New Rule Adjusts Special Enrollment Periods And Some CO-OP Provisions

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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).
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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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