States gain marketplace flexibility with 2019 Payment Notice final rule
CMS released the Notice of Benefit and Payment Parameters for 2019 final rule April 9 to give states additional flexibility when choosing benefits in essential health benefit (EHB) benchmark plans offered under health insurance marketplaces.
In the past, states were required to include 10 specific EHB options. They will now have 50 to choose from. States will be able to create their own set of benefits that could form their own EHB benchmark plan.
The final rule includes an amendment to the risk adjustment data validation program and recalibrates the program for the 2019 benefit year so that it includes new data that accurately reflects the experiences of individual and small group market enrollees. CMS will permit states where HHS operates the risk adjustment program to request up to a 50% a reduction in risk adjustment transfers for individual, small group, and merged markets. To further strengthen program integrity, the final rule requires exchanges to implement stronger checks for verifying applicant income eligibility.
CMS will have special enrollment periods (SEP) for dependents who are newly enrolling in exchange coverage and are to be added to the application of a current enrollee. CMS amended start date options for SEPs for dependents enrolling because of birth, adoption, foster care placement, or court order. The final rule qualifies pregnant women receiving coverage through the Children’s Health Insurance Program for a loss-of-coverage SEP.
The final rule reduces quality improvement activity reporting burdens on insurers and permits states to request adjustments to the medical loss ratio for their market if the state can prove a lower medical loss ratio would stabilize its insurance market.
The final rule will allow the Small Business Health Options Program Exchanges to eliminate their online enrollment process to allow employers to directly enroll employees through a registered Exchange broker, agent, or issuer. The rule also increases the role of state regulators in the rate review process.