CMS Releases Re-Enrollment Rule for 2015 Coverage & Other Important Updates

CMS Releases Re-Enrollment Rule for 2015 Coverage & Other Important Updates

Late Thursday afternoon the Centers for Medicare and Medicaid Services (CMS) released a proposed rule on re-enrollment in individual and small group exchange plans for 2015. Under the proposed rule, most people who have already enrolled in exchange coverage in the individual market, even subsidized coverage, will not have to fill out a new application or go back through in 2015. Agent and broker NPN numbers will be passed through with the re-enrollment.
If a consumer did not give the marketplace permission to access their tax records automatically in the last open enrollment period, their subsidy this year could be impacted. If that information is not updated, those consumers could lose their subsidy. If a consumer did grant the exchange access, the marketplace will contact the IRS for the information needed for subsidy determinations. Some however, will have to go back into the marketplace and renew their coverage if, for example, their income changed, they got married or they want to switch their health insurance plan.

Auto-Enrollment Repeal Bill Filed in the Senate
We’re not just dealing with exchange re-enrollment here in D.C., there has also been some new activity on auto-enrollment. The health reform law’s auto-enrollment requirement for employers with 200 or more employees is still on hold until the Department of Labor issues implementing regulations, but many employers would just like to see the whole requirement go away. That’s why Senator Johnny Isakson (R-GA) introduced a bill in the Senate, S. 2546, this week to repeal it.

Musical Carrier Chairs
With the 2014 open enrollment period behind us, many are looking ahead to 2015, including the insurance carriers. Last year, we all watched as the federal government and states struggled to build exchanges, then, as the exchanges seemingly began to come together, we looked to the carriers to see who would actually sell in the new marketplaces. As it turned out, many were hesitant to enter into the new exchanges, resulting in several, single carrier heavy marketplaces. Now, as we look ahead to 2015, some carriers are choosing to step out of certain exchanges while others are throwing their products into the market. Needless to say, 2015 will be an interesting year, especially with the new re-enrollment regulations what were released just this week. If most consumers are expected to re-enroll in their current plans, how well will the carriers just entering the exchange marketplace do now?
One large carrier, Wellmark, that offers Blue Cross and Blue Shield plans in Iowa and South Dakota, has decided that they have had enough of the federal exchange. They announced earlier this week that they intend to pull out of the Iowa and South Dakota exchanges in 2015, citing continued challenges with The carrier also released data that shows how health reform compliance is impacting the pricing of their products. In Iowa, Wellmark has 130,000 members enrolled in grandfathered coverage that doesn’t meet PPACA standards.

90-Day Waiting Period Limitation Final Rule Released
Late last week, the Department of the Treasury released a final rule on the 90-day waiting period limitation. The final rule, applicable to all group health plans, including self-funded plans, issued for plan years beginning on or after January 1, 2015, clarified that the maximum allowed length of any reasonable and bona-fide employment-based orientation person cannot exceed 90 days.
The 90 days includes all calendar days, including weekends, holidays and any employee orientation training beginning on the enrollment date. The “waiting period” is further defined as the amount of time that must pass before coverage for an employee or dependent that is otherwise eligible to enroll under the term of a group health plan becomes effective. It further states that being otherwise eligible to enroll in a plan means having met the plan’s substantive eligibility conditions. The plan may still impose substantive eligibility criteria, but it may not impose conditions for the sake of passing time.

Legal Brief
If following health policy-related lawsuits is one of your things, then this week was a good one. (Yes, we are aware that very few people count court-watching amongst their hobbies, but that’s why you keep reading the Washington Update–we take care of the nerdiest things for you.) Anyhoo, not only did House Speaker John Boehner announce he would be pursuing a lawsuit against President Barack Obama for misusing executive powers relative to the health reform law among other topics, but the Supreme Court also struck down President Obama’s National Labor Relations Board (NLRB) recess appointments. That Supreme Court ruling may not seem like it has any health policy implications, but remember controversial former Centers for Medicare and Medicaid Services (CMS) Administrator Don Berwick was a recess appointee. Plus we learned that the high court’s decision on the Hobby Lobby case challenging the contraceptive mandate for private businesses will be announced this coming Monday.
As for the Supreme Court action, the decision gives the Senate broad power to thwart future recess appointments, but did not go as far as some proponents may have hoped. The court ruled 9-0 that since the Senate wasn’t actually in recess when the president made his three NLRB “recess” appointments, none are actually constitutional. However, the four most conservative justices would have gone further arguing that really recess appointments should not occur during short Senate recesses. Instead they wrote in a partial dissent that recess appointments should only be valid when they occur between the Senate’s yearly break. The appointments decision was really only the prelude for us SCOTUS blog devotees. On Monday we will learn the fate of the contraceptive mandate, which could have far-reaching implications on the health reform law’s regulation of private businesses.