Trump Administration issues new rules for Obamacare enrollment, network adequacy

April 14, 2017
The Centers for Medicare and Medicaid Services (CMS) has issued a final rule regarding network adequacy in the Affordable Care Act (ACA) health care exchanges. The rules states that CMS would defer to the states’ reviews of the adequacy of health plan networks.

The American Academy of Dermatology Association (AADA) ― along with several other physician and patient organizations ― opposed this proposal, arguing that this policy could create inconsistencies among states with varying levels of adequacy and different methods for assessing adequacy. However, the Administration stated that it anticipates that states will adopt standards per the National Association of Insurance Commissioners (NAIC) network adequacy legislation. The AADA will continue to monitor state network adequacy efforts to ensure patients and providers are protected.

Additionally, the rule shortens the 2018 enrollment period for patients looking to purchase health care through the ACA exchanges to Nov. 1 to Dec. 15. Previously, patients had three months to enroll ― from Nov. 1 to Jan. 31. The rule also allows insurers to pay a lower percentage of beneficiaries’ medical costs in ‘silver’ plans ― insurers can opt to cover 66 percent of medical costs, as opposed to the current 70 percent. The rule also grants insurers the authority to deny coverage to beneficiaries who have not paid their premiums. The rule does not address the individual mandate and it also increased subsidies for the ACA exchanges.