CMS Releases Form And Rate Filing Instructions For Five States, Quality Rating System Guidance

The Affordable Care Act (ACA) provides that if a state lacks the authority or is otherwise substantially unable to enforce the ACA’s health insurance reform provisions, the Centers for Medicare and Medicaid Services (CMS) shall itself enforce those provisions directly. Currently CMS directly enforces the ACA’s insurance market reform provisions in Alabama, Missouri, Oklahoma, Texas, and Wyoming. On February 5, 2016, CMS released 2017 form and rate filing instructions for insurers in those five states. Insurers providing individual or group health insurance products (other than excepted benefits and grandfathered products) must file their forms with CMS. Forms must be submitted through the Health Insurance Oversight System (HIOS). The instructions describe which forms must be filed through HIOS for each product (a package of benefits using a particular network type within a service area) and for each of the plans (pairings of a product with a cost-sharing level, provider networks, and service areas) within each product. Instructions are included as to which specific templates and justifications must be filed with qualified health plan (QHP) and non-QHP products. Forms may be filed after April 11, 2016 and must be filed by May 11, 2016, except that forms on student health products and large group products must be filed 60 days prior to marketing. The instructions list a number of issues that insurers should be careful about: Non-grandfathered small group and individual mar...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Following the ACA Insurance and Coverage Quality Alabama Essential Health Benefits Health Insurance Oversight System Missouri Oklahoma QHPs qualified health plans Texas Wyoming Source Type: blogs