April 20, 2017

Trump Administration Issues Final Market Stabilization Rule

Holland & Knight Healthcare Blog
Nicole M. Elliott

On April 13, 2017, the Department of Health and Human Services (HHS) finalized a regulation under the Affordable Care Act (ACA). The “Market Stabilization Rule” is aimed and lowering premiums and stabilizing the individual and small group markets. "The Market Stabilization Rule" is industry favorable in that it:

  • Significantly shortens the ACA’s open enrollment period to 45 days for the individual market. For 2018, the open enrollment period will begin Nov. 1, 2017 and end Dec. 15, 2017.
  • Tightens the verification rules for special enrollment periods for Health Insurance Marketplaces (Exchanges). Individuals signing up outside the open enrollment period will have to submit documentation illustrating that they are entitled to a special enrollment period.
  • Loosens guaranteed availability rules. Issuers can refuse to effectuate health care coverage if the individual has any outstanding debt for coverage during the past 12 months and until outstanding premiums are paid.
  • Provides additional actuarial value flexibility. The de minimis range for individual and small group market plans can be -4/+2 percentage points for each coverage level other than bronze. For bronze level plans, the new de minimis range is +5/-4 percentage points.
  • Changes network adequacy rules. State regulators, rather than federal regulators, who have a sufficient network adequacy review process are charged with ensuring that plans have network adequacy.
  • Lowers the threshold for essential community providers (ECPs). Issuers need to contract with at least 20% of the available ECPs in each plan’s service area, rather than the previous set threshold of 30%.

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