CMS Issues Final 2019 Marketplace Rule / by Joe Furia

Debbie Johnston, Senior Vice President of Policy Development 

Earlier this week, the Centers for Medicare & Medicaid Services (CMS) issued a final rule setting standards for health plans sold through the Affordable Care Act’s (ACA) marketplaces for 2019. The Agency also published the 2019 Letter to issuers selling on the federally-facilitated exchanges. The final rule includes several policy changes, such as:

  • Granting states more flexibility to determine how exchange plans must comply with the ACA's 10 essential health benefits requirements
  • Modifying the ACA's medical-loss ratio requirements to make it easier for states to request lower thresholds
  • Increasing, from 10% to 15%, the threshold at which states must review insurers' premium rate increases
  • Requiring exchanges to put in place stronger checks to verify individuals' incomes when they apply for federal subsidies
  • Easing navigator requirements, such that  navigators will no longer need to be located in the exchange's geographic area, nor will at least one need to be a "community and consumer focused" nonprofit
  • Transferring network adequacy oversight to states
  • Updating the ACA's risk-adjustment model "to reduce burdens" on insurers

Initial qualified health plan applications are due June 20th.