The draft Annual Letter to Issuers released today (2019 Draft Letter) provides guidance to issuers interested in offering Qualified Health Plans (QHPs) in the Federally-facilitated Exchange (FFE) for the 2019 coverage year. The 2019 Draft Letter provides information on key dates for the QHP certification process; standards that will be used to evaluate QHPs for certification; and oversight procedures, consumer support policies and programs.
This year’s Draft Letter includes some new sections and content. Some of the policies in the Draft Letter released today include:
QHP Certification Timeline for 2019: The 2019 Draft Letter outlines key dates for the QHP certification process in the FFEs for plan years beginning in 2019. Our approach to the timeline for 2019 is similar to the timeline for the 2018 plan year. States will have until September 25, 2018, to confirm plan lists, and issuers will still have until late September to sign and return their certification agreement to CMS. To provide additional flexibility to issuers and states for plan year 2019, we are proposing a deadline for the QHP application Rates Table Template of July 25, 2018 – a month later than the initial submission deadline for the rest of the QHP application. The proposed Rates Table Template deadline aligns with the deadline for issuers in States with an effective rate review programs to submit rate filing justifications for single risk pool coverage that includes QHPs into the URR module.
States Role in QHP Certification: The 2019 Draft Letter describes our proposed approach in the 2019 Payment Notice Proposed Rule to expand the role of States in the QHP certification process for FFEs, including FFEs where the State performs plan management functions. Specifically, we proposed to rely on States for additional certification review areas such as accreditation requirements, quality improvement strategy reporting, and service area; and to continue to rely on States for network adequacy reviews.
Other QHP Requirements: We also discuss a proposal in the 2019 Payment Notice Proposed Rule to continue using a general essential community provider (ECP) enforcement standard whereby the issuer will be considered to have satisfied the regulatory standard if an application demonstrates satisfaction with several criteria, and to continue using a 20 percent general ECP standard. As in the 2019 Payment Notice Proposed Rule, we discuss the proposed removal of the meaningful difference standard and the proposal to not specify standardized options for plan year 2019.
Direct Enrollment: We discuss guidance on the oversight mechanisms for Direct Enrollment (DE) entities.
State-Based Exchanges on the Federal Platform (SBE-FPs): We reference proposals from the 2019 Payment Notice Proposed Rule including the elimination of the requirements for SBE-FPs to enforce FFE standards for network adequacy, essential community providers, and the Federal meaningful difference standard. We also describe how proposed changes to the FF-SHOP will impact SBE-FPs.
The 2019 Draft Letter is available here: /CCIIO/Resources/Regulations-and-Guidance/Downloads/Draft-2019-Letter-to-Issuers-in-the-Federally-facilitated-Marketplaces.pdf (PDF)
The 2019 Payment Notice Proposed Rule is available here: https://www.gpo.gov/fdsys/pkg/FR-2017-11-02/pdf/2017-23599.pdf