CMS Issues Final Regulations for Insurers in ACA Marketplace

The CMS released final regulations for ACA marketplaces in 2018. The agency, last Friday, also issued the final letter to insurers regarding new provisions for participating in the exchanges. The regulations, according to the Hill, are designed to make the marketplace more appealing to insurers, after big name companies like Aetna and UnitedHealth Group pulled out recently. For instance they allow health plans to remain in the exchanges even if they shelve old products and introduce new ones. They also include a new method of risk adjustment, which insurers have complained does not presently shield them from financial loss because of high-cost enrollees.


“In sum, the Obama administration seems to have in one massive dump completed its regulatory agenda for implementing the health insurance title of the ACA,” writes Timothy Jost, JD, is an emeritus professor at the Washington and Lee University School of Law in the Health Affairs blog. Tellingly, the 465-page final regulations take effect January 17; President-elect Donald Trump’s inauguration is January 20.


Though the final regulations are not controversial, writes Jost, the Obama administration clearly saw the need for laying out regulations for 2018 before it leaves office, “rather than leaving the market to the vagaries and confusion of a presidential transition.” CMS shortened the time period for approval: from the usual 60 days to 30 days.


The Hill: “The action comes on the heels of the administration’s move to launch a pilot program to require documentation to make sure people signing up in ObamaCare’s extra signup periods actually qualify. Insurers have complained that sick people are driving up costs by gaming the system and signing up during these extra periods.”


Source: The Hill