CHA News Article

HHS Issues Proposed Rule for 2019 Health Insurance Marketplaces

On Friday, the U.S. Department of Health and Human Services issued a proposed rule for health insurance marketplaces for plan year 2019, applicable to federally facilitated exchanges and state-based exchanges on the federal platform. The Affordable Care Act allowed each state to operate its own exchange. Currently, 11 states – including California – and the District of Columbia operate their own state-based exchanges. Five states utilize the state-based exchange on the federal platform model, and the remaining 34 states use federally facilitated exchanges.

The proposed rule sets forth payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs, cost-sharing parameters and cost-sharing reductions, and user fees for applicable exchanges. It would provide states with additional flexibility in selecting an essential health benefit-benchmark plan for plan year 2019 and later years, determining qualified health plan certification standards, and establishing and operating exchanges including the Small Business Health Options Program (SHOP) Exchanges.

It also proposes changes to standards for exchanges, required functions of the SHOP exchanges, actuarial value for standalone dental plans, the rate review program, the medical loss ratio program, eligibility and enrollment, and exemptions. 

Comments on the proposed rule are due Nov. 27. CHA is reviewing the rule to determine its impact on California’s marketplace, Covered California, which operates as a state-based exchange.