The Centers for Medicare & Medicaid Services (CMS) released the final payment notice for 2021 last week as the Trump administration finalized a string of regulatory changes to Affordable Care Act (ACA) marketplace. The agency’s rule outlines ACA plan regulations that impact qualified health plans (QHP) for the 2021 coverage year.
The notice keeps lower fees in place for health insurers participating in the federal exchange, with rates at 3% for plans listed on the federally facilitated exchange and 2.5% for those on the state platform.
According to CMS Administrator Seema Verma, the Trump Administration took office amid an individual market in turmoil, “Our policies delivered a sorely needed course correction, prioritizing competition and flexibility over prescriptiveness,” she said of the cabinet’s actions.
In light of the pandemic, CMS granted payers a week extension for QHP certification and the rate review timeline, giving insurers more time to assess the impact of the virus on their business. Payers have struggled to give guidance, arguing that providing outlook on membership and pricing is increasingly difficult amid uncertainties surrounding utilization.
The rule highlights that issuers are also able to offer patients high-value services with zero cost sharing as well as wellness incentives.
Other key changes in the rule include:
- Enhancements made to periodic data to minimize chances of sending incorrect subsidies to the deceased or dual-enrolled Medicare beneficiaries have been finalized.
- Requiring states cover the cost of any new state-mandated insurance benefits, in addition to the ACA’s essential health benefits.
- Flexibility in customizing how quality information is displayed for states that run their own exchanges.
Check out CMS’ final letter to issuers here.