Outsource Medical Billing
ACA Exchange Marketplace

It seemed that Tom Price was eager to oversee the transition of the government away from the Affordable Care Act (ACA) when he was elected as the new Secretary of the Department of Health and Human Services (HHS). Additionally, reports also indicated that he also wanted to implement a new act to replace the ACA. However, Tom Price has actually been trying to stabilize the Healthcare Exchange market of ACA for next year in the first months of his tenure.

The Centers for Medicare and Medicaid Services (CMS) recently published a final rule in order to strengthen both the small group and individual health insurance exchanges that were established by the ACA. CMS’ final rule has adopted several provisions from the proposed rule, which was issued in the month of February.

The final rule proposed by CMS has introduced plenty of insurer-friendly adjustments to the ACA marketplaces in order to maintain the viability of the exchanges in the 2018 year plan. The ACA insurance markets are currently dealing with rising premiums, insurers exiting the exchanges, and declining enrollment. Reports indicate that some ACA insurance markets have been witnessing a dramatic 100 percent premium increase while others will have only a single insurer selling plans next year.

The Republican-controlled Congress is engaged in the process of replacing and repealing the ACA. However, the replace and repeal process has become a lot more slower than many members in the GOP base had earlier anticipated. There is still a strong possibility that the Congressional Republicans will ultimately come together in order to deliver their 7-year plus campaign promise of repealing and replacing the ACA. This is because the replacement provisions that are currently being debated might not take place until 2020.

Medical Billing Companies
Health And Human Services

The ACA marketplace will somehow have to continue functioning during the transition phase. Even so, CMS’ final rule is planning to address some of the key challenges that the insurance exchanges will have to encounter during the transition years. Some of the changes proposed by CMS in the final rule include:

  • Shortening the open enrollment period of 2016 to a maximum of six weeks (November 1, 2017 – December 15, 2017);
  • Strengthening the requirements for enrolling into a plan outside of the open enrollment period with a special enrollment period (SEP); and
  • Mandating insurers to submit additional verification documents for the SEP enrollments.

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