December 15, 2015

Mike Adelberg: ‘Assertive' CMS Tackles Big Issues in Proposed Rules for Public Health Plans

The Centers for Medicare and Medicaid Services (CMS) takes on a number of big issues in a proposed regulation that would change the rules for health plans sold through public exchanges. According to Inside Health Insurance Exchanges, the proposals—outlined in CMS’s Notice of Benefit and Payment Parameters (BPP)—include measures to standardize “qualified health plans for and adequacy requirements for their provider networks,” tweak the risk-mitigation programs, tighten up oversight to reduce fraudulent enrollments, and move against health insurance agents and brokers suspected of fraud.

“This year’s Payment Notice takes on some big topics and puts CMS in a more assertive posture in overseeing the federal exchanges,” Mike Adelberg, senior director for FaegreBD Consulting, said. “But the agency didn’t push aggressively on all fronts. For example, some were predicting that CMS would put out new guidance on discriminatory benefits, but the agency did not do so.”

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