Payers have argued special enrollment periods allow recently sick individuals to join health plans and drive up costs. To regulate special enrollment periods, CMS will launch a pilot program next year to evaluate a pre-enrollment verification system. The system will require enrollees to provide documentation to prove they are eligible for special enrollment periods.
The pilot program will evaluate the impact of requiring further documentation on ACA compliance, enrollment, sustainability of coverage, risk pools and other outcomes, according to the report. CMS is still determining the scope of the pilot.
More articles about payer issues:
BCBS of Michigan unveils value-based program, employer fee
In New Hampshire, low reimbursements may impede opioid abuse treatment
Florida residents to face on average 19% premium rate hike
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
