CMS recently released a final rule with the goal of stabilizing Exchange markets for 2018. The agency also issued several significant guidance documents where CMS extended the deadlines for 2018 rate and Exchange qualified health plan application submissions, adopted a good faith compliance standard for 2018 and delegated additional plan certification responsibilities to states. While these steps may provide some comfort for issuers, the agency did not address the most significant areas of issuer concern when it comes to 2018 Exchange participation. Namely, the Final Rule and guidance documents do not resolve ongoing uncertainty regarding cost-sharing reduction funding, the enforcement of the individual mandate or ongoing efforts to repeal the Affordable Care Act.
CMS Aims to Stabilize Exchanges but Does Not Address Issuers’ Biggest Questions
Posted In Health and Welfare Plans
Tags: ACA, Affordable Care Act, AHCA, American Health Care Act, Centers for Medicare and Medicaid Services, CMS, cost-sharing reduction funding, CSR funding, exchanges, Federally-Facilitated Marketplace, FFM, Final Rule, good faith compliance standard, health plan issuers, Internal Revenue Service, market stabilization rule, Proposed Rule, QHP, QHP Application Review, QHP certification process, Qualified Health Plan, Trump Administration
Ankur J. GoelAnkur J. Goel represents health industry clients in significant compliance, False Claims Act, litigation and regulatory matters. Ankur works with a range of health industry clients. He represents health plans on issues arising under Medicare Advantage, Part D, and health insurance exchanges, as well as health care providers on a variety of complex enforcement, compliance, regulatory and litigation matters. Read Ankur Goel's full bio.
Jeremy EarlJeremy Earl focuses his practice on providing complex regulatory counseling and advice to a variety of health care organizations such as health insurers, health maintenance organizations, pharmacy benefit managers, health care providers and other industry stakeholders on federal and state regulatory matters. He also drafted and negotiated numerous value-based provider reimbursement agreements on behalf of managed care entities and health care providers such as accountable care organizations (ACOs), health systems and health insurers. Jeremy has been quoted in trade and national publications, including HealthPayer Intelligence, Modern Healthcare, Managed Care Executive, Business Insurance and Vox.com. Read Jeremy Earl's full bio.
Seth SchneerSeth Schneer advises clients on a wide range of health care matters, including compliance with the Affordable Care Act. Read Seth Schneer's full bio.
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