Obama administration adjusts ACA exchange program for 2018

If the Trump administration sticks to the current Affordable Care Act exchange system framework, applications from would-be 2018 HealthCare.gov issuers could arrive from April 5 through May 3.

Proposed 2018 health plan rates could hit the web Aug. 1.

Open enrollment for 2018 coverage run from Nov. 1, and last until Jan. 31, 2018.

Seema Verma, the Trump administration’s pick to be the next Centers for Medicare & Medicaid Services (CMS) administrator, might oversee efforts in March to let health insurers know how much they should expect to get from or pay into the ACA risk-adjustment program for 2016.

The officials now running CMS have put those dates on a list of key HealthCare.gov and Affordable Care Act commercial health insurance regulation dates for 2017. The date list is part of a new packet of documents showing how CMS expects HealthCare.gov, the ACA exchange plan rate review system, and the ACA insurer risk management programs to work in the coming year.

Related: 3 darts for agents in the new ACA 2018 draft rules

In addition to releasing the key date list, CMS officials have posted a letter to would-be 2018 HealthCare.gov plan issuers, and final version of the Notice of Benefit and Payment Parameters for 2018.

The new ACA parameters regulation shows how CMS expects to adjust ACA rules and benchmark numbers in 2018. For 2018, for example, CMS expects to charge exchange plan issuers a user fee equal to 3.5 percent of premiums in states that rely solely on HealthCare.gov to handle ACA exchange plan enrollment, marketing and account administration services.

In states that help with marketing but use the HealthCare.gov enrollment system, CMS will charge a 3 percent user fee, according to the ACA package.

In the packet, CMS also has:

• Started creating an independent compliance and data security audit vendor program for agents and brokers that enroll consumers directly in HealthCare.gov plans.

• Fleshed out the rules for validating the enrollee health score data health insurers feed into the ACA risk-adjusting program. The program is supposed to shift cash from insurers with higher-risk enrollees to issuers with lower-risk enrollees. Regulators have decided, for example, that issuers with more than $15 million in premiums should have their risk score data validated every year. Smaller issuers would go through a random audit target selection process.

• Tightened the rules for special enrollment period applicants, or applicants who apply outside the ordinary open enrollment period.

Special enrollments

The ACA now blocks insurers from using health-related information other than location when deciding whether to sell coverage to an applicant, and it blocks them from using health information other than location, age and tobacco use when deciding how much the coverage should cost.

Insurers, regulators and exchange managers came up with the open enrollment system to try to keep people from waiting until they get sick to apply for coverage. The system puts limits on when people can apply for coverage without showing they have what the government sees as a good excuse,