Thread by @charles_gaba

📣 WONKY BUT IMPORTANT:
CMS releases 2nd half of #NBPP2022 rule; will save #ACA enrollees $400 in out of pocket costs; COBRA SEP & more! acasignups.net/21/04/30/cms-r…

1. CMS is rejecting a Trump rule re. how maximum out of pocket (MOOP) expenses are increased; by reverting back to the prior formula, the MOOP increase will be $400 - $800 less than it otherwise would have been.

2. CMS has confirmed that those taking advantage of the #AmRescuePlan's COBRA subsidies thru September WILL be able to switch to an #ACA plan for October - December via a Special Enrollment Period! (this is a big deal for several million people).

3. CMS is tweaking the rules for enrolling in Catastrophic coverage for those over 30. Honestly, I'm not sure I see the point of this with the expanded #ACA subsidies for at least next year, but I suppose it could be useful for some folks.

4. Trump's CMS tried to ram through a bunch of complicated changes to the Risk Adjustment formula (which is already complicated to begin with) without taking nearly enough time to study it. Biden's CMS is rejecting those changes and will revisit them later on.

5. Trump's CMS wanted to crack down even harder on SEP eligibility verification (requiring people to upload documentation to prove they're eligible to enroll outside of Open Enrollment). This seems a little silly under the current circumstances. Biden's CMS is rejecting it.

6. CMS is *adding* SEP eligibility if you were reasonably unaware of your eligibility in time, or if you lose subsidy eligibility mid-year and want to downgrade to a less-expensive plan.

7. Some 3rd-party private brokers which sell ACA plans have been hiding info about them or only listing certain plans. Trump's CMS wanted to explicitly ALLOW this. Biden's CMS is cracking down on this practice & requiring 3rd-party sites to display all the info for all plans.

8. Some 3rd-party private brokers have been EXTREMELY scuzzy about misrepresenting #JunkPlans as #ACA plans (or vice-versa), confusing the hell out of people & directing some to enroll in garbage.

Again, Trump wanted to APPROVE of this. Biden's CMS is cracking down on it.

9. CMS is moving forward with a "QHP Enrollee Experience / Rating System" which I think will basically amount to "Yelp for ACA plans" so you know if a given carrier/plan is good or sucks.

10. ⚠️ HUGE! CMS seems to be setting the stage for FIXING THE FAMILY GLITCH which has been preventing millions of families from being eligible for #ACA subsidies all these years.

There's some other oddball stuff which is probably important but which isn't really in my wheelhouse.

HOWEVER, it's the last part of the summary & what it refers to which I'm most geeked about:

"CMS anticipates additional rulemaking for the 2022 payment notice later this year."

12/ HERE'S WHY: Last fall, you may recall I was pushing the panic button on several OTHER #NBPP2022 rules Trump's CMS Admin was trying to shove through on her way out the door.

One was merely questionable, but the other two were VERY concerning:

13/ The first would have cut HC.gov's user fees by 25 - 30%. Those are the fees which *fund* HCgov's operations. The fees were already cut a few years ago which seemed appropriate, but this latest cut seemed excessive. Biden's CMS is splitting the difference.

14/ MORE IMPORTANTLY, Trump's CMS Admin wanted to *codify* gutting ACA Sec. 1332. This section is supposed to *protect* ACA regs; instead, Seema Verma "reinterpreted" it in a way to let states *gut* some of those protections. Biden's CMS will be "revisiting" that rule this year.

15/ FINALLY, Trump's CMS Admin also wanted to allow states to OUT of using HC.gov or ANY ACA exchange at all--leaving people at the mercy of the same 3rd-party brokers she also wanted to let hawk junk plans. Biden's CMS will also be "revisiting" this rule.

16/ (I have nothing against 3rd-party sites selling #ACA plans...in fact one of them has an ad on my site...but they aren't all as scrupulous about selling ACA plans *exclusively* or about other business practices. Letting states rely *purely* on them would be a terrible idea.)

Unfortunately, Trump CMS Admin Seema Verma was able to slip this into her "reinterpreted" Sec. 1332 waiver for the Georgia before she left office. If enacted, Georgia will drop out of HCgov *altogether* starting in 2023.

Fortunately, they're being sued: healthaffairs.org/do/10.1377/hbl…

Between the lawsuit (which has a very strong case) and Biden's CMS planning on "revisiting" both the Section 1332 changes *and* the "opt out of HCgov" rule change, I'm *fairly* confident that Georgia's 1332 waiver will be quashed before it goes into effect.