CMS recently posted on their blog that they intend to stop some of the special enrollment periods for the Federal HIE. Insurers around the country find this news welcoming.

Ever since the HIEs started operating three years ago, government officials have frequently extended enrollment periods for health insurance plans. This was primarily to afford more time to consumers who hadn’t enrolled at the time, sometimes due the exchange website malfunctioning. With these extensions, individuals could cite additional ‘life events’ qualifying them for re-entry into the insurance marketplace.

Health plans frequently bring up the issue of consumers exploiting special enrollment periods to avoid buying insurance until they need it. And once that happens, are they tend to obtain the maximum possible assistance available under the scheme.

The extensions often turn out to be an additional avenue for costlier patients to enroll, also adding uncertainty to the beneficiary mix. Most of these enrollment periods are eliminated in the recent announcement, and although this does not cut the number of sicker beneficiaries exploiting the system, it will add certainty to the process where insurers are concerned.

The administration will not end the practice altogether, but will instead monitor how special enrolment periods can be better adjusted. The periods being cut for now are for:

  • Consumers who signed up with excessive advance payments of the premium tax credit, owing to a redundant or duplicate policy.
  • Consumers for whom Social Security Income for tax dependents was accounted for improperly.
  • Lawfully present non-citizens who were affected by a system error the when determining their advance payments of the premium tax credit.
  • Lawfully present non-citizens with incomes under 100% FPL, who care under certain processing delays.
  • Consumers who qualify for or have enrolled in COBRA, and do not fully know their coverage options.
  • Consumers previously signed up in the Pre-Existing Condition Health Insurance Program.
  • Tax season special enrollment.

Furthermore, CMS offered new details on the enrollment period set up for consumers who have moved from their health plan permanently and have other plans open to them. In this regard, CMS has clarified that the special enrollment period cannot be used for a temporary move. This includes instances where the consumer is admitted in a hospital in another area.

Apart from the blog post, CMS admin Andy Slavitt said at healthcare conference that the ACA’s risk adjustment programs would also be reviewed.

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