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CMS proposed rule addresses certain marketplace standards

March 21, 2014

The Centers for Medicare & Medicaid Services (CMS) March 14 issued a proposed rule addressing various health insurance exchange and insurance market standards for 2015 and beyond under the Affordable Care Act (ACA).

The rule proposes standards related to product discontinuation and renewal; quality reporting; non-discrimination standards; minimum certification standards and responsibilities of Qualified Health Plan (QHP) issuers; the Small Business Health Options Program (SHOP); consumer assistance programs; and enforcement remedies in federally facilitated exchanges.

Among other provisions, the rule would require navigators and non-navigator assistance personnel to obtain authorization before accessing a consumer’s personally identifiable information;
require application counselors to be recertified at least annually; subject navigators and application counselors to civil money penalties for noncompliance with federal requirements; modify the timeframe for insurers to include ICD-10 conversion costs in their medical loss ratio calculation; increase the administrative cost ceiling and profit floor for QHPs by 2% each; and provide that excess reinsurance contributions by all plans be given to the Treasury Department.

The rule also specifies certain types of state laws applicable to navigators, certified application counselors and non-navigator assistance personnel that the Department of Health and Human Services considers to conflict with or prevent certain ACA provisions.

For more, click on:
http://tinyurl.com/kogdpm4.