“Patient Protection and Affordable Care Act; Market Stabilization” Proposed Rule

February 17, 2017

On February 15, 2017 the Centers for Medicare & Medicaid Services (CMS) released a proposed rule entitled, “Patient Protection and Affordable Care Act; Market Stabilization.”

In general, the proposed rule is designed to bring stability to the Exchange marketplace in light of issuer exits and increases in rates in many areas of the country,while Congress works on drafting potential Affordable Care Act (ACA) replacement package(s).While a legislative package could potentially come together as early as mid-March, this expedited timeframe is subject to a great deal of uncertainty. The proposed rule includes a number of modifications to existing policies designed to stabilize the risk pool in the individual health insurance market and limit issuers’ financial risks in the Exchange marketplace, including, for example, changing the dates for the open enrollment period and adopting new documentation requirements for special enrollment periods. The rule also includes proposed changes that are intended to affirm the role of States in overseeing the health insurance markets, including modifications related to network adequacy and to the number of participating community providers included within an issuer’s network.