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CMS seeks to give states more freedom to define essential benefits

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FierceHealthcare reports that the  Trump administration has proposed a new federal rule to  give states more freedom  to define essential health benefits, as well as other changes to the regulations governing the individual and small-group markets.

The 2019 Notice of Benefit and Payment Parameters (PDF) was released Friday by the Centers for Medicare & Medicaid Services.

Fierce reported that “{p}erhaps most notably, CMS’s proposed rule would allow states to alter their essential health benefits  {EHB} benchmark plan annually, beginning as early as 2019.”

“As mandated by the Affordable Care Act, insurers in the individual and small-group markets will still have to cover 10 basic benefits, such as preventive care and prescription drugs. But once CMS’s proposed rule takes effect, states could borrow another state’s EHB benchmark plan—in whole or part—or create a new one altogether, provided it follows certain criteria,” the news service reported.

CMS said: “In addition to granting states more flexibility regulating their markets, we believe this change would permit states to modify EHBs to increase affordability of health insurance in the individual and small group markets.”

But the agency conceded that the proposed changes might cause some people  with specific health needs to lose coverage for certain services, depending on what option their state chooses.

 Fierce reported that CMS also seeks to (in the news service’s words), among other things:
  • “Allow states to assume a larger role in the qualified health plan certification process for the federally facilitated exchanges.”
  • “Explore ways to make state-based exchanges that use the platform a more appealing and sustainable option for states.”
  • “Gives states ‘significantly more flexibility’  {in CMS’s words} in how they operate a Small Business Health Options Program, also known as SHOP.”
  • “Recalibrate the parameters for risk adjustment methodology and give states more flexibility regarding risk adjustment transfers in their markets.”
  • “Let states  apply for an adjustment to their individual market medical loss ratio standard.”
  • “Raise the threshold for review of ‘unreasonable’ premium increases from 10% to 15%.”
  • “Remove the requirement that each exchange have at least two navigator entities, and the rule that navigators provide in-person outreach/enrollment support.”

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