April 13, 2018
CMS Releases Regulations: Many folks were waiting for the Payment Notice and other updates to help set rates and they were not disappointed. Wakely, in short order, will be releasing a full summary of the Payment Notice, Issuer Letter, and more but a few themes:
- State Flexibility – States were granted far more authority to reshape EHB and risk adjustment programs than they’ve ever had. It remains to be seen (and analysis on effects) but there could be even more divergence between states
- Program Integrity – CMS and Exchanges will conduct far more validation on individuals who are applying for subsidies. Given prior experiences with income verification this is likely to reduce to the number of people with APTC.
- Reduction Regulations – CMS also reduced a number of regulatory requirements for SHOP, Rate Review, and obtaining an exemption from the Individual Mandate in 2018 (yes it’s still on the books this year).
State Activity Watch
- Medicaid Expansion – Virginia appears poised to pass a Medicaid Expansion bill in the near future. Several lawmakers opposing the expansion have shifted positions in recent weeks. Virginia is currently in a special legislative session on the topic.
- State Individual Mandates- New Jersey’s state lawmakers are advancing a bill that would have an individual mandate in place for the 2019 benefit year. New Jersey is also considering a 1332 waiver/reinsurance program. Massachusetts already has a mandate in my place and the District of Columbia is actively considering one.
- All-Payer coming to California? California is considering a proposal that would give the state the authority to regulate prices that health insurance plans charge doctors. It would not set prices for Medicaid or Medicare plans but would cover commercial rates.
Research Watch
Wakely released analysis on the effects of short-term duration plans on the ACA individual market due to the potential regulatory change. You can read it here.