Molina Healthcare sends out HHS Proposed Rule for 2018 Plan Year

Dear Marketing General Agency Partners:

As part of our ongoing efforts to ensure you are informed of the new developments around the marketplace please see the latest communication fro HHS.

Today, Wednesday, February 15th, the Department of Health and Human Services (HHS) released the pre-publication version of a Market Stabilization proposed rule. It will be published in the

Federal Register on Friday, February 17th for a 20-day comment period. Comments are due by Tuesday, March 7th. AHIP’s detailed summary of the proposed rule is attached. We will review the proposed rule on upcoming AHIP calls and seek input to develop comments by the deadline.


HHS proposes the following changes for the 2018 plan year:

  • Guaranteed Availability: Modify the interpretation of guaranteed availability to allow issuers to apply premiums for new coverage to any outstanding debt related to termination for non-payment of premiums for coverage the policyholder was enrolled in with that issuer over the last 12 months.
  • Special Enrollment Periods (SEPs): Expand the pre-enrollment verification pilot planned for June 2017 from 50% of all new enrollments to 100% and will include all categories of SEPs. In addition, for current enrollees who experience certain SEPs, HHS proposes several changes: new dependents can be added to the current plan only and for other certain SEPs plan changes are limited to the same metal tier. HHS also proposes to require prior coverage of at least one day in the last 60 days in order to qualify for the marriage and permanent move SEP.
  • Open Enrollment Period: Shorten the 2018 annual open enrollment period for the individual market to November 1, 2017, to December 15, 2017.
  • Actuarial Value (AV): Modify the allowable variation in actuarial value to +2/-4 percentage points for all non-grandfathered plans. If finalized, HHS would update the AV calculator accordingly.
  • Network Adequacy: Defer to the states’ reviews in states with the authority and means to assess issuer network adequacy.
  • Essential Community Providers (ECPs): Revert to the 2014 plan year standards to require issuers contract with at least 20 percent of available ECPs in the service area. HHS would also allow issuers to continue the write-in process used for the 2017 plan year.
  • Qualified Health Plan (QHP) Certification Calendar: Revise the timeline for the QHP certification and rate review process for plan year 2018 to provide issuers additional time to implement proposed changes that are finalized prior to the 2018 coverage year. HHS will release an updated timeline through separate guidance. While the proposed rule largely defers to State authority, HHS intends to encourage State-based Exchanges to similarly modify form and rate filing deadlines to provide issuers sufficient time to implement these changes.
  • Final QHP Templates: HHS has also indicated that it will not wait until finalization of the rule to release final QHP templates – these will be released soon so that issuers can begin preparing to submit their QHP applications.


Regards, Molina Broker Support Unit