Exchanges would no longer haveto redetermine whether an enrollee is eligible for financialsubsidies when it processes a voluntary termination of exchangecoverage for someone dually enrolled in other qualifyingcoverage.

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In its quest to keep ineligible people from receiving subsidies to purchase health careinsurance under the Affordable Care Act, the Centers for Medicareand Medicaid is proposing to change the rules on standards thatgovern ACA-compliant plans.

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According to Modern Healthcare, CMS is looking for feedbackon whether it should terminate automatic reenrollment forlow-income exchange enrollees who receive $0 premium plans with taxcredits. The agency is asking whether it should require thoseenrollees to actively update their application during openenrollment in order to avoid having their advanced premium taxcredits for the next year terminated or cut.

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Related: Pharmacy benefit managers crack down on copayassistance programs

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Exchanges, meanwhile, would no longer have to redeterminewhether an enrollee is eligible for financial subsidies when itprocesses a voluntary termination of exchange coverage for someonewho is dually enrolled in other qualifying coverage; at present,that is a requirement for the exchanges. They would also no longerhave to redetermine eligibility for subsidies when an enrollee isidentified through periodic data matching as deceased, which CMSsaid would lower the risk of incorrect subsidy payments.

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According to CMS, "We remain concerned that automaticreenrollment may lead to incorrect expenditures of (advancedpremium tax credit), some of which cannot be recovered through thereconciliation process due to statutory caps. We believe that theremay be particular risk associated with enrollees who areautomatically reenrolled with APTC that cover the entire planpremium, since such enrollees do not need to make payments tocontinue coverage."

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The changes are included in the proposed HHS Notice of Benefitand Payment Parameters for 2021, with comments due on March 2.

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Another proposed change would targeta regulation finalized for the 2020 plan year that lethealth insurers implement copay accumulator programs so that coupons fromdrug manufacturers could not be used toward a patient's annuallimit on out-of-pocket costs when a generic drug is available.Instead, for 2021, the proposal would extend the policy to letinsurers exclude drug manufacturer coupons from applying to theannual limit on cost-sharing even when there is no generic drugavailable.

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"Not only will it increase patients' costs, but it willtranslate in insurance companies collecting even more money offprescription drugs," Carl Schmid, the former deputy executivedirector of the AIDS Institute who is now with the newly formednonprofit organization HIV + Hepatitis Policy Institute, is quotedsaying of the proposal, which he said would make it more difficultfor patients to afford and continue taking their medications. Headded, "We urge HHS not to finalize such an anti-patientproposal."

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Other changes proposed include the addition of a few new specialenrollment periods; technical changes to the way insurers' medicalloss ratios are calculated; a move toward value-based insuranceplan designs to push patients to look for higher-value care atlower costs; technical updates to the risk adjustment program; andupdates to the maximum annual limit on how much patients can payout-of-pocket for their medical care. CMS proposes increasing thatlimit to $8,550 for self-only coverage and $17,100 for familycoverage, which amounts to a 4.9 percent increase above 2020limits.

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Marlene Satter

Marlene Y. Satter has worked in and written about the financial industry for decades.