State-Based Marketplaces Self-Sustainable, According to CMS Official

The Acting Administrator for CMS, Andy Slavitt, testified before the United States House Committee on Energy and Commerce that all State-based Marketplaces (SBMs) have sufficient funding sources to be self-sustaining, reports Bloomberg News. As of 2015, SBMs could no longer rely on establishment funding, also known as 1311 grants, for continued operation and were required by law to be self-sustainable. Slavitt defended CMS's processes for distributing the grant funding, testifying that CMS conducted close reviews of SBM expenditures and that the agency has denied the use of federal funds 69 times this year and recouped more than $200 million from SBMs for using establishment funding inappropriately on operating expenses.

CMS Announces Automated Payment Process for Federally-Facilitated Marketplace Insurers

Beginning in January 2016, CMS will implement an automated payment system that will enable Federally-facilitated Marketplace (FFM) issuers to receive advanced payments that were previously remitted through a manual process. While the manual process required FFM issuers to self-report enrollment and payment amounts, the new system will use data from the FFM to determine the appropriate payment amounts. Insurers will undergo a readiness evaluation before beginning to receive the automated payments and those deemed not ready will have 25% of their payments withheld through June and 50% of payments withheld beginning in July.

Maine: Co-op Freezing Enrollment Beginning January 1, 2016

Community Health Options (CHO), the only profitable ACA co-op, announced that it will freeze enrollment in individual plans starting January 1, 2016. Current CHO enrollees will still be able to renew coverage for 2016, and CHO, which has over 80% of the State's Marketplace enrollment, will continue to accept new enrollments through December 26. CHO has not frozen enrollment in its small group plans, which will remain on the Marketplace. According to the Bureau of Insurance, the co-op experienced substantial losses in the third quarter due to higher than expected enrollment and claims.