Health Insurance Exchanges Centers for Medicare & Medicaid Services

Health Insurance Exchanges are government-regulated private health insurance markets where individuals can purchase standardized health insurance plans.
News & Analysis as of

CMS Proposes Affordable Care Act Exchange, Individual, and Small Group Insurance Market Changes

Not relying on Congress to take action on the Affordable Care Act, the Centers for Medicare and Medicaid Services (“CMS”) has proposed new regulations intended to attract health insurance issuers back into ACA health...more

Reducing the Regulatory Stranglehold on Federally Facilitated Exchanges: Will It Work?

The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule aimed at improving the individual and small group markets that have been plagued with instability as issuers continue exiting the Exchanges....more

CMS Proposes Changes to Stabilize ACA Health Insurance Markets

At the same time Republican Congressional leaders are attempting to develop legislation to repeal and replace the Affordable Care Act (ACA), CMS has published a proposed rule that is intended to help stabilize the Affordable...more

Trump administration issues proposed health insurance market stabilization rule: Will it be enough to stabilize exchange...

On 15 February 2017, the Centers for Medicare & Medicaid Services (CMS) took a step toward addressing concerns about the stability of the individual and small group health insurance markets by proposing a modicum of...more

CMS, IRS Address Affordable Care Act Issues in Transition

The Centers for Medicare and Medicaid Services (CMS) and the IRS have each published guidance on matters arising under the Affordable Care Act (ACA). It is too early to tell whether these measures—some of the first guidance...more

The Affordable Care Act: On the Fast Track to Repeal

On January 20, hours after his inauguration, President Donald Trump issued an executive order directing the heads of all executive departments and agencies to “waive, defer, grant exemptions from, or delay the implementation...more

President Trump Signs Executive Order on Affordable Care Act

On Friday January 20, 2017, President Trump signed an executive order titled “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal.” The Order directs the Secretary of Health and...more

Health Care Reform 2017: Substance, Process, and Timeline

President-elect Donald J. Trump campaigned on a promise to “repeal and replace” the Affordable Care Act (“ACA”). For several years, the newly reelected Republican majority in Congress has likewise identified ACA repeal as a...more

Risk Adjustment Update: CMS and the states react to insurer exits

The close of 2016 will mark the end of the third full year that the Affordable Care Act (ACA) has been fully implemented. Data is available for the first two "reporting years," 2014 and 2015, for which health insurers and...more

Manatt on Health Reform: Weekly Highlights - July 2016 #4

CMS’ increase of the “income verification threshold” makes eligibility determinations easier for consumers; Oregon CO-OP policyholders can credit out-of-pocket spending towards new plans; and report finds that 13 million...more

Exchange Players File ACA Lawsuits Against CMS

The Affordable Care Act (ACA) has been the impetus for extensive litigation since it was enacted in 2010. The Supreme Court has heard oral argument in four cases, and scores of other cases have been filed in the lower courts....more

Manatt on Health Reform: Weekly Highlights - April 2016 #4

CMS's sweeping final rule aligns Medicaid and CHIP managed care with QHP and Medicare Advantage regulations; New York's DSRIP is enabling change in the State's Medicaid delivery system; and Medicaid expansion reduces...more

Doing the Cha-Cha on Exchange Rules: CMS Moves Forward on Standardized Plan Offerings but Steps Back from Instituting Minimum...

On March 8, 2016, the Centers for Medicare & Medicaid Services (“CMS”) released a final rule titled “Patient Protection and Affordable Care Act; CMS Notice of Benefit and Payment Parameters for 2017” (“Final Rule”)[1] setting...more

CMS Finalizes 2017 Requirements for ACA Marketplace Plans

CMS has published its annual Notice of Benefit and Payment Parameters, which governs participation in the Affordable Care Act (ACA) Health Insurance Marketplaces for 2017. The sweeping rule addresses protection of consumers...more

The 2017 Exchange Regulations: Network Adequacy Challenges Remain

The Centers for Medicare and Medicaid Services (CMS) recently issued the final 2017 Benefit and Payment Parameters Rule (Final Rule) and concurrently released a final 2017 Letter to Issuers (Letter to Issuers) in the...more

CMS Finalizes Funding Methodology for ACA Basic Health Program for 2017-2018

On February 29, 2016, CMS is publishing its final methodology for determining federal payment amounts to states that elect to establish a Basic Health Program (BHP) to offer health benefits to low-income individuals otherwise...more

IREG Update - Co-Op member migration: Giving "risk adjustment" a whole new meaning

Co-Op member migration: Giving "risk adjustment" a whole new meaning As the Co-Ops created under the Patient Protection and Affordable Care Act fail one after another and their members enroll in coverage with other...more

Health Care Advisory: Highlights of the OIG’s 2016 Work Plan

On November 2, 2015, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) issued its Work Plan for Fiscal Year 2016 (“2016 Work Plan”).1 The 2016 Work Plan outlines the areas of...more

Washington Healthcare Update

Elections for Speaker of the House and Potential Changes at Ways and Means Committee - Rep. Paul Ryan (R-WI) announced Tuesday (Oct. 20) that he will run for the House Speaker position if the major House Republican...more

More Data Vulnerabilities, Cyber Breaches Detected in Healthcare Exchanges

Government audits continue to reveal that millions of people’s personally identifiable information is at risk. Continuous audit reports by the Office of the Inspector General (OIG) of The Department of Health and Human...more

Washington Healthcare Update

Bicameral Bill Introduced to Provide HHS Authority to Reject Proposed Insurance Rates - Before Congress left for its Columbus Day recess, Rep. Jan Schakowsky (D-IL) and Sen. Diane Feinstein (D-CA) introduced the Health...more

Employers Will Begin Receiving Premium Subsidy Award Notices From The Health Care Exchange in 2016

Beginning in 2016, the Centers for Medicare & Medicaid Services (CMS) will begin its process of verifying the eligibility of recipients who receive the Affordable Care Act’s (ACA) advanced premium tax credit to help purchase...more

Washington Healthcare Update

This Week: Senate Judiciary Committee Hearing Focuses on Health Insurers Merger... Arkansas to Delay Setting Up Its Own State Exchange...The Centers for Medicare and Medicaid Services (CMS) Announces Medicare Advantage...more

Manatt on Health Reform: Weekly Highlights - September 2015 #4

The Massachusetts Marketplace takes steps to ease consumer confusion by reducing choice among QHPs; North Carolina appears poised to pass Medicaid reform legislation; and bipartisan support is gaining for defining businesses...more

Healthcare.gov: No 2015 Employer Subsidy Notices

On September 18, 2015, the Centers for Medicare and Medicaid Services (CMS) published a set of “Frequently Asked Questions Regarding the Federally-Facilitated Marketplace’s (FFM) 2016 Employer Notice Program.”...more

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