CMS releases final Market Stabilization Rule

On April 13, 2017, the Centers for Medicare and Medicaid Services (CMS) released the final Patient Protection and Affordable Care Act; Market Stabilization Rule. The final rule is aimed at stabilizing the individual and small group markets by tightening enrollment standards and providing increased flexibility related to standards for Qualified Health Plans (QHPs), as outlined in detail below. The final rule also seeks to provide greater deference to state regulation of health insurance.

Upon issuing the final regulations, CMS also released:

• Finalized timelines for QHP certification and the rate review process for 2018 coverage;
• Updated Actuarial Value (AV) Calculator for 2018; and
• FAQ on Compliance Standards and QHP certification guidance for Issuers in the Federally-facilitated Marketplaces (FFMs)

PCG subject matter experts have created a comprehensive summary to assist regulators as they seek to understand what the rule changes and updated timelines mean for the coverage and markets in their states. The team also hosted a webinar on Thursday, April 20th to review the final rule. For a copy of the webinar recording or the presentation slides, please email healthpolicynews@pcgus.com.

Published by Margot Thistle

Margot Thistle, Esq. is a managing editor of Health Policy News who has spent much of her career working directly on Affordable Care Act policy and implementation, including having lead plan management operational and policy planning for Vermont Health Connect, a state-based exchange. During her time at PCG, Ms. Thistle has worked extensively with state insurance departments and state agencies on health policy, market stabilization, and regulatory compliance matters. Ms. Thistle 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. Ms. Thistle still has her admission ticket to the signing of Chapter 58 of the Acts of 2006, the historical Massachusetts health reform bill that preceded the ACA. View all posts by Margot Thistle