CMS Leaves Door (Slightly) Open for Insurers to Make Last-Minute ACA Plan Tweaks

by Leslie Small

According to CMS, Affordable Care Act exchange insurers should start revising their rate filings now to account for a court ruling that put several provisions of a Trump administration rule on hold — including changes to how much health plans’ actuarial value (AV) vary. And if the court, by Sept. 19, fails to grant emergency relief sought by the administration that would reverse the AV rule changes, CMS says it will go through with the last-minute filing revisions.

The memo, issued by CMS on Sept. 5, aims to update insurers on the consequences of recent rulings in a case challenging the Trump administration’s Marketplace Integrity and Affordability Rule. (For a full recap of what the case entails and what the rulings say, please see our previous article.)

While many provisions in the ACA marketplace rule are being challenged in two separate lawsuits filed by select U.S. cities and states, the only part of the rule that could realistically change in the weeks before open enrollment begins is a provision that changes the allowable range for actuarial value (AV) variation.

In other words, the rule would have allowed insurers to make their plans less generous than previously allowed — at least before a Maryland district court struck down key parts of the regulation. The Trump administration is now asking for an emergency stay of just the AV provision, arguing that changing the plan-design guardrails this late in the game would throw the market into chaos. AHIP, the main trade group for health insurers, filed an amicus brief supporting the administration’s motion.

Here's what CMS said in its Sept. 5 memo to ACA exchange insurers:

CMS said it will “will make available a brief window” — Sept. 30 to Oct. 1 — during which insurers in states that use the HealthCare.gov enrollment platform may refile their Qualified Health Plan data submission “for plans with actuarial values that comply with the court’s order.”

The agency added: “If CMS is able to obtain a stay pending appeal by September 19, we intend to allow issuers to revert to the actuarial values that fall within the revised de minimis ranges under the Marketplace Integrity and Affordability Final Rule and included in the previously finalized rate filings. However, to avoid confusion and ensure an orderly open enrollment period, if CMS is unable to obtain such a stay by September 19, we do not anticipate allowing issuers to revert to those de minimis actuarial value ranges.”

Thus, all eyes are on the courts as the Nov. 1 open enrollment draws ever closer.