The Centers for Medicare & Medicaid Services has published a final rule intended to help improve the risk pool and stabilize the Affordable Care Act (ACA) Insurance Exchanges for 2018 – even as CMS contends that consumers “have faced double-digit premium increases, fewer plans to choose from, and a market that continues to be threatened by insurance issuer exits.” Major provisions of the final rule will:

  • End the 2018 open enrollment period for the individual market on December 15, 2017 (instead of January 31, 2018) to require individuals to sign up for coverage before the beginning of the plan year (unless they are eligible for a special enrollment period);
  • Expand pre-enrollment verification of eligibility to all new consumers who seek to enroll through special enrollment periods to address “concerns from issuers about potential misuse and abuse of special enrollment periods,” and make other revisions to special enrollment period regulations;
  • Allow issuers to collect unpaid premiums prior to reenrolling an individual in the next year’s plan;
  • Increase the de minimis variation in the actuarial values used to determine levels of coverage; and
  • Revise the network adequacy review process and lower the minimum essential community provider (ECP) threshold from 30 percent to 20 percent of the available ECPs in a plan’s service area.

Additional announcements regarding the process issuers must follow for the 2018 plan year are posted on the CMS website.