23.

For the PPACA reinsurance program, CCIIO wants each insurer to make a contribution for the 2015 benefit year by Jan. 15. If an insurer decides to split its payment into two parts, instead of making one combined payment, the second payment will be due Nov. 15.

In another document, a memo from Samara Lorenz, director of the CCIIO oversight group, CCIIO has asked for comments from state insurance regulators about the proposed filing deadlines.

Lorenz says in the memo that CCIIO’s understanding is that regulators in some states had serious problems with the rate review program deadlines the agency set for the 2015 filing year, “due to state legislative or regulatory requirements and the time of negotiations with issuers.”

CCIIO wants to give states with state-based exchanges up until Aug. 31 to show rate filings to the public, and up until Nov. 1 to post final rate increases. States that want the additional rate review deadline flexibility should contact CCIIO’s parent agency, the Centers for Medicare & Medicaid Services (CMS), by April 11, Lorenz says.

See also:

Feds: HHS exchange agent who fibs could owe $250,000 fine

CMS updates exchange plan agent advice

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