By Wire Reports
October 23, 2018
The Centers for
Medicare & Medicaid Services and the U.S. Department of the Treasury issued
new guidance so states can move their insurance markets away from the
Affordable Care Act's rules and regulations.
The goal is
to increase choice and competition within the states' insurance markets,
CMS said in a news release.
The new guidance
grants states more flexibility to design alternatives to the ACA and to give
Americans more options to get health coverage that better meets their needs,
CMS said. Under this new policy, states will be able to pursue waivers to
improve their insurance markets, increase coverage options for their residents,
and ensure that people with pre-existing conditions are protected. These
waivers are called State Relief and Empowerment Waivers.
With this guidance,
states will be able to develop approaches to increase consumer control and
expand choice and competition in their markets. In addition to this guidance,
CMS is also preparing to release waiver concepts to help spur conversations and
ideas with states, and illustrate how states might take advantage of this
opportunity to move beyond the ACA.
Federal law, under
Section 1332 of the ACA, authorizes states to waive certain provisions of the
law so long as the new state waiver plan meets specific criteria, or
“guardrails,” that help guarantee people retain access to coverage that is at
least as comprehensive and affordable as without the waiver, covers as many
individuals, and is deficit neutral to the federal government.
However, guidance
issued under the Obama administration in 2015 limited the types of state waiver
proposals that the federal government would approve. To date, these limitations
have effectively restricted state waivers to just one type, a reinsurance
waiver.
Today's guidance
outlines five principles for states to follow as they work to develop new
approaches. Moving forward, state waivers should aim to: provide increased
access to affordable private market coverage; encourage sustainable spending
growth; foster state innovation; support and empower those in need; and promote
consumer-driven healthcare.
The new
flexibilities available to states include the following:
·
Allows states to provide consumers with plan options that best
meet their needs, while, at the same time, ensuring people, including those
with pre-existing conditions, retain access to the same level of coverage
available today without the waiver;
·
Continues to require that a comparable number of people have
coverage, but expands the definition of coverage to include more types of
coverage, such as short-term plans;
·
Provides greater flexibility for states to consider improvements
in comprehensiveness and affordability for state residents as a whole versus
the prior focus on specific populations;
·
Supports increased variation and flexibility for states that may
want to leverage components of the Federal Exchange platform to implement new
models; and
·
Provides flexibility for states to meet the state legislative
authority requirement. The guidance clarifies that in certain circumstances,
existing state legislation that provides statutory authority to enforce ACA
provisions and the state plan, combined with a duly-enacted state regulation or
executive order, may satisfy the requirement that the state enact a law.
A fact sheet
on today’s guidance can be found here: https://www.cms.gov/CCIIO/Programs-and-Initiatives/State-Innovation-Waivers/Downloads/SRE-Waiver-Fact-Sheet.pdf
The guidance on
State Relief and Empowerment Waivers can be found here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-23182.pdf
and on 10/24/2018
available online at https://www.federalregister.gov/documents/2018/10/24/2018-23182/state-relief-and-empowerment-waivers
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