Brief

Final ACA regulations tighten enrollment window, loosen coverage requirements

Dive Brief:

  • The CMS issued final regulations for the Affordable Care Act market stabiization just before the holiday weekend. The rule included several changes the previous administration had resisted which are meant to shore up the individual market.
  • The regulations shorten the open enrollment period for 2018 and tighten restrictions for signing up during special enrollment periods.
  • They also drop the requirement for all policies to have an actuarial value of at least 60%, allow states to enforce their own network adequacy standards and decrease the percentage of essential community providers that insurers must include in their networks.

Dive Insight:

With the Republican effort to repeal the ACA currently stopped in its tracks as far as anyone can tell, President Donald Trump’s administration now turns to altering the law however it can to better reflect conservative healthcare policies.

Insurers mostly praised the changes, and Marilyn Tavenner, CEO of America's Health Insurance Plans said in a statement they will “improve the functioning of the individual market” and provide “greater flexibility in product and benefit design, and simplified administrative processes.”

Patient advocate groups, however, said they are concerned the new regulations will make it harder for people to get coverage and shift more costs to patients.

“Despite loud protests by the thousands who submitted comments and others around the country concerned about what this will do to the marketplace, the Trump Administration is moving forward with changes that will knowingly make it more difficult for consumers to obtain affordable coverage and care,” Families USA experts said in a statement.

The regulations aren’t likely to calm concern that the individual market is unstable, particularly since they don’t address whether the administration will continue to enforce the individual mandate or whether payers will continue to receive cost-sharing subsidy payments.

American Medical Association President Andrew W. Gurman issued a statement on Thursday: “While we agree steps must be taken promptly to stabilize the individual insurance market, the American Medical Association believes the regulations issued by the Centers for Medicare & Medicaid Services on Thursday still need to address the resulting inequity of the ACA’s grace period, which allows issuers to collect unpaid premiums for months in which health care services were provided but not actually covered by insurance. Moreover, we believe reducing the open enrollment period to six weeks will not provide enough time for consumers to enroll, and we are concerned that moving oversight of network adequacy completely to the states will not provide sufficient protection for physicians and their patients.”

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Filed Under: Health Law Policy & Regulation
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