CMS Report Finds No QHPs With CHIP-Comparable Coverage for Children

CMS has completed its review comparing benefits and cost sharing in qualified health plans (QHPs) to those offered through the Children's Health Insurance Program (CHIP), in an effort to certify any QHP with CHIP-comparable coverage. The Affordable Care Act requires the Secretary to certify QHPs with CHIP-comparable coverage in the event that a federal funding shortfall requires CHIP children to transition to the Marketplace. Based on the agency's findings, the Secretary did not certify any QHP as having CHIP-comparable coverage. To conduct its comparative analysis, CMS reviewed the benefit package for "child-specific services" and associated cost sharing for the second lowest cost silver plan (SLCSP) in the largest rating area in each state. The report concludes that while coverage of "core" benefits (such as physician and laboratory services) are similar between the two programs, "child-specific services" (such as dental and habilitation) and services for children with special health care needs are more comprehensive in CHIP. The report also found that the actuarial value of CHIP exceeds the actuarial value of the SLCSP in every state except Utah, where the two programs were equivalent. However, when premiums are included in total out-of-pocket spending estimates, Utah's QHP was more expensive than CHIP.

New Report Counters Dire Media Predictions for 2016 Marketplace Premiums

Average premiums for the lowest cost silver plan increased 4.3% from 2015 to 2016, according to a new report by the Urban Institute. The report found that the average premium of the lowest cost silver plan decreased in six states, increased by less than 5% in five states, increased 5%-10% in five states, and increased by more than 10% in four states. The states with the largest increases tended to be those with premiums below the 2015 national average of $264 per month. These modest increases counter early media reports anticipating double-digit premium rate increases for 2016 based on requested—not approved—rates. This report reviewed the final approved premiums for the three largest rating areas in 20 states and the District of Columbia.

States React to Proposed User Fee for Platform

Bruce Gilbert, executive director of Nevada's Silver State Health Insurance Exchange, said a proposed 3% user fee on issuers selling qualified health plans in a State-based Exchange on the federal platform (SBE-FP) may be too costly for the Exchange, leading it to seek services from a private sector contractor, according to Joel Ario of Manatt Health, a former insurance commissioner and CMS official, noted that the 3% fee was a surprise, higher than the mid-2% figure stakeholders had anticipated, and that the cost may deter states from using the federal platform. The director of Oregon's Exchange, also currently an SBE-FP, noted that it plans to consider other vendors and will issue a Request for Proposals in mid-December. The new rule was proposed in the Department of Health and Human Services' Notice of Benefit and Payment Parameters for 2017.

California: Marketplace to Highlight Select Vision Plans on Website

The Covered California board announced that the Marketplace will provide links from its website to select vision plan websites starting in 2016 in order to help consumers connect with and obtain vision coverage. While the Marketplace will not sell vision coverage directly, the new initiative will enable vision plans to sell standalone coverage to Marketplace consumers, including outside of open enrollment periods. The board released a Request for Proposals to evaluate and select vision plan partners for 2016, which will be announced during the week of December 21.