New Rule Gives Web-based Brokers Access to 2023 ACA Exchange Markets

Last Thursday, the Centers for Medicare & Medicaid Services proposed that states could use Section 1332 waivers to customize their Exchanges and allow web-based insurers to sell insurance by 2023; some stakeholders contend the changes undermine key tenets of the Affordable Care Act.

The  agency’s final rule, Notice of Benefit and Payment Parameters for 2022 was released January 14 and finalizes some standards included in the proposed rule for states, Exchanges, and issuers in the individual and small group markets.

Inside Health Policy provides this snapshot of the major policies finalized by CMS,

• Reduction of the exchange user fee from 3% to 2.25% of premiums for carriers in federal exchange and from 2.25% to 1.75% of premiums for state-based exchanges that use the federal platform
• Codifying the Trump administration’s revised 1332 waiver
• Clarification that insurers must accept payments from health reimbursement accounts
• Ending network adequacy requirements for plans without networks
• Allows states to rely on web-brokers and other entities for enrollment

This final bullet hasn’t gone so well for Georgia, a state hoping to be the first in the nation to bypass HealthCare.gov and send Georgia consumers to private agents when purchasing federally subsidized health insurance.

On Jan. 14, a federal lawsuit was filed charging the Georgia plan would “tear a hole” in the ACA. According to reporting from ABC News, the lawsuit was filed by two Atlanta-based groups — Planned Parenthood Southeast and Feminist Women’s Health Center and contends the move to private brokers and insurers would decrease enrollment, shift consumers to junk insurance plans that provide inadequate coverage and increase premiums.

A CMS fact sheet provides details on this controversial provision (and tests your acronym vocabulary),

HHS is finalizing the proposal to establish in regulation a new option by which a State Exchange, SBE-FP or FFE state may facilitate enrollment of qualified individuals into individual market qualified health plans (QHPs) primarily through approved private-sector, direct enrollment (DE) entities (such as QHP issuers and web brokers). Under this new “Exchange Direct Enrollment option” (DE option), instead of a single, Exchange enrollment website, an SBE, SBE-FP or FFE state that is approved by HHS to implement the DE option will approve DE entities to operate private-sector websites through which consumers can apply for and enroll in QHP coverage offered through the Exchange, as well as receive a determination of eligibility for QHP coverage, advance premium tax credit (APTC) and cost-sharing reductions (CSRs) from the Exchange (if otherwise eligible).

According to Modern Healthcare, The Alliance of Community Health Plans and the American Medical Association are concerned about the privatization of the Exchange market. Worried brokers and insurers will steer low-income consumers toward private, substandard plans without explaining they were eligible for Medicaid and concerned the move “could make it harder for people to find high-quality, ACA-compliant insurance with full benefits and could reduce overall enrollment.”

The Centers for Medicare & Medicaid Services expects to address the Notice of Benefit and Payment Parameters for 2022 proposals not included in the final rule during later rule making.