The Strange Making of the “Marketplace Stabilization Rule”

The Strange Making of the “Marketplace Stabilization Rule”
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On April 13 CMS published the agency's final “market stabilization” rule.  The proposed rule was summarized by THCB's editors on February 15, the day it was published, and on March 22 THCB published my essay in which I noted CMS provided no evidence any of the proposed reforms would actually stabilize the state marketplaces.  The final rule, ostensibly a carbon copy of the proposed, finalizes the six proposed changes without, again, providing any evidence these changes will stabilize the markets by increasing enrollment and issuer participation.

Briefly, the final rule will reduce the 2018 enrollment window from three months or to six weeks, or from November 1 to December 15.  The rule narrows the definition of guaranteed availability by allowing issuers to apply re-enrollment payments to outstanding debt.  The rule will require 100 percent verification for enrollees' attempting to acquire insurance during a Special Enrollment Period (SEP) and places other payment, eligibility and exceptional circumstances restrictions on SEP enrollment.  The rule finalizes an increase in de minimus variation from +/- 2 percent to -4/+2 percent except for bronze plans which increases to -4/+5 percent.  The rule will allow states to determine plan  network adequacy or make a determination using an issuer's accreditation status.  The rule finalizes a reduction from 30 to 20 percent of plan providers being defined as an Essential Community Provider (ECP).  For plans that cannot meet the 20 percent determination, CMS will allow for a narrative explanation.

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