On October 27, CMS released a proposed rule (and fact sheet) on the 2019 Notice of Benefit and Payment Parameters. This is an annual Affordable Care act (ACA) rule that pulls together all the major changes that CMS intends to implement for the next plan year for the marketplaces (in particular, the federally facilitated exchange (FFE) and SHOP marketplaces), the premium stabilization programs, and the health insurance market reforms generally.
Proposed changes in defining the essential health benefits (EHB) package may be the most significant proposal outlined by CMS, as the agency seeks to provide states with additional flexibility in how they select their EHB-benchmark plans for benefit years 2019 and beyond. For the 2014 plan year and again for the 2017 plan year, CMS directed states to select their EHB-benchmark plan from among 10 CMS-specified plan options, or default to their state’s largest small group plan based on enrollment. Under its new proposal, CMS would allow states to change their EHB benchmark plan on a yearly basis, and states would have four different options in doing so: maintain the current 2017 EHB-benchmark plan, select another state’s 2017 EHB-benchmark plan, replace one or more EHB categories from another state’s 2017 EHB-benchmark plan, or select a new EHB-benchmark plan altogether, provided that the new EHB-benchmark plan does not provide more benefits than a set of comparison plans and is equal to the scope of benefits provided under a typical employer plan.
AKF submitted a comment letter to CMS expressing our concern that the proposed changes in defining the EHB package could weaken the level of meaningful health coverage available to individuals with a chronic disease.