CMS Releases Draft 2017 Federal Marketplace Issuer Letter

CMS released a draft 2017 letter to qualified health plan (QHP) issuers on the Federally-facilitated Marketplace (FFM) proposing network adequacy standards, including time and distance standards for certain provider or facility types based on population density. FFM states could apply their own standards if they use a "quantifiable metric" that is acceptable to CMS. The letter also discusses how a network breadth rating would be determined and displayed on HealthCare.gov. The letter provides additional information for QHP issuers on formulary reviews, benefit and plan designs, data requirements, and meaningful difference. Comments on the letter's proposed guidance will be accepted through January 17.

OIG Finds CMS Did Not Effectively Monitor Tax Credit Payments to Issuers

The HHS Office of Inspector General (OIG) released a report finding that CMS did not effectively ensure advance payments of the premium tax credit (APTC) were provided only to qualified health plan (QHP) issuers for enrollees who had paid their monthly premiums. CMS's process required relying on QHP issuers to verify that enrollees paid their premiums and attest that APTC payment information reported to CMS was accurate. The report recommends that CMS establish procedures to calculate APTC payments that do not rely on issuers' attestations, and that CMS consult with the IRS on sharing APTC payment data throughout the year. CMS agreed with the first recommendation and, as of October 2015, announced it is pilot-testing an automated policy-based payment process with issuers.

Kentucky: Governor Alerts Secretary of Plan to Transition to Federal Marketplace

In a letter to HHS Secretary Burwell, Governor Matt Bevin (R) formally announced his plan to transition kynect, Kentucky's State-based Marketplace, to HealthCare.gov thereby fulfilling a campaign promise. Many advocates quickly voiced their disappointment, citing kynect's accessibility and ease of use. According to the Courier-Journal, Governor Bevin indicated that the State would make the transition "as soon as is practicable." Kynect will remain functional until the transition takes place.

New York: First-of-Its-Kind Law Permits Year-Round Marketplace Enrollment for Eligible Pregnant Women

Governor Andrew Cuomo (D) signed legislation making New York the first state to designate pregnancy as a qualifying life event, thereby allowing eligible pregnant women to enroll in coverage through the Marketplace, New York State of Health, outside of the annual open enrollment period. Previously, pregnant women who were eligible for Marketplace insurance had to wait until the annual open enrollment period or the birth of their baby to enroll in coverage.