CMS issues final 2018 market guidance

The Centers for Medicare and Medicaid Services (CMS) finalized its annual Notice of Benefit and Payment Parameters for 2018 (NBPP) and its 2018 Letter to Issuers in the Federally-Facilitated Marketplaces(Letter) on December 16, 2016. As is typical, the NBPP addresses a breadth of issues relative to health plan regulation as well as Marketplace operations. The Letter provides operational and technical guidance for issuers seeking to offer Qualified Health Plans (QHPs) and Standalone Dental Plans (SADPs) on Federally-Facilitated Marketplaces (FFMs) and State-Based Marketplaces on the Federal Platform (SBM-FPs).

Key changes CMS made when finalizing the documents include:

• adjusting the certification and rate review timelines;
• making changes to risk adjustment calculation; and
• declining to institute proposed changes to network adequacy and discriminatory plan review.

CMS also instituted policy changes on which input was sought in the proposed NBPP and draft Letter, including:

• related to guaranteed issue and small group coverage;
• devoting 3% of FFM user fees to education and outreach;
• continuing to pro-rate the SBM-FP user fee (to 2% for 2018); and
• eliminating the FF-SHOP participation requirement for small group carriers that participate in the individual market FFM.

CMS also announced: which standardized plan options apply to each FFM and SBM-FP state; a March 1st deadline for SBM-FP states to notify CMS if they plan to participate in the differential display of CMS standardized options; and, other clarifications to the standardized options.

These and additional provisions revised from the proposed NBPP and draft Letter are highlighted in a summary of the final NBPP and Letter drafted by subject matter experts from PCG’s Health team. The summary focuses on policy changes related to health plan regulation and certification and Marketplace establishment.

• Manual for Reconciliation of the Cost-Sharing Reduction Component of Advanced Payments for Benefit Year 2016: https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Final-Manual-for-Reconciliation-of-the-Cost-Sharing-Reduction-Component-of-Advance-Payments-for-the-2016-Benefit-Year.pdf
• Key Priorities for FFM Compliance Reviews for the 2017 Benefit Year: https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/Compliance_Review_Table-KeyPriorities_2017Final.pdf
• FAQ on Agent/Broker Compensation and Discriminatory Marketing Practices: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/Agent-Broker-Compensation-and-Discriminatory-Marketing-Practices.pdf
• Final 2018 Actuarial Value Calculator Methodology: https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Final-2018-AVC-Methodology121616.pdf
• Key Dates for 2017: QHP Certification, Rate Review, Risk adjustment and Reinsurance: https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Key-Dates-for-Calendar-Year-2017-12-16-16.pdf
• Bulletin: Timing of Submission and Posting of Rate Filing Justifications for the 2017 Filing Year for Single Risk Pool Coverage: https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/RR-timeline-bulletin-final-12-16-16.pdf
• Final CMS ECP list for PY 2018: https://www.cms.gov/cciio/programs-and…/final-cms-ecp-list-py-2018_12-16-16.xlsx

Published by Lisa Kaplan Howe

Lisa Kaplan Howe (J.D.) is a Senior Advisor who has spent her career working in health law and policy. At PCG, she focuses on statutory and regulatory analysis and strategic advising, particularly related to health care policy. Lisa has provided subject matter expertise to support state health care reform efforts, including policy development and regulatory support for health insurance Marketplaces and state insurance plan management efforts, Medicaid expansion and Medicaid Waivers (including DSRIP Waivers) and State Innovation Waivers. Lisa led PCG’s work with the New Hampshire Insurance Department relative the state’s Section 1115 Medicaid Waiver to provide coverage to newly-eligible adults through the Marketplace and continues to support the states’ Marketplace plan management work. In those roles, Lisa has served as the chief advisor and policy expert related to Medicaid and private insurance law to the New Hampshire Insurance Department, helping to identify, analyze and lead strategic consideration of federal opportunities and requirements. Lisa is also part of the team helping to design Colorado’s Delivery System Reform Incentive Payment (DSRIP) program. Ms. Kaplan Howe also provides broad policy and regulatory support to PCG’s other health care clients across the country, analyzing policy and regulatory developments, providing strategic advice relative to regulatory questions, and drafting policy briefs and position papers. Lisa is a managing editor of PCG’s monthly health practice area newsletter, Health Policy News. Prior to joining PCG, Lisa served as Policy Director at New Hampshire Voices for Health, where she led legislative and regulatory analysis, strategic planning, and implementation of the organization’s policy agenda. Her work included drafting bills, amendments, testimony, and communications and testifying at hearings. Lisa also held the positions of Private Market Policy Manager and Consumer Health Policy Coordinator at Health Care for All of Massachusetts. While there, she managed private insurance market policy work and was a member of the organization’s internal health reform team. Lisa also practiced law in the Ropes & Gray health care department, advising health care provider and insurer clients. View all posts by Lisa Kaplan Howe