Outsource Medical Billing

Open Enrollment Period

The Centers for Medicare & Medicaid Services (CMS) has recently issued a proposed rule for 2018, and the rule proposes new reforms that are crucial to stabilize the small group and individual health insurance markets to protect patients.

It is reported that the proposed rule will make changes to special enrollment periods, guaranteed availability, the annual open enrollment period, essential community providers, network adequacy standards, and actuarial value requirements. CMS has also announced upcoming changes to the timeline of the qualified health plan certification.

“Americans participating in the individual health insurance markets deserve as many health insurance options as possible,” said Dr. Patrick Conway, Acting Administrator of the Centers for Medicare & Medicaid Services. “This proposal will take steps to stabilize the Marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options. They will help protect Americans enrolled in the individual and small group health insurance markets while future reforms are being debated.”

This rule proposes many policy and operational changes that are aimed at stabilizing the marketplace.

Special Enrollment Period Pre-Enrollment Verification

The new rule proposes to expand the pre-enrollment verification of eligibility to persons who newly enroll via special enrollment periods in marketplaces making use of the heathcare.gov platform. The proposed changes would help ensure that the special enrollment periods are available to all who are eligible to enroll, but will need the individuals to produce supporting documentation, which is a common practice in employer health insurance market.

Determining The Level Of Coverage

The rule also propose to make adjustments to the minimal range that is used for finding the level of coverage by offering improved flexibility to the issuers to offer patients with more and more insurance coverage options.

Guaranteed Availability

The new rule also proposes to address potential abuses in the healthcare industry. This is by allowing an issuer to collect premiums for previous unpaid coverage, before enrolling a patient in the healthcare plan for the next year with the same issuer. This step will also incentivize patients to help them avoid lapses on coverage.

Qualified Health Plan (QHP) Certification Calendar

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Medicare & Medicaid Services

In the new rule, CMS has announced their intentions to release a revised timeline for the rate reviews process and QHP certification for the plan year 2018. It is reported that the revised timeline would offer the issuers more time to implement the proposed changes that are finalized by the rule, before the 2018 coverage year.

Network Adequacy

The rule also reaffirms the traditional role of states to serve people. CMS proposed to defer to reviews of the states in the states with authority and also plans to assess adequacy of the issuer network. It is the states that are positioned best to make sure that the residents are getting access to high quality care networks.

Open Enrollment Period

The new rule also proposes to cut the upcoming annual open enrollment period for individual market. For the 2018 coverage year, the rule proposed an open enrollment period from Nov 1, 2017 to Dec 15, 2017.

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