- CMS late Friday unveiled its proposed annual Notice of Benefit and Payment Parameters for 2017, governing participation in the ACA health insurance marketplaces.
- The proposed rule includes changes on a variety of proposals and improvements to the premium stabilization programs, including streamlining direct enrollment so customers can easily use websites of agents and brokers and keeping the federal marketplace user fee stable for 2017.
- The proposed rule seeks comments on proposals that will provide continued choice and competition for consumers as well as a vital health plan market. Comments will be until no longer than 5 p.m. on Dec. 2015.
To protect consumer access to healthcare providers and delivery organizations, the proposal asks states to establish a provider network adequacy standard for health plans in the federal marketplace, subject to minimum criteria that CMS will establish at a later date, with a default time and distance standard otherwise.
CMS is proposing to give issuers the choice of offering plans with standardized options such as cost-sharing. According to the agency, health plans would not be required to issue such plans and could continue to offer other plans with more variable plan designs, as well as the proposed optional standardized plans, so consumers can choose the plan that’s right for them.
The proposed rule would also increase options for employees in the federal Small Business Health Options Program (SHOP) for plan years beginning in 2017 and beyond. Under current regulations, employers participating in the federal SHOP Marketplace can offer their employees either one health plan and/or one dental plan, or all health and dental plans across one metal level (or actuarial value, for dental plans). Under the proposal, employers would be able to offer all plans across all levels of coverage from one insurance company.
The proposed rule additionally seeks comments on the child age rating curve to reflect risk more accurately and on the open enrollment period for 2018 and beyond.
Under the proposal the open enrollment period for 2017 would remain November 1 – January 31, the agency noted.