Implementing Health Reform: Wraparound Coverage Excepted Benefits And Draft 2016 Letter To Issuers (Updated)

Update, December 21, Draft 2016 Letter to Issuers: Each year CMS releases a letter to issuers (insurers) in the federally facilitated marketplace setting out the ground rules for coverage through the FFM for the coming year.  A draft letter is published for comments, followed by the final letter.  The letter covers insurers that issue qualified health plans (QHPs), including stand-alone dental plans (SADPs), and covers the small business (FF-SHOP) marketplace as well as the individual marketplace. On December 19, 2014, CMS  published the draft 2016 letter.  Not surprisingly, since it covers the third year of operation of the marketplace, the 2016 letter is quite similar to those of preceding years.   The letter is based on previously published rules governing QHPs and the marketplaces, as well as on the proposed 2016 Benefit and Payment Parameters Rule (which I covered on Health Affairs Blog here and here). The Role Of States The letter notes that insurers are required to comply with state regulatory requirements and that CMS will depend on states to perform rate and form review and ensure compliance with general insurance laws.  Additionally, states may assume responsibility for plan management functions, in which case they will make QHP certification recommendations to CMS.  CMS is responsible, however, for final QHP certification decisions.  In states not performing plan management review, CMS will incorporate state regulatory decisions into its review to the exte...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: All Categories Employer-Sponsored Insurance Health Reform Patient Safety Pharma Policy States Source Type: blogs