Avalere Health
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Insights

Mar 18, 2014

CMS Releases Proposed Rule on Exchange and Insurance Market Standards for 2015 and Beyond

Published

Mar 18, 2014

On March 14, CMS released the Exchange and Insurance Market Standards for 2015 and Beyond proposed rule.

Generally, the rule includes provisions that were signaled in the 2015 Notice of Benefit and Payment Parameters final rule, including policies relating to health insurance discontinuation and renewal, quality reporting and enrollee satisfaction surveys, the Small Business Health Options Program (SHOP), adjustments to risk corridors and medical loss ratio (MLR) in light of transitional policies, and technical issues associated with 2014 open enrollment. The rule also proposes stronger standards for Navigators and other consumer assistance entities.

The proposed changes to the premium stabilization programs and MLR provisions should benefit health plans during this transitional period. In addition, HHS’ proposal to allow state regulators to request a delay in employee choice for 2015 should help stabilize risk pools in the small group market and encourage more issuers to participate in the SHOP. Health plans also may have more flexibility to make certain modifications without being considered to have discontinued coverage; therefore, plans may be able to comply with the guaranteed renewability requirement more easily. However, plans may view the associated proposed notice requirements as administratively burdensome.

The proposal to require plans to expedite the process to cover a non-formulary drug under certain circumstances will help ensure that consumers have timely access to certain prescription drugs. In addition, HHS’ proposal to heighten its quality standards is a step towards greater coverage transparency.

Comments on this proposed rule are due April 21. Comments on the Draft Notices When Discontinuing or Renewing a Product in the Group or Individual Market guidance are due April 18. HHS also intends to release technical guidance on a number of these provisions, including the proposed methodology for calculating quality ratings and details regarding measure specifications and data validation processes (expected sometime this year), ESS vendors, and details regarding the display of rating information and ESS results in marketing materials next year.

View CMS’ full proposed rule here.

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