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Robert B. Vogel, MD, JD
Retinal Ophthalmologist at Piedmont Eye Center, Lynchburg VA;
Attorney, Overbey Hawkins & Wright, PLLS, Lynchburg, VA;
Adjunct Professor, Humanities and Bioethics, Liberty University School of Medicine, Lynchburg, VA.
The Centers for Medicare and Medicaid Services (CMS) has issued the Health and Human Services Notice of Benefits and Payment Parameters for 2019. “The final rule will mitigate the harmful impacts of Obamacare and empower states to regulate their insurance market,” CMS said in a statement.
CMS said that “between 2013 and 2017 … average premiums more than doubled in the states using the Federal Health Insurance Exchange platform, and half of the counties in America had only one issuer to choose from this year.”
The final rule, according to CMS Administrator Seema Verma, is designed to “give states new tools to stabilize their health insurance markets and empower citizens to find coverage that fits their families’ needs and budgets.”
One change involves the essential health benefits (EHB) package that states must offer. States will now be allowed to choose from any of the 50 EHB-benchmark plans available in the country last year, rather than being limited to just 10 options. The states also will be able to build their own benchmark plans (with some limitations).
The rule also amends medical loss ratio (MLR) standards, allowing states to determine if MLR adjustments could help to stabilize the individual insurance market. The current MLR rule requires payers to spend at least 80% of premium income on healthcare benefits.
Another change addresses special enrollment periods for new dependents, allowing alternative start dates so that they don’t have to wait for the next enrollment period to gain coverage. This also will apply to pregnant women receiving health insurance through the Children’s Health Insurance Program who are threatened with loss of coverage because of the enrollment period.
The rest of the final rule’s changes are outlined in the statement on the CMS website.
Healthcare Risk Management
Published monthly, seven-time award-winning Healthcare Risk Management is your latest tool for avoiding lawsuits at your facility. Inside each issue, you'll find the latest information on patient safety, medical errors, technology risks, and more. You'll also receive Legal Review & Commentary, a monthly supplement with legal analyses of two recent cases involving hospitals and physicians.