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April 26, 2019 Outreach and Enrollment News

Author: Amanda Tekely/Tuesday, April 30, 2019/Categories: Outreach News

CMS Issues Final Rule for 2020

On Jan. 17, CMS released the 2020 Notice of Benefit and Payment Parameters Proposed Rule to finalize standards for issuers and Exchanges in the Health Insurance Marketplace. A version of these proposed rules was made final on April 18, 2019. In the past, these rules were finalized earlier, meaning this year the window of time allotted for insurers and department of insurances to approve rates for 2020 is reduced. Insurers still must submit their qualified health plans (QHPs) to the Centers for Medicare and Medicaid Services (CMS) by June 19, 2019. Here are some highlights from the final rule:

  • Automatic re-enrollment into QHPs will continue
  • CMS reminded insurers of essential health benefits (EHB) nondiscrimination requirements, which prohibit discrimination in benefit design or the implementation of benefit design based on age, expected length of life, present or predicted disability, degree of medical dependency, quality of life or other health conditions
  • CMS declined to adopt changes to its regulations on guaranteed renewability regarding mid-year formulary changes
  • CMS did not finalize a proposed change to change the drug formulary for brand-name prescription drugs and general equivalents so it could consider the brand name drug not to be EHB if the generic drug is available and medically appropriate
  • The CMS proposal to require insurers that cover non-Hyde abortion services to also offer at least one "mirror QHP" without the coverage of non-Hyde abortion services but otherwise identical benefit coverage is still under review and was not finalized
  • No changes will be made to Silver loading of QHPs
  • The Navigator training for 2020 will be streamlined to four broad categories instead of the existing 20 topics and certain types of assistance, including post-enrollment assistance, are permissible but not required
  • Individuals can claim hardship exemptions through the tax filing process without having to obtain an exemption certificate number from an Exchange
  • New special enrollment periods (SEPs) are available for consumers enrolled in off-exchange coverage that qualifies as minimal essential coverage (MEC) who experience a decrease in household income and are newly determined to be eligible for advance premium tax credits (APTC)

CMS also released a Fact Sheet of the Final Rules to provide a brief overview of the regulatory changes. See the official Final Rule.


MAWD Now Accepts Online Payments

The Medical Assistance for Workers with Disabilities (MAWD) program permits Pennsylvanians with a disability to work, earn money and keep full medical coverage through the Pennsylvania Department of Human Services. MAWD recipients pay a monthly premium of five percent of monthly net income after allowable deductions for coverage. Beginning May 2019, premium payments can be made online. Visit www.humanservices.state.pa.us/MAWDOnlinePayments. To view the MAWD brochure, click here.


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