Proposed changes to the Health Insurance Marketplaces by the Centers for Medicare & Medicaid Services include standards that would refine the risk adjustment of enrollees, boost the number of standardized plan options and open the door to changes in how the number of essential community providers in a given area are determined.
One of the changes to the risk-adjustment process in the health insurance marketplaces would be implemented in 2017, that being a change to how partial year enrollments are evaluated for risk, according to an AHA Special Bulletin on the matter.
CMS also would like to both reduce its reliance on prescription drug utilization and alter its treatment of high-cost enrollees in risk adjustment in changes that if finalized would take hold in 2018. The AHA supports the partial-year and drug utilization changes, but is still analyzing the high-cost enrollee regulations to ensure there are no unintended negative consequences for the hospital field, according to the bulletin.
Among other changes, CMS proposed that the number of standardized plans be increased to four at the Bronze level and three at all of the others.
The proposed rule also includes a request for ideas on how to optimally count essential community providers, 30 percent of which in a given area must have contracts with a marketplace insurer.