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5 Warm Fuzzies CMS Is Sending to State Insurance Regulators

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President Donald Trump’s version of the Center for Consumer Information and Insurance Oversight is promising state health insurance regulators that it will try to be nicer to them than former President Barack Obama’s CCIIO was.

CCIIO is the unit at the Centers for Medicare & Medicaid Services directly in charge of the Affordable Care Act rules and programs that affect commercial health insurance. The talked about some of the ways it will try to be easier on state regulators’ nerves late last week, in a new batch of guidance. The guidance came out around the same time as a major new set of final individual major medical insurance enrollment regulations for 2018.

(Related: CMS Officially Shortens 2018 Individual Health Enrollment Period)

CMS is part of the U.S. Department of Health and Human Services. The Senate has confirmed Dr. Tom Price as HHS secretary, and Seema Verma, a former Indiana health program builder, as CMS administrator. CCIIO still has an acting director, Jeff Wu, who has been held over from the days of the Obama administration.

CCIIO did not put any officials’ names on the new batch of guidance, but officials took pains to emphasize their interest in changing course.

“The agency is committed to returning to states their traditional authority to regulate health plans,” CCIIO says in the first sentence of the guidance. “We seek to ensure that policies empower states to make decisions that work best for their markets, understanding there are differences from state to state.”

The agency also talks about five specific areas in which its parent, CMS, will try to be more flexible.

Grades (Image: Thinkstock)

Here’s a look at how CCIIO hopes to give state officials more room to maneuver, even if Congress is slow to change ACA rules.

1. CMS will trust states to certify exchange plans.

In the past, CMS let states handle some activities related to review of adequacy of the health plans offered through the HHS exchange enrollment and account administration system.

In the future, CMS will rely heavily on state plan certification reviews, and, even if a state has not agreed to cooperate with enough to have the official authority to review exchange plans, CMS will trust that state’s regulators to handle some review activities.

2. CMS will ask the states whether an issuer is licensed.

In the past, CMS looked into whether issuers were really licensed and in good standing.

For plan years 2018 and later, CMS will trust the states to tell it whether issuers are licensed and in good standing.

“We expect this will reduce burden on issuers and promote deference to states’ historical role in these areas,” CCIIO says.

3. CMS will let states decide whether exchange plans have adequate provider networks.

Some states have already been handling that job, but CMS will let all states handle network reviews for 2018, CCIIO says.

If a state lacks the means to conduct the reviews, CMS will assume that an issuer accredited by a major accreditation entity has an adequate network, CCIIO says.

CMS will review a network only if a state cannot review the network and the issuer is not accredited.

4. CMS will let states analyze their own exchange plans’ service areas.

CCIIO says state officials are clearly better positioned to analyze service areas than officials in Washington are.

5. CMS will let states analyze their own exchange plans covered drug lists and cost-sharing rules.

If a state already has approval to manage its exchange plans, it can analyze the plans’ formularies, CCIIO says.

In states that are not approved for plan oversight, CCIIO will still analyze the formularies, the agency says.

— Read ACA definitions: Federal executive branch agencies on ThinkAdvisor.