CMS releases proposed 2027 ACA Rules
CMS published its annual proposed Notice of Benefit and Payment Parameters that establishes rules that impact the 2027 individual and small group market. Wakely will be writing up a longer summary of the rule, here are a few key themes:
- Focus on lower gross premiums – CMS proposed a number of novel policies that would allow catastrophic and bronze plans to exceed the annual maximum out of pocket limit, with the goal of reducing gross premiums.
- Program Integrity Rule, Round 2 – Several policies that were previously in the Program that were are under court injunction (such as failure to reconcile) were reproposed.
- OBBBA Implementation – Provisions from the OBBBA that removed premium tax credits from certain legal immigrants were proposed to be codified in the rule
- Cost Sharing Reductions (CSRs) – CMS proposed a number of new reporting requirements on issuers as a part of this 2027 filings in regard to cost-sharing reductions. Issuers will have to include estimates of what 2025 CSR payments would have been and additional details on how they arrived at their CSR load factor.
Overall, the proposed rule is expected to reduce Marketplace enrollment by 1.2 to 2.0 million enrollees. Comments are due March 11, and a final rule is expected in late Spring.
Public Health Cuts
Four states (California, Colorado, Illinois, and Minnesota) sued the Trump Administration for cutting $600 million in public health funding. The grants were to be used for public health emergencies, disease outbreaks, and other surveillance programs.
TrumpRx Launches
The Trump Administration launched a new website that provides coupon cards that can be used at participating pharmacies for direct-to-consumer purchasing (i.e., designed to be used outside of insurance).
Vaccines
The FDA director refused to fil (rejected) an application by Moderna for a new mRNA flu vaccine. It is rare for the FDA to refuse to file an application although comes in an environment where HHS/FDA have put increased scrutiny on vaccines.
