CMS Final Rule Shortens 2018 Enrollment Period in Effort to Stabilize Insurance Markets
The Centers for Medicare and Medicaid Services (CMS) last month issued a final rule to increase choices and encourage stability in the Affordable Care Act health insurance market for 2018. For psychiatrists and their patients, among the most important aspects of the rule—which is designed to address market instability created by departures of insurance companies from the health care exchanges—is the abbreviated enrollment period for 2018. Under the rule, the annual open enrollment period for 2018 will more closely align with Medicare and the private market; it will begin on November 1 and end on December 15.
The change is designed to encourage individuals to enroll in coverage prior to the beginning of the year. CMS believes the proposed change will “improve individual market risk pools by reducing opportunities for adverse selection by those who learn they will need medical services in late December and January and will encourage healthier individuals who might have previously enrolled in partial year coverage after December 15 to instead enroll in coverage for the full year.”
According to CMS, the final rule also does the following:
Requires individuals to submit supporting documentation for special enrollment periods to ensure that only those who are eligible are able to enroll. The rule is designed to encourage individuals to stay enrolled in coverage all year, reducing gaps in coverage and resulting in fewer individual mandate penalties.
Allows issuers to require individuals to pay back past due premiums before enrolling in a plan with the same issuer for the next year.
Allows issuers additional actuarial value flexibility to develop more choices with lower premium options for consumers and to continue offering existing plans.
Allows states oversight of “network adequacy” in exchange plans—that is, determining if plans have enough providers to ensure real access to care.
The CMS final rule can be accessed here. APA members seeking more information about how the final rule on market stabilization may affect their patients and their practice may contact Michelle Dirst at [email protected]. ■
