CMS Releases New Enrollment Manual for Issuers

CMS released an updated enrollment manual for Qualified Health Plan issuers in states that rely on HealthCare.gov for eligibility and enrollment functionality. The manual largely assembles previously posted operational and policy guidance on enrollment transactions, direct enrollment, special enrollment periods, premiums, terminations, retroactivity, reinstatements, and enrollment reconciliation. Any new guidance in the manual supersedes all previous CMS enrollment bulletins and is effective immediately. A chapter-by-chapter summary of the manual can be found at the Health Affairs Blog.

Issuers to Receive Fraction of Requested Risk Corridors Payments for 2014

CMS announced that Qualified Health Plan issuers will receive $362 million of the requested $2.9 billion in risk corridors payments for 2014. Assuming full collection of risk corridors charges, issuers across the board will therefore receive 12.6% of their requested payments. CMS will begin collecting the risk corridor payments, meant to help provide protection against claims uncertainty for the first three years of the Marketplace program, in November 2015 and paying issuers starting December 2015.

Nevada: Insurance Division Petitions to Operate Health CO-OP During Closing Months

Nevada's Division of Insurance filed a petition to place Nevada Health CO-OP into a “conservation-rehabilitation receivership” (that is, to gain control of the CO-OP’s assets, distribution of funds and administration) due to concerns that the CO-OP’s financial position is unsound. The CO-OP announced in August that it would close at the end of 2015 due to financial difficulties; however, after reviewing the CO-OP's proposed wind down plan, Acting Insurance Commissioner Amy Parks said the CO-OP required greater State oversight to ensure it can continue paying claims and providing services to its members through December 2015. Parks confirmed that, despite the petition, CO-OP members can continue to access their plan benefits through the end of the year.