The Association for Community Affiliated Plans (ACAP) thanks you for providing us with an opportunity to comment on the Draft 2016 Letter to Issuers in the Federally-facilitated Marketplaces. ACAP thanks CCIIO for its efforts to provide clear, practicable guidance for states and qualified health plans (QHPs) for participation in the Marketplace in 2016.
ACAP is an association of 59 not-for-profit and community-based Safety Net Health Plans (SNHPs) located in 24 states. Our member plans provide coverage to approximately 12 million individuals enrolled in Medicaid, the Children’s Health Insurance Program (CHIP) and Medicare Special Needs Plans for duallyeligible individuals. Nationally, ACAP plans serve roughly one-third of all Medicaid managed care enrollees. Seventeen of ACAP’s Safety Net Health Plan members have elected to offer qualified health plans (QHPs) in the Marketplaces in 2015.
Summary of ACAP’s Comments
Please find below a list of ACAP’s comments. ACAP has opted to respond to a select subset of proposals in the draft Letter that are particularly relevant to Safety Net Health Plans, rather than to all of the guidance. Recognizing that 2015 represents only the second full year of Marketplace operations, we understand the need for changes to guidance and process; however, ACAP plans would like to impress upon CCIIO the growing need for stability with regard to policies and procedures in the Marketplace.
The positions summarized below are explained in greater detail later in the letter.
Key Dates for QHP Certification: ACAP urges CCIIO to delay the start date of the initial submission window from March 16, as proposed, to April 1 to give Safety Net Health Plans and other QHP issuers adequate time to develop their QHP applications. We encourage CCIIO to consider using the proposed timeline outlined below.
Recertification: ACAP requests that the final Letter to Issuers clarify that Qualified Health Plans can be altered in accordance with the uniform modification standards outlined in 45 C.F.R. 147.106(e), so that reasonable modifications of cost-sharing structure and benefits will not put plan recertification in jeopardy.
Network Adequacy: ACAP supports CCIIO’s proposed provider directory requirements as described under sections 156.230(b)(1)-(2) of the 2016 Proposed Benefit and Payment Parameters, including the requirement that directories be updated at least monthly. We oppose the requirement outlined in the proposed rule that issuers complete a provider directory template and believe that CCIIO should a) engage members of the issuer community, consumer advocates, providers and 2 other relevant parties in a workgroup to develop a definition of and discuss the feasibility and details of a machine-readable format, b) provide the public an opportunity to comment on that definition, and b) provide a three-year transition period before any such requirement goes into effect.
Prescription Drugs: ACAP supports CCIIO’s formulary URL requirements as proposed under section 156.122(d) of the 2016 Proposed Benefit and Payment Parameters, including the requirements that formularies be accurate and easily accessible. We oppose the requirement outlined in the proposed rule that issuers complete a formulary template for purposes of creating a consumerfriendly tool and believe that CCIIO should a) engage members of the issuer community, consumer advocates, providers and other relevant parties in a workgroup to develop a definition of and discuss the feasibility and details of a machine-readable format, b) provide the public an opportunity to comment on that definition, and b) provide a three-year transition period before any such requirement goes into effect.
Consumer Support and Related Issues: ACAP requests that that CCIIO include both the enrollee ID and the enrollee’s date of birth in all HICS cases.