Stakeholders received insight on the Obama administration’s expected approach to the certification and oversight of qualified health plans (“QHPs”) late Friday, December 19, 2014, with the release by the Centers for Medicare & Medicaid Services (“CMS”) of its Draft 2016 Letter to Issuers in the Federally-facilitated Marketplaces (“Draft Letter”). This annual release comes more than a month earlier than the release of the 2015 version of this document.
While the Draft Letter largely mirrors the provisions of its 2015 predecessor, or restates earlier proposals, CMS does include several significant changes in approach for the 2016 application cycle. These changes include the use of an earlier timeline for application submission, review, and approval, as well as a more extensive review of benefit offerings for compliance with non-discrimination requirements.
That same day, the administration, through the Departments of Health and Human Services, Labor and Treasury (collectively, “Departments”) released a proposed amendment to expand federal regulations on excepted benefits to exempt wraparound coverage offered by group health plans from specific Affordable Care Act market-wide health insurance reform requirements (“Proposed Rule”).
The Draft Letter speaks specifically to issuers seeking to offer QHPs in the individual and small group markets through the Federally-facilitated Marketplaces. However, issuers seeking to offer coverage in State-based Marketplaces and outside the Marketplace should also closely review this guidance for insights into CMS’s perspective on market-wide provisions discussed in the context of QHPs. The Proposed Rule addresses small and large employer group health insurance offerings.
CMS is accepting comments on the Draft Letter through January 12, 2015. The Departments are accepting comments on the Proposed Rule through January 22, 2015.