Letter to CCIIO on Notice of Benefit and Payment Parameters for 2016: Proposed Rule

The Association for Community Affiliated Plans (ACAP) respectfully submits comments regarding HHS Notice of Benefit and Payment Parameters for 2016: Proposed Rule.

ACAP is an association of 58 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 dually-eligible individuals. Nationally, ACAP plans serve roughly onethird of all Medicaid managed care enrollees. Fifteen 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 Notice that are particularly relevant to Safety Net Health Plans, rather than to the entire rule. ACAP is supportive of many of the proposals in the draft Notice, and in particular agrees with CCIIO’s intention to extend hold harmless policies for plans as long as Exchange guidance continues to evolve. 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 building need for stabilization.

The positions summarized below are explained in greater detail later in the letter.

 Risk Adjustment. ACAP believes CMS should continue to utilize the risk adjustment factors outlined in the 2014 Payment Notice for both the 2014 and 2015 benefit years for the purposes of calculating risk adjustment scores that will determine final transfer payments. We propose CMS recalibrate the risk adjustment factors using the proposed three-year data approach and run the 2015 benefit year data alongside the current risk adjustment factors, outlined in the 2014 Payment Notice, as a simulation. Also, ACAP requests that the risk adjustment data submission timeline outlined in 153.420(b) be moved from April 30th to July 31st for the initial year of risk adjustment data collection to ensure plans have adequate time to accurately complete their submissions.

 Good Faith Safe Harbor. ACAP supports extending the good faith safe harbor standard as it relates to the risk adjustment, the reinsurance, and the risk corridor 2 programs under 153.740(a), but believes this protection should include all 2015 benefit year data reported in 2016.

 Consumer Assistance. ACAP supports a requirement that QHP issuers provide telephonic interpreter services in at least 150 languages as proposed in the draft Notice. Alternatively, ACAP would support a requirement to allow issuers to employ telephonic interpreter services in a reduced number of languages, with justification by the issuer to CCIIO.

 Re-enrollment in a QHP. ACAP strongly discourages CCIIO from employing the hierarchical re-enrollment policy as described in the draft Notice. Should CCIIO choose to implement such a process, ACAP strongly suggests that CCIIO ensure that consumers receive clear information about the consequences of passive enrollment, and implement a special enrollment period for consumers who are placed in a different plan but wish to return to their previous coverage.

 Special Enrollment Period. ACAP strongly supports a new special enrollment period for qualified individuals in non-Medicaid expansion states who were previously ineligible for advance payments of the premium tax credit due to low income and who have experienced an increase in income.

 Prescription Drug Policy. ACAP urges CCIIO to adopt the proposed prescription drug policy requiring use of a pharmacy and therapeutic committee, and opposes a policy incorporating employing the AHFS system.

 Network Adequacy. ACAP supports CCIIO’s proposed provider directory requirements under sections 156.230(b)(1)-(2), including the requirement that directories be updated at least monthly. We oppose the requirement that issuers complete a provider directory template 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 machinereadable 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.

 Good Faith in Compliance. ACAP supports CCIIO’s proposal to extend through 2015 the policy not to impose sanctions on any QHP issuer in the FFM if the issuer has made good faith efforts to comply with applicable requirements.

 Quality Improvement Strategy. ACAP supports flexibility for QHP issuers in tailoring a QIS to fit the needs of issuers’ specific covered populations, and supports an annual reporting requirement. We provide feedback to CCIIO regarding the QIS in the attached letter.


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