By Robert B. Barnett Jr., J.D.
Qualified health plans for 2020 under the ACA are due for review in June 2019 with open enrollment to commence in November.
CMS has released its 2020 draft letter addressed to those issuers in the federally-facilitated exchanges that will be seeking to offer qualified health plans in 2020. While most of the requirements set forth in the letter are a continuation of prior year requirements, the letter incorporates additional standards set forth in CMS’s proposed rule titled, "Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2020," CMS 9926-P (CMS Letter, January 17, 2019).
Certification process. The certification process for issuers has not been changed from prior years. Key plan year 2020 dates, however, have been released. The initial qualified health plan application submission window for 2020 plans is April 25, 2019, through June 19, 2019. The optional Early Bird qualified health plan submission deadline is May 22, 2019. The Early Bird option is for those issuers that want to submit application data prior to the first formal submission deadline. CMS will review the application prior to the first submission deadline. If the identified corrections are corrected, CMS will not flag it as a correction in the full review round, and the issuer will not receive a correction notice. The first qualified health plan application deadline is June 19, 2019. Open enrollment begins on November 1, 2019.
All issuers must obtain Health Insurance Oversight System (HIOS) product and plan IDs using HIOS. All issuers must also register for the PM Community to receive correction and certification notices, as well as all other application-related communications. Issuers applying for qualified health plan certification in federally-facilitated exchanges, excluding those states performing plan management functions, are required to submit their qualified health plan applications in HIOS. Issuers should not assume that applications filed in other platforms will be transferred to HIOS.
Issuers will be allowed to make changes to their applications beyond corrections that CMS has identified in its application review. The relevant schedule is as follows: (1) initial application submission, April 25 to June 19, 2019, (2) qualified health plan review and modification, June 20 to August 21, 2019, (3) data changes after the application deadline, August 22 to October 4, 2019, and (4) after final data submission, October 5, 2019 onward.
Qualified health plan standards. The certification standards are largely unchanged from prior years. One change under CMS’s new proposed rule involves abortion coverage. Under the proposed rule, qualified health plan issuers that elect to offer coverage for non-Hyde abortion services in a qualified health plan offered on the individual market exchange must also offer a plan that does not offer non-Hyde abortion coverage, but is otherwise equivalent to one that does, beginning in 2020. Even if the issuer offers multiple plans covering non-Hyde abortion coverage, it would be required to offer only one "mirror" plan in each service area.
Stand-alone dental plans. Beginning in 2020, the annual limitation on cost sharing for one covered child under a stand-alone dental plan is $350 increased by the percent increase of the inflation index for dental services for 2018 over 2016. Because the increase between 2016 and 2018 was less than $25, it gets rounded down to $0. Thus, the annual cost sharing for plan year 2020 will be $350 for one child and $700 for two or more children.
Direct enrollment. The proposed rule also changes federally-facilitated exchange oversight mechanisms for direct enrollment entities. CMS will provide further guidance about the oversight after the 2020 payment notice rule becomes final. The proposed changes include audit standards for direct enrollment entities. It also extends oversight of direct enrollment agents and brokers to web-broker enrollment entities.
State-based exchanges. Current state-based exchanges on the federal platform renewed their federal platform agreement for January 1, 2018, for a five-year term ending January 1, 2023. States that are transitioning to the federal platform for plan year 2020, however, will need to execute the federal platform agreement with CMS before open enrollment.
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