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CMS to tighten rules for special enrollment periods

Insurers have voiced concerns about consumers gaming the system

In response to health insurers' concerns about the Affordable Care Act special enrollment periods (SEPs), the federal government plans to tighten its regulations to thwart "bad actors" on the exchanges who can be costly to the plans covering them.

"It's critical to enforce the integrity of the open enrollment period," Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt said at a J.P. Morgan healthcare conference Monday, according to the Wall Street Journal.

Therefore, CMS plans to eliminate certain criteria for SEP sign-ups and clarify other language related to eligibility, Slavitt said, though he provided few other details. He did, however, add that CMS has formed an enforcement task force to keep consumers from enrolling in plans when they are not eligible for a SEP, saying it has already canceled coverage for some individuals who didn't qualify, the article notes.

In a host of comment letters sent to CMS about its 2017 Notice of Benefit and Payment Parameters, insurers and other stakeholders have complained that consumers' use of SEPs threatens the stability of the exchanges. These customers are higher utilizers of services and switch plans more often than those who sign up during standard enrollment periods, insurers say, warning these practices lead to higher costs for health plans, and ultimately, consumers. Several of the letters urged CMS to adopt stricter rules for SEPs.

UnitedHealth cited the high costs of covering SEP customers when it said it may pull out of the exchanges in 2017, an announcement that sparked concerns about the ACA marketplace's stability.

The government already decided to forgo a special enrollment period during tax season this year, FierceHealthPayer has reported. About 950,000 new customers selected a plan on Healthcare.gov during the SEP from Feb. 23 to June 30 last year, CMS has said, 15 percent of whom signed up during tax season to avoid paying the penalty for remaining uninsured.

To learn more:
- read the WSJ article

Related Articles:
Special enrollment periods costly and open to abuse, insurers warn
UnitedHealth's exchange exit threat: What it means
Government won't offer a special tax season enrollment period this year
AHIP, insurers criticize proposed ACA marketplace reforms
Fewer than expected buy coverage during tax season enrollment period