CMS Updates Payer Guidelines for 2019 Qualified Health Plans
CMS provided new dates, reporting requirements, and regulatory updates for payers that want to sell qualified health plans in 2019.
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By - CMS has issued a draft letter that outlines guidelines, dates, reporting, and regulatory requirements for payers that want to sell qualified health plans (QHPs) in 2019.
The Annual Letter to Insurers includes new information, and updates from previous years, for payers seeking to sell QHPs on the federal health insurance exchange.
These updates include extended timelines to submit reporting requirements, changes to how QHP performance is measured, and new policies for state-based exchanges that rely on federal resources.
Several QHP accreditation measures remain unchanged from previous years, such as a plan’s licensure, network adequacy, quality reporting, prescription drug benefits, and discriminatory benefit reviews. CMS will also continue to perform data integrity reviews of certain plan data relating to plan display on HealthCare.gov, such as annual re-enrollment.
Additionally, the draft letter highlighted how the 2019 Payment Notice Proposed Rule could either modify several QHP guidelines, or make some guidelines obsolete by that year.
CMS stated that states have until September 25, 2018 to confirm QHP plan lists. The deadline for payers to submit a QHP application is June 20th, 2018. Payers also will have an extra month to submit QHP Rates Table Templates, which must be submitted by July 25, 2018. CMS said the extra month should give payers to develop adequate rates for the QHPs.
All payers submitting QHPs have to obtain Health Insurance Oversight System (HIOS) product and plan IDs for their plans, so administrators can efficiently catalogue a payer’s QHP.
For 2019, payers must also register for the Center for Consumer Information and Insurance Oversight (CCIIO) Plan Management Community to receive correction and certification notices as well as other communications.
CMS will continue to work with states to coordinate oversight related to direct enrollment procedures and entities including participating payers, agents, and brokers.
However, in the 2019 Payment Notice Proposed Rule, CMS proposed changes that allow direct enrollment entities to use third parties for operational reviews of payers and enrollment brokers. The agency believes this will reduce regulatory burden on entities involved in direct enrollment.
CMS added that Small Business Health Option Program (SHOP) QHPs would not be required to follow guidance from previous years if the 2019 Payment Notice Proposed Rule is finalized. Depending on the outcome for the proposed rule, CMS would offer guidance as needed.
“Issuers applying for certification of plans as QHPs to be offered through federally-facilitated SHOPs for plan years beginning in 2019 should review the 2019 Payment Notice Proposed Rule and the final rule when it is promulgated,” CMS added.
The 2019 Payment Proposed Rule also would adjust policies for state-based exchanges on the federal platform (SBE-FPs). Under the rule, CMS would have SBE-FPs perform plan data review for QHP certification standards. The rule also would continue to defer all certification reviews for individual market and SHOP QHPs to the SBE-FPs.
Payers and related stakeholders can submit comments and possible changes to new QHP guidelines by December 17th, 2018.
