In light of changes to CMS’ risk adjustment methodology, CMS is giving insurers until September 5, 2017 to submit final 2018 rates for individual marketplace plans. According to a Center for Consumer Information and Insurance (CCIIO) report, CMS decided to alter its risk adjustment methodology because state departments of insurance (DOIs) have permitted issuers to increase their 2018 rates to account for uncompensated liability arising from the government’s inability to make cost sharing reduction (CRS) payments to issuers (CCIIO Report, August 10, 2017).
The programs. Because the government has been unable to meet its (CSR) obligations, under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), CMS revised its risk adjustment methodology to assume greater plan liability in states that have permitted increased rates. If a state elects to not allow insurers to modify their 2018 rate filings, CMS requests that the state inform the agency by September 5, 2017.
New deadlines. Issuers offering plans through the ACA exchanges for single risk pool coverage must submit modified 2018 rates by September 5, 2017. States and CMS plan to review the modified rate filings between September 6 and September 9, 2017. The agency’s target date to post final rate filing information is November 11, 2017—the first day of open enrollment.
CSR. Currently, the Trump Administration is continuing to make CSR payments on a monthly basis. However, continued funding of the CSR payments remains uncertain (see House Dems demand Trump continue paying ACA cost-sharing reduction subsidies, May 31, 2017). The Congressional Budget Office (CBO) released a report on August 15, 2017, which estimated that the termination of CSR payments would cause premiums to rise 20 percent in 2018 (see Terminating ACA insurer payments would cause premiums, uninsured rate to yo-yo, August 16, 2017).
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