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Trump's Team Schedules ACA Framework Review

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A new regulatory review could give the Trump administration a chance to start making big changes to Affordable Care Act-related health insurance rules and programs for 2019.

The Centers for Medicare and Medicaid Services has put an ACA framework review project in a new federal government to-do list.

The U.S. Department of Health and Human Services included the ACA framework review project in its new semiannual regulatory agenda. HHS is preparing to publish the agenda in the Federal Register on Thursday, alongside similar documents from other federal departments.

(Related: Obama Administration Adjusts ACA Exchange Program for 2018)

HHS has listed the ACA framework project as agenda item 117.

Item 117 calls for CMS to conduct a “Section 610 review” of the Calendar Year 2019 Notice of Benefit and Payment Parameters sometime in September 2017.

CMS officials could use the review to start efforts to change the ACA rules governing small health insurance agencies, small physician practices, small employers and other small companies and small nonprofit organizations.


The ACA exchange system opened for business in October 2013, and most of the ACA rules that affect commercial health insurance underwriting and benefits, such as the preventive services coverage mandate, took effect in January 2014.

CMS explains how the commercial health insurance rules and programs will really work in a given year in the parameters notices. The agency began developing the first parameters notice, for 2014, in 2012.

Section 603 of the Regulatory Flexibility Act requires an agency to analyze how a proposed regulation might affect small entities in the future.

Section 610 of the act requires an agency to analyze the impact of a regulation within 10 years after the regulation being completed.

Calendar (Image: Thinkstock)

(Image: Thinkstock)

Under the administration of former President Barack Obama, federal regulators stated in the regulatory agenda entry for the 2015 parameters notice project that it was not sure whether it had to conduct a small entity impact analysis of the notice.

For the other parameters notices, for 2014, 2016, 2017 and 2018, officials said conducting a detailed small entity impact analysis was unnecessary.

For the 2018 notice, for example, HHS and CMS officials said in a preamble that they did not have to conduct a detailed impact analysis.

Officials said they had predicted in the proposed version of the notice that the notice would have a significant effect on only a small number of entities. No one filed any comments objecting to that determination, officials said.

What Will the Review Do?

HHS conducts Section 610 reviews under every administration. A year ago, for example, under the administration of former President Barack Obama, HHS was planning to start a total of nine Section 610 reviews. The new regulatory agenda shows HHS is planning to start just five 610 reviews.

The parameters notice Section 610 review is the only ACA-related item on the HHS regulatory agenda.

A year ago, Obama’s HHS also had one ACA item on the to-do list: an effort to complete work on an ACA nondiscrimination regulation.

Lindsey Murtagh, the review agenda item contact person, joined CMS in 2015, during the Obama administration. That could a sign that the scope of the review, and the resulting changes, could be modest.

But Seema Verma, Trump’s CMS administrator, ran a company that trained the ACA public exchange navigators in Indiana, and she has already made significant changes in the ACA parameters for 2018.

One of her first moves, for example, was to change the 2018 open enrollment deadline to Dec. 15, from Jan. 31, in an effort to give consumers more of an incentive to pay for coverage all year round, rather than only when they expect to get sick.

— Read CMS Officially Shortens 2018 Individual Health Enrollment Period on ThinkAdvisor.

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