The Obama administration is starting to set the rules for how HealthCare.gov and other Affordable Care Act programs and rules might work in 2018.
The Centers for Medicare & Medicaid Services, an arm of the U.S. Department of Health and Human Services, already is gearing up to open the fourth ACA individual major medical coverage open enrollment period, which is set to start Nov. 1 and run until Jan. 31, 2017.
Related: CMS posts 2017 PPACA World rules
Even if Donald Trump wins the presidential election Nov. 8 and enters the White House with strong majorities in both the House and the Senate in January, he might have trouble making big changes in ACA programs until 2018.
A President Trump, or a President Hillary Clinton, probably could play a big role in shaping how ACA programs work, or disappear, in 2018.
But CMS is preparing for the possibility that the ACA system will work roughly the same way in 2018 that it works now. The agency is on track to publish a draft of a key ACA system framework document, Benefit and Payment Parameters for 2018, in the Federal Register Sept. 6.
An early version of the framework draft is already available here.
Comments will be due 30 days after the publication date.
CMS runs HealthCare.gov, an ACA enrollment and administration system that provides ACA exchange services that are unwilling or unable to provide the services themselves. CMS also oversees the ACA exchange programs operated by states, and it enforces ACA underwriting and coverage standards rules that apply to the commercial health coverage market.
Many of the provisions apply mainly to the managers of the ACA public exchanges and to major medical coverage issuers.
CMS has proposed, for example, that the fee HealthCare.gov charges plan issuers should stay at 3.5 percent in 2018. The issuer user fee has been set at 3.5 percent since the exchange system opened for business in 2014.
CMS has also sketched out changes in the ACA risk-adjustment program, a program that’s supposed to use cash from issuers that end up with low-risk enrollees to help issuers with high-risk scores. CMS uses information from the issuers to give each enrollee a risk score. Part of the parameters document fleshes out a previously announced system for auditing the enrollee health information that issuers send to the risk-adjustment program administrators.
CMS says it expects total risk-adjustment program user fee revenue to total $35 million in 2018, the same as in 2017. But growth in the number of health plan enrollees covered by the program could reduce the per-user cost of the program to $1.32 per enrollee per year in 2018, from $1.56 per enrollee per year in 2017.
Some proposed provisions could have a direct effect on retail agents, the Web brokers that connect directly with HealthCare.gov systems, or on both retail agents and Web brokers.
Related: Health insurers choose their pipes
Some producers may ask whether any agents or brokers will bother to try to do business with HealthCare.gov in the future, given all of the problems insurers and producers have reported having with the program this year. But a CMS agent registration database shows that, as of Tuesday, the agency had already registered 17,423 agents for the individual market, and 4,277 agents for the Small Business Health Options Program market.
For a look at some of the provisions that could affect agents and Web brokers, read on:
An agent’s exchange plan sales site should be different from this, except when it should be the same. (Image: CMS)
1. Producers’ exchange plan sites should be like HealthCare.gov, and not like HealthCare.gov.
HealthCare.gov managers want to stop agents or brokers that enroll people directly in exchange coverage themselves from using marketing names, Web addresses or design practices that could make consumers think they are using HealthCare.gov.