CMS has released its final rule updating policies applying to qualified health plans (QHPs) offered on Affordable Care Act (ACA) Exchanges for 2019.  In the final rule, CMS stresses its goal of providing states greater flexibility and control over their insurance markets, particularly in the areas of: selection of essential health benefits benchmark plans; the operation and establishment of Exchanges, including Small Business Health Options Program Exchanges; rate review requirements; the process for receiving adjustments to the individual market medical loss ratio standard; and certification of qualified health plans (QHPs). The rule also finalizes policies pertaining to, among other things:  risk adjustment and risk adjustment data validation programs; cost-sharing parameters; user fees; special enrollment periods; and program integrity safeguards.  The final rule is scheduled to be published on April 17, 2018. 

In related news, CMS also released:

  • The 2019 Letter to Issuers in the Federally-facilitated Exchanges (FFE), which provides operational and technical guidance to issuers seeking to offer QHPs in the FFE for plan years beginning in 2019.
  • Guidance expanding eligibility for the shared responsibility payment hardship exemption to individuals living in counties with no issuers or only one issuer, counties where all plans include abortion as a benefit contrary to one’s belief, or because of the need for specialty care.
  • A bulletin extending for an additional year a current transitional policy for non-grandfathered coverage in the small group and individual health insurance markets.