New ACA-Related announcements from the Federal Administration

Lisa Kaplan Howe on May 18, 2017

The administration is taking more limited steps to influence implementation of the law, including two upcoming changes to enrollment through Marketplaces announcements last month.
On May 15, the Centers for Medicare and Medicaid Services (CMS) announced that it will be proposing a rule to have enrollment into Federally-facilitated Small Business Marketplace (known as Small Business Health Options Program or “SHOP”) health insurance plans go directly through insurers as of 2018. Two days later, on May 17, CMS released guidance enabling (but not requiring) full direct enrollment in individual market Federally-facilitated Marketplace (FFM) plans starting for open enrollment for plan year 2018.

Changes Coming to Marketplace Enrollment

Federally-Facilitated SHOP Enrollment
The Centers for Medicare and Medicaid Services (CMS) announced on Monday, May 15, that it will be proposing a rule to have enrollment into Federally-facilitated Small Business Marketplace (known as Small Business Health Options Program or “SHOP”) health insurance plans go directly through insurers as of 2018.
The rule will not eliminate the Federally-facilitated SHOP (FF-SHOP) in full, but the FF-SHOP will stop facilitating online enrollments into FF-SHOP plans. The FF-SHOP will continue to certify FF-SHOP plans, determine eligibility for SHOP coverage, and serve as a window shopping portal.  However, once they are determined eligible and have chosen a plan, small employers will be directed to FF-SHOP insurers or registered agents / brokers to enroll. Eligible small employers will be able to continue accessing the Small Business Health Care Tax Credit, however, it seems unlikely that employer choice will continue.
Employers will be able to continue to enroll in 2017 FF-SHOP plans online through November 15, 2017. Employers that enroll in 2017 coverage can continue to use healthcare.gov to enroll employees and pay premiums until the end of the plan year.
This change only directly applies to FF-SHOPs.  State-based SHOPs (SB-SHOPs) will have the option to continue facilitating enrollment through the SB-SHOP online portal or to also adopt direct enrollment.
Federally-Facilitated Marketplace Enrollment
Similarly, CMS released guidance on Wednesday, May 17, enabling (but not requiring) full direct enrollment in individual market Federally-facilitated Marketplace (FFM) plans starting for open enrollment for plan year 2018. Unlike for the FF-SHOP, consumers will still have the option to enroll online through healthcare.gov.
While direct enrollment was already allowed, consumers previously were redirected to healthcare.gov to complete the eligibility process prior to enrolling through an insurer or web-based broker. Under the new guidance, consumers can complete the process in full through a third-party website.
This change applies to FFMs and State-Based Marketplaces on the Federal Platform (SBM-FPs). Technical rules and compliance requirements for completing the process were outlined, including for entities that wish to facilitate “direct enrollments.” Future guidance on privacy and security requirements may be issued.

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.

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