- CMS is proposing "periodic data matching standards" in Affordable Care Act exchanges to ensure premium subsidies aren't being paid to deceased or dual-eligible enrollees. The agency is also requiring states to notify the agency annually of any state-required benefits in which the ACA dictates states must cover certain costs.
- Also in the proposed benefit and payment parameters for 2021, which are rules that govern how health plans are offered on the federal and state ACA exchanges, CMS is seeking input on whether to reduce the user fees health plans are charged to participate in the state and federal exchanges. CMS claims such a reduction, if achievable, could be used to lower premiums.
- However, the agency is also seeking comments regarding a proposal requiring those low-income exchange enrollees who pay no premiums to revisit the exchange during open enrollment to assert they're entitled to the same level of subsidy the following calendar year.
CMS Administrator Seema Verma is examining ways to continue to put downward pressure on premiums for consumers. The agency is toying with the idea — and wants feedback on — reducing the user fee for the 2021 plan year. The agency believes any reduction on the fee will be passed on to consumers in the form of lower premiums.
Still, critics argue other proposed reporting requirements will put an undue burden on those who have the least expensive premiums.
The tightening of rules on premium subsidies suggests CMS wants people who are eligible for Medicare to keep that program for their sole coverage. That could subject them to tax bills for clawed back premium subsidies. Ditto for the estates of recently deceased exchange enrollees.
Yet CMS is also seeking input on reducing the user fee health plans pay to participate on the exchanges. It was cut last year from from 3.5% to 3% percent of premiums collected on the federal exchanges, and 3% to 2.5% on state-based exchanges.
"Savings from CMS' ongoing efforts to improve the efficiency of the exchanges using Healthcare.gov may make further reductions in the user fee possible and these reductions would be passed on to consumers through lower premiums," the agency claimed in a statement.
Back in the squeezing the consumer category, CMS also wants comments on a proposal that would require exchange enrollees who pay zero premiums due to obtaining high tax credits to have their eligibility redetermined during the open enrollment period, or potentially lose their credits or coverage.
Kaiser Family Foundation Vice President Cynthia Cox wrote on Twitter that proposal would be relevant for relatively small group of about 300,000 enrollees but said "the effect for them would be huge" in creating a new reporting burden for low-income people seeking coverage.
CMS also proposed extending one more year the availability of non-ACA compliant health plans. The extension would require the plans be within ACA compliance by the first day of 2022.