January 22, 2016

Mike Adelberg: CMS ‘Might Draw Criticism' for Increased Role in Rate Review, Network Adequacy

In its fourth annual draft annual letter to issuers, released at the end of 2015, the Centers for Medicare and Medicaid Services (CMS) indicated plans to take a more assertive regulatory hand in federally facilitated health exchanges (FFEs) in 2017. An Inside Health Insurance Exchanges article said the letter suggests “CMS will be less willing to defer to market forces and state regulators in reviewing and certifying QHPs (qualified health plans).” In the article, Mike Adelberg, senior director for FaegreBD Consulting, said CMS’s firmer hand “might draw criticism from both insurers and states given current insurer losses, continued funding uncertainties and polarized politics.” Adelberg also provided some perspective, observing that the two largest state-run exchanges, California and New York, remain more prescriptive than CMS in regulating areas such as standardizing health plan designs and capping consumer cost. 

The complete Inside Health Insurance Exchanges article is available to subscribers.

Adelberg recently authored an update that provides a more in-depth analysis of CMS’s recent announcements. 

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