On May 6, the Centers for Medicare & Medicaid Services (CMS)
released an interim final rule, to be officially published
on May 11, that revises the rules on two aspects of the Affordable
Care Act: special enrollment periods (SEPs) and Consumer Operated
and Oriented Plans (CO-OPs).
The existing SEP parameters are being revised in response to
concerns that allowing individuals to switch in and out of coverage
on state health insurance marketplaces, or exchanges, results
in increased costs. CMS is tightening the eligibility requirements
for qualifying for a SEP, including new documentation requirements
for Healthcare.gov customers who want to access coverage through a
SEP. The rule will also allow each exchange to determine how to
implement certain SEP provisions.
In regard to CO-OPs, the rule will revise certain governance
requirements to (1) permit CO-OPs to enter into private market
transactions to access needed capital for financial stability in
the absence of future federal loans, (2) allow CO-OPs to recruit
representatives of licensees of non-exchange health plans to sit on
CO-OP boards, and (3) remove the requirement that a majority of
voting directors be members of the CO-OP.
Comments on the interim final rule will be due by July 5, 2016.
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