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Regulation and Compliance > State Regulation

For, 2017 menu season starts April 11

Your article was successfully shared with the contacts you provided. managers are getting ready to find out what plans will be on each state’s menu for the 2017 open enrollment period.

The Centers for Medicare & Medicaid Services (CMS), the agency in charge of, has set the qualified health plan (QHP) application period to run from April 11 through May 11. CMS hopes to lock in the information it needs to fill the enrollment system’s health plan database by Aug. 23.

That schedule applies directly only to the states that use the system. States with their own locally run Patient Protection and Affordable Care Act (PPACA) exchange programs can use different QHP review schedules.

The QHP application period for 2015 ran from April 15 through May 15.

CMS also oversees a PPACA rate review program for non-grandfathered individual and small-group major medical plans. An issuer is supposed to file justifications for any 2017 rate increases of 10 percent a more.

State insurance regulators review rates in some states. CMS reviews rates in others.

In the CMS review states, issuers’ preliminary justifications for double-digit rate increases are due May 11. CMS plans to post the justifications online on May 25. Final rates and justifications are supposed to be in CMS systems by Aug. 23.

A state with its own state-based rate review system may set a different rate review schedule.

Observers are watching closely to see how much interest health carriers have in doing business with the PPACA exchange system in 2017. CMS could give an early indication in the next few days, when it releases a preliminary count of the number of issuers that say they want to sell dental plans through for 2017. CMS posts the counts to help states administer a PPACA children’s dental benefits mandate.

A year ago, CMS reported that issuers wanted a total of 141 dental plan sales relationships in in 2016. That was up from an estimate of 127 for 2015, but it was down from an estimate of 183 for 2014.

CMS has also given insurers some information about the payments coming from PPACA risk management programs. The agency hopes to get some payments from a PPACA reinsurance program to insurers by April, and it’s hoping to get them some information about what they might get from or owe to the PPACA risk-adjustment program this month.

The reinsurance program is a temporary program that uses flat per-enrollee payments from most carriers to help pay the costs of individual and family coverage holders with catastrophic claims.

The risk-adjustment program is supposed to use cash from QHP issuers with low-risk enrollees to compensate issuers with high-risk enrollees.

See also:

PPACA risk programs: Will those kidneys work?

HHS exchanges attract more dental insurers


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