CMS Releases Payer Guidelines for 2019 Health Plans

The CMS recently released a draft letter to notify payers of the guideline changes for 2019 qualifying health plans. The letter is released annually to update payers on policy changes that have impacted the deadlines and characteristics of qualifying health plans. 

“[The letter] provides updates on operational and technical guidance for the 2019 plan year for issuers seeking to offer qualified health plans, including stand-alone dental plans, in the Federally- facilitated Exchanges or the Federally-facilitated Small Business Health Options Programs,” the Agency wrote.

Deadlines for payers highlighted in the letter included June 20, the date payers will have to submit application for health plans; September 25, the date states have to confirm health plan lists; and July 25, the date rate table templates are due to the CMS for review. 

Among policy changes highlighted in the letter, payers will have to register Health Insurance Oversight System IDs for their health plans to make oversight easier for administrators. Payers will also have to sign up for the Center for Consumer Information and Insurance Oversight Plan Management Community, a notification platform that will keep quality health plan communications and notifications streamlined. 

CMS has also taken steps to reduce the regulatory burden on agents, brokers, and issuers who use direct reenrollment by changing the 2019 payment notice proposed rule. 

“In the 2019 Payment Notice Proposed Rule, CMS proposed changes… to permit [direct-enrollment] entities to select their own third-party entity to conduct operational readiness reviews for agents, brokers, and issuers participating in direct enrollment,” the Agency wrote.

The letter also clarified that states operating state-based exchanges will retain authority and primary responsibility over management of quality health plans. 

However, a change notes that “States would no longer be able to elect and seek approval to operate an State-based Exchanges on the Federal platform for Small Business Health Options Programs, although existing State-based Exchanges on the Federal platform for [small businesses] that are currently approved to operate as such by CMS would be able to maintain their existing status.”

—David Costill