Final 2015 HIX Rule Includes Measures to Stabilize Premium Rates
CMS officials say they are making changes to the HIX risk corridors program to account for "unexpected administrative costs and pricing uncertainties."
Federal officials have released market standards and regulations for the PPACA exchanges. The final 2015 rule, released last week, includes risk program adjustments crafted to ease upward pressure on premium rates, more robust collection of quality information from insurers, and tighter standards for "navigators" who help people pick the HIX health plan that best suits their needs.
In addition to those changes, the final rule requires health plans to make coverage decisions within 24 hours on essential prescription drugs that are not covered by the plan. It also provides flexibility to states in the administration of the Small Business Health Options Program, within which PPACA exchanges offer group insurance coverage to small employers.
"This rule will help to improve consumer protections, keep premiums affordable, and make additional information available to consumers in the future, such as quality ratings that will help them to better compare and choose plans," CMS officials said in a blog post Friday.
Accounting for HIX Risk
In a fact sheet accompanying the rule's release, CMS officials said they are making changes to the HIX risk corridors program to account for "unexpected administrative costs and pricing uncertainties." The risk corridor changes feature raising the ceiling on administrative costs by two percentage points and raising the floor on profits by two percent.
- Readmissions: No Quick Fix to Costly Hospital Challenge
- How Top-Ranked MA Plans Earn Their Stars
- House Calls Key to Pioneer ACO Success
- How Telehealth Pays Off for Providers, Patients
- Ebola: Health Officials Try to Quell Front Line Fears
- Defensive Medicine Still Prevalent Despite Tort Reform
- 4 Ways to Lower the Cost to Collect from Self-Pay Patients
- 'Overtreatment' Debate Circles Back to Lung Cancer Screening
- How Hospitals Can Become 'Upstreamists'
- Partners HealthCare M&A Deal Under Scrutiny