Feds firm up health rate filing calendar.
Byline: Allison Bell
Insurers in states with state-based exchange programs may get a little time to tweak 2016 major medical prices to reflect any earth-shaking news that comes out this summer.
Samara Lorenz, director of the oversight group at the Center for Consumer Information & Insurance Oversight (CCIIO), talks about CCIIO's views on 2016 rate filing deadlines in a memo aimed primarily at states with state-based Patient Protection and Affordable Care Act (PPACA) exchange programs.
The U.S. Department of Health and Human Services (HHS) has put the Centers for Medicare & Medicaid Services (CMS) in charge of setting up and running the PPACA programs that affect the commercial health insurance market. CCIIO is the CMS division that oversees the PPACA programs for CMS.
The 2016 PPACA open enrollment period is set to start Nov. 1 and run until Jan. 31, 2016.
CCIIO officials told insurers and state insurance regulators in April that insurers must file rates for 2016 individual and small-group coverage by May 15, and that CCIIO has to have final rate information for qualified health plans (QHPs), or exchange plans, in the Health Insurance and Oversight System (HIOS) by Aug. 25. CCIIO uses HIOS to feed QHP information into the HealthCare.gov exchange enrollment system.
See also: CCIIO posts health plan filing dates
In the new memo, Lorenz says states with state-based exchanges have asked CMS whether the deadlines apply to state-based exchanges.
The deadlines given in the earlier memo apply in all states, Lorenz writes.
But, this year, CMS will let states that have state-run exchanges and handle their own rate review process take somewhat longer to get rate filings through the final approval process.
A state with a state-run exchange must set a June 5 deadline for proposed rate increases, and it must post information about rate increase requests that are subject to review on the Web by June 19, Lorenz says.
A state with a state-run exchange must feed rate submissions into HIOS by Oct. 9, and it must post information about the actual final increases by Nov. 1, Lorenz says.
The memo seems to imply that states with state-based exchanges may have up until Oct. 9 to let insurers adjust rates.
This year, the U.S. Supreme Court seems to be on track to release a decision on King vs. Burwell (Case Number 14-114), a case that could have a direct effect on major medical risk in states with low Medicaid income eligibility limits, in late June.
CCIIO will not tell insurers how much cash they might be able to get from two of the PPACA "three R's" risk-management programs -- a reinsurance program and risk-adjustment program -- until June 30.
See also: Feds post PPACA reinsurance program data
CCIIO will not tell insurers what they can expect to get from the third risk-management program, a temporary risk corridors program, until Aug. 14.
See also: Risk corridors battleground emerges
The operations of the three R's programs could affect final product profit and loss totals for 2014, and 2014 experience may change the assumptions insurers use to set 2016 prices.