CMS made sweeping changes to ACA rules that added exemptions from coverage requirements and shifted control to states, the government announced in a final notice issued March 9. The rules will take effect for ACA health plans sold this fall for 2019 coverage.
Here are seven changes to note, according to The Washington Post.
1. CMS's new rules enable more Americans to avoid the requirement that most consumers be insured. Congress repealed the penalty for the ACA individual mandate in December, but it remains in effect through the end of this year.
2. CMS created a "hardship exemption" from insurance coverage for residents of counties with only one or no insurers. People who oppose abortion and live somewhere where the only available plan covers abortion services can also apply for the exemption. About half of U.S. counties have only one ACA insurer this year.
3. With greater control over what they can select as an Essential Health Benefits-benchmark plan, states will have more flexibility to determine whether plans meet ACA standards.
"Instead of being limited to 10 options, states will now be able to choose from the 50 EHB-benchmark plans used for the 2017 plan year in other states or select specific EHB categories, such as drug coverage or hospitalization, from among the categories used for the 2017 plan year in other states," CMS said.
4. The final rule returns oversight regarding Qualified Health Plan Certification Standards to states. They will be responsible for making sure marketplace plans have enough doctors and other care providers in their networks.
5. Under the final rule, insurers won't be required to provide a standardized set of benefits. If insurers can prove a higher profile would improve their financial stability, they will no longer be required to allot 80 percent of their income to customers' care.
6. The new rules eliminate the requirement that every area has at least two navigator groups, one of which is local.
7. The new rules are an effort by the Trump administration to diminish the impact of the ACA, after Congress was unsuccessful in repealing it.
CMS Administrator Seema Verma told reporters during a phone call that "the law needs congressional action to repeal, but until the law changes we won't stand idly by as Americans suffer," The Washington Post reported.