On June 28th, the Centers for Medicare and Medicaid Services (CMS) and the Treasury Department proposed a rule intending to expand access to health coverage and modernize the ACA Marketplaces.
Softheon supports all efforts aimed at increasing enrollments for groups with notably higher rates of uninsured or underinsured individuals.
The rule brings about the third installment of the Notice of Benefit and Payment Parameters (NBPP) for 2022 and differs from its predecessors in its efforts to reverse policies implemented during the Trump Administration and implement a range of new policies. For simplicity, Softheon refers to this new installment as NBPP Part III to accurately reflect how new policies build upon recent rulemaking processes initiated in Part I and Part II.
Proposed Expansion of Enrollment Periods
In efforts to expand access to coverage for all individuals on or interested in the Marketplace, NBPP Part III proposes extending the individual market open enrollment period starting with the 2022 benefit year. The newly suggested open enrollment period for the upcoming year would span from November 1st, 2021 to January 15th, 2022. This would permanently extend open enrollment to lengths similar to those during the early years of the ACA, giving consumers another month to enroll in health plans compared to the 2019 open enrollment period.
Enrolling in the Marketplaces with fewer date restrictions resulted in a successful 2021 COVID-19 Special Enrollment Period (SEP). More than 940,000 individuals signed up for health coverage on federal exchanges between February 15th and April 30th. This sharp increase in enrollments compared to the same time period in 2020 and 2019 signifies demand for increased availability of marketplace health plans.
NBPP Part III also proposes a monthly SEP for members with a household income at or below 150% of the federal poverty level. Low-income consumers could use the SEP to enroll in a platinum-like silver plan with minimal cost-sharing requirements.
This monthly SEP would enable millions of uninsured Americans to capitalize on the increased health coverage savings made available through the American Rescue Plan (ARP). Approximately 20% of the uninsured in the U.S. have income below 150% of the FPL. Those who had been unable to afford coverage may now be able to sign up for high quality coverage for free or at a greatly reduced cost due to the increased value of Advance Premium Tax Credits (APTC). This SEP would be particularly useful for individuals who lose Medicaid coverage during the redeterminations planned for the conclusion of the Public Health Emergency (PHE).
Increased User Support
The NBPP Part III seeks to revitalize the Navigator Program, reversing changes under the Trump Administration. The NBPP Part III aims to reduce health disparities by educating individuals at an increased risk of being provided misinformation. Specifically, it would reinstate requirements surrounding the enrollment information and assistance activities that FFM (Federally Facilitated Marketplace) Navigators must provide.
Under the NBBP Part III, Navigators would aid in:
- Filing an appeal of an eligibility determination;
- Applying for an exemption to the requirement of minimum essential coverage;
- Helping members gain the needed documentation for filing for and reconciling premium tax credits; and
- Increasing health care and insurance literacy.
To account for increased funding for Navigators, state transitions to SBMs (State Based Marketplaces), internal federal projections, and other factors, the NBPP Part III recommends an increase in user fees for both the FFM and SBM-FP states (which use the federal platform for eligibility and enrollment). User fees would rise to 2.75% for the FFE and to 2.25% of premiums for SBM-FPs, up from 2.25% and 1.75%, respectively. The increases are higher than those initiated in January but lower than those currently in effect for the 2021 plan year.
User fee reductions proposed in Part I were intended to lower premiums for consumers. The Part III proposed user fee rates still exhibit a net reduction while accommodating programs designed to increase the availability of coverage.
Clarification to Current Rules
One type of existing SEP allows consumers who gain APTC to enroll in an Exchange plan. This clarification provides guidance to those with new APTC eligibilities due to the ARP. Only those with a new eligibility determination providing APTC of more than $0 will be eligible for this SEP.
Another provision of the Part III rule clarifies regulatory language surrounding insurers’ mandates under the Mental Health Parity and Addiction Equity Act (MHPAEA).
Modification to States’ Health Insurance Offerings
The NBPP Part III proposes repealing the Exchange Direct Enrollment option (Exchange DE) finalized in the January Part I rule. The Exchange DE option would have allowed states to permit approved direct enrollment entities (e.g., such as online agents and web brokers) to enroll eligible individuals into Qualified Health Plans (QHP) and certain other health insurance options, such as short-term medical plans. While never implemented, this option would provide an alternative to the current system of a unified exchange (e.g., HealthCare.gov), requiring vendors to create a consumer-facing portal that connects to a centralized back-end eligibility system. The complexities of such an option, along with no states expressing interest in implementing it, triggered the repeal.
Recent legislative changes to the ACA Marketplace in the ARP, and efforts to expand ACA coverage, called for a new allocation of resources that the Biden Administration felt the Exchange DE program would not promote. Additionally, the Administration expressed apprehension regarding how deviation from a centralized marketplace could affect consumer experience and the accessibility of coverage options.
Clarifications to Guidelines Imposed on Section 1332 Waivers
Part III would change requirements for states to gain federal approval for a section 1332 State Innovation Waiver and the process for amendments and extensions of such waivers. If finalized, the NBPP Part III would supersede Trump Administration guidance and the NBPP Part I provisions which promoted a more permissive view of the types of 1332 waivers that are approvable.
Section 1332 allows states to bypass – or waive – specific ACA requirements if they demonstrate that their waiver program meets certain standards. In order for a Section 1332 waiver to be approvable, states are required to demonstrate they will provide at least as comprehensive coverage, at least the same protection against excessive out-of-pocket costs, and offer coverage to a comparable number of individuals. Waivers are also not allowed to increase the federal deficit. Past interpretations of these requirements, issued by the Trump Administration, were criticized for subjectiveness and raised concern regarding the quality of coverage under section 1332 waivers. The NBBP Part III aims to redefine and clarify these guidelines to ensure individuals have broad access to quality and affordable coverage, and vulnerable populations (such as seniors and children) are protected.
Proposed Changes Aim to Expand Access to Coverage and Address Healthcare Inequality
Proposed measures in the NBBP Part III directly correlate to the Biden Administration’s goals to increase access to affordability coverage, reducing the burden for both issuers and consumers.
Efforts center around improving access to uninsured people negatively affected by health disparities. Of America’s 30 million uninsured population, half are people of color, and 10.9 million are eligible for subsidies under the ACA and ARP. The Kaiser Family Foundation reports that of those eligible for a free platinum-like silver plan, 46% speak a language other than English in their home, and 65% have a high school education or less.
These staggering statistics point to the issues regarding access and affordable and comprehensive coverage that contribute heavily to the rates of uninsured. COVID-19 exasperated health disparities, further contributing to the drive to propose this Rule while there is time for it to be implemented before the 2022 open enrollment period.
Exchanges Must Prepare to Accommodate Current and Upcoming Changes
New administrations bring changing policies that affect health plans and government agencies alike.
Investing in an adaptable and configurable platform will allow issuers and exchanges to meet changing regulations with ease. Composable solutions such as Softheon also reduce processing time, administrative overhead, and human error.
With the CMS announcing the approval of $20 million in grants to SBMs called for under the ARP to help implement technological improvements to current systems, now is the time to consider partnering with a trusted technology vendor to ensure timely adaptation of changing ACA requirements.
To learn more about Softheon and how we craft technology solutions designed to accommodate the needs stated in these CMS regulations, visit www.softheon.com or email firstname.lastname@example.org.
Meet the Author
Josh Schultz is a Senior Policy Analyst at Softheon, where he advises the company on health policy issues affecting businesses and government health agencies. Prior to Softheon, Josh worked for a non-profit agency assisting Medicare beneficiaries, a technology company, and consulting firms.