ACA Standardized Plans, Star Ratings Pilot to Start in 2017

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By Sara Hansard

April 29 — A pilot program displaying quality star ratings for Affordable Care Act marketplace plans will begin in five states during open enrollment for 2017, the Centers for Medicare & Medicaid Services announced April 29.

In a blog posting Kevin Counihan, chief executive officer of the federal HealthCare.gov marketplace, and Patrick Conway, principal deputy administrator of the CMS, said the ACA open enrollment period for 2017 will feature a pilot program for a five-star quality rating system, and also offer standardized health plans.

The star rating system for qualified health plans sold in the ACA marketplaces is similar to that used for Medicare Advantage plans. The system is intended to provide comparable information to consumers about the quality of health-care services and enrollee experiences for the ACA plans.

The 2017 open enrollment period is slated for Nov. 1 through Jan. 31, 2017.

Simple Choice Plans

The Simple Choice Plans are standardized health plans with uniform deductibles, out-of-pocket limits and standard copayments that insurers have the option of offering on the HealthCare.gov marketplace under a final rule released Feb. 29 by the Department of Health and Human Services (40 HCDR, 3/1/16).

Many consumers have been confused by varying out-of-pocket limits in plans sold in the same actuarial level metal tier in the marketplaces and the Simple Choice Plans are intended to allow consumers to compare plans more easily based on fewer factors like monthly premiums and providers in plan networks.

“We expect these plans will be a core part of the shopping experience on HealthCare.gov,” the blog posting said. “Simple Choice Plans will display prominently in Plan Compare, with clear visual cues that show consumers the plans that are easy to compare vs. the ones that should be researched for differences,” it said.

Consumers can also choose to see only the Simple Choice Plans to quickly compare them, it said. The CMS is testing display options and descriptions for the Simple Choice Plans, the blog posting said, adding that “our approach does not stifle innovation so health plans can continue to offer all kinds of benefit options that will also be easy for consumers to find.”

Insurance companies had argued against offering standardized plans, saying they will inhibit insurers' ability to promote more economical plans, such as those that have narrow provider networks.

Republican Criticism

House Republicans joined in criticizing the standardized plans.

“We are concerned CMS's policies will continue a pattern of allowing Washington bureaucrats to pick winners and losers by propping up plans that meet arbitrary requirements, instead of preserving choice and encouraging consumers to select plans that best meet their unique needs,” Ways and Means Committee Chairman Kevin Brady (R-Texas), Energy and Commerce Committee Chairman Fred Upton (R-Mich.) and 32 other Republican committee members said in an April 29 letter to Andy Slavitt, CMS acting administrator.

There is “no guarantee that CMS will not limit these options in the future,” the letter said, noting that in its earlier proposed rule the CMS said it “may consider limiting the number of plan options in future years, to further simplify the health plan shopping experience for consumers.” The letter asked Slavitt to provide information on how the standardized benchmarks were developed by May 20, and they asked for a briefing by CMS staff before May 13.

Pilot Quality Rating System

The pilot quality rating system will include plans in Michigan, Ohio, Pennsylvania, Virginia and Wisconsin, states that were selected because they have a large number of health plans participating, the blog posting said. States that operate their own ACA marketplaces can choose to display the quality rating information, and such information will be available in all of the federal HealthCare.gov states during open enrollment for 2018, the CMS said.

“As with all quality ratings, they simplify a lot of information and in some cases, consumers would be wise to go beyond what they see here,” it said.

Star ratings are used to evaluate how well physicians coordinate to provide good care, whether the plan's network providers give care that achieves the best results and how enrollees rate their doctors and the care they receive, the blog posting said.

The pilot will provide the CMS with feedback that can be used to develop quality rating information nationwide, the blog posting said.

For the 2016 plan year HealthCare.gov added tools allowing consumers to see if their physicians are in plan networks or how prescription drugs are covered in plans.

To contact the reporter on this story: Sara Hansard in Washington at shansard@bna.com

To contact the editor responsible for this story: Janey Cohen at jcohen@bna.com