In November of 2013, the Centers for Medicare & Medicaid Services (CMS) introduced the concept of “grandmothered plans,” coverage in place prior to 2014 that would have been prohibited as of 2014 as a result of changes under the Affordable Care Act (ACA). CMS issued guidance permitting those plans to be renewed for existing policyholders if permitted by states.
Specifically, such plans are not considered to be out of compliance with ACA provisions related to:
- Fair health insurance premiums (Section 2701)
- Guaranteed availability and renewability of coverage (Sections 2702 and 2703)
- Prohibition of pre-existing condition exclusions and other discrimination based on health status (Section 2704)
- Prohibition of discrimination based on health status (Section 2705)
- Non-discrimination in health care (Section 2706)
- Comprehensive health insurance coverage (Section 2707)
- Coverage for individuals in approved clinical trials (Section 2709)
- Single risk pool (Section 1312(c))
Initially, CMS permitted grandmothered plans to be renewed for policy years starting as late as October 1, 2014. CMS subsequently extended grandmothered plans that have been continually renewed, most recently through policy years starting on or after October 1, 2017, provided that all such policies end by December 31, 2017.
On February 23, 2017, CMS issued a
bulletin that, once again, extended grandmothered plans, allowing them to be renewed for policy years beginning on or before October 1, 2018, provided that all such policies end by December 31, 2018. Once again, this applies in states that also allow for such plans. States may also adopt the policy in a more limited manner. The guidance also sets forth consumer notice requirements.
Like this:
Like Loading...
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
[…] Click here to continue reading about this guidance. […]