On Thursday, CMS released the proposed 2020 Notice of Benefit and Payment Parameters (NBPP) and draft letter to issuers. The 331-page proposed regulation and 22-page draft letter are issued annually and establish requirements for the individual and small-business marketplaces. Among the proposed changes are reducing the marketplace user fee, prescription drug incentives, and navigator roles. The administration is also seeking feedback on, in future years, ending the practice of auto re-enrollment into marketplace plans, as well as how to resolve the issue of “silver loading” – a practice employed by insurers in response to the Trump Administration’s decision in 2017 to no longer fund the ACA’s cost-sharing reduction payments. Comments on the proposal are due by February 19 with a final rule expected by early spring. NAHU will submit a detailed comment letter on behalf of all members of the association.
The proposed rule’s release was delayed due to the ongoing partial government shutdown, which could stall its finalization depending on when the federal government resumes normal funded operations. This could also complicate the ability of insurers to adequately prepare for the upcoming plan year without timely information to act on marketplace operations. NAHU is closely monitoring ongoing negotiations over appropriations as it relates to the ability for federal agencies to release timely rulemaking and is urging Congress and the administration to come to an agreement to prevent additional market instability.
In addition to the NBPP and letter to issuers, CMS also released the 2019 Rate Review Timeline Bulletin, Proposed Key Dates for Calendar Year 2019 (including QHP Certification, rate review and risk adjustment), and the 2020 Actuarial Value Calculator and Methodology.
Major proposed changes include:
Auto Re-Enrollment: Administration seeks feedback on automatic re-enrollment processes and capabilities on ways to reduce eligibility errors and potential government misspending for future rulemaking to be effective no sooner than 2021.
Silver-Loading/Silver-Switching: Administration seeks a legislative solution to restore CSR funds that were halted by the administration in 2017. They further request comment on ways to address this practice in future rulemaking to be effective no sooner than 2021.
Exchange User Fee: The fee would be reduced from 3.5% to 3% for plans sold through healthcare.gov, and from 3% to 2.5% for plans sold on state-based exchanges.
Cost-sharing: The limit for self-only coverage cost sharing would increase from $7,900 to $8,200, while the limit for family coverage would increase from $15,800 to $16,400. Pharmaceutical manufacturer coupons would not be counted towards annual cost-sharing limits if medically appropriate generic is available.
Prescription Drugs: Allow issuers to adopt mid-year formulary changes to incentivize greater enrollee use of lower-cost generic drugs.
Tax Credit Indexing: Transition to using private premiums per enrollee instead of employer-sponsored premiums per enrollee for “premium growth.” This would result in an index factor increase of roughly 2.5%, with a projected net savings of $900 million in federal tax credits and 100,000 fewer marketplace enrollees.
Navigators/Assistors: Authorizes navigators to provide post-enrollment outreach, assist consumers with web-brokers, and revises the training requirements.
Special Enrollment Periods: Establish a new SEP for individuals enrolled off-marketplace who become eligible for advance premium tax credits due to a decrease in household income.
Web-Brokers: Specifically define “web-brokers” in order to clarify general references in the rules to web-brokers, agents, and brokers, as well as adding “direct enrollment technology providers” as a type of web-broker. Restrict websites from recommending certain QHPs based on compensation. Increase regulations and oversight of web-brokers to ensure exchange program integrity. |
