National Council for Mental Wellbeing

Skip to content National Council for Mental Wellbeing
Find a Provider
National Council for Mental Wellbeing logo
Your source for the latest updates from Capitol Hill. We translate policy into practice so you can learn how policy trends will affect your work and how best to prepare.

Michael Petruzzelli

, National Council for Mental Wellbeing

CMS Proposes Insurance Marketplace Rules for 2019

November 9, 2017 | Health Insurance Exchanges | Comments
Share on LinkedIn

Last month, the Centers for Medicare and Medicaid Services (CMS) proposed new marketplace rules for the 2019 open enrollment period. The rule reflects an executive order signed by President Trump earlier in his administration to roll back regulatory requirements on insurance agencies and states. Of importance, the rules would allow for states to tinker with the essential health benefits benchmark every year.

The CY 2019 Notice of Benefit and Payment Parameters includes proposals that affect Qualified Health Plans, Federally Facilitated Exchanges and State-based Exchanges for the 2019 plan year. The most significant proposals put forth this year include allowing states to update their benchmark plans more frequently and have more latitude on how they define the essential benefits, including coverage of mental health and addiction services.


The rule allows for the states to exercise the following approaches:

  • Selecting state’s EHB-benchmark plan as its own
  • Replacing one or more EHB categories of benefits under its own benchmark plan with the same categories used by under another in the same year. This type of sharing would allow for creative approaches to compiling EHB benchmark plans that could result in reduced coverage in some categories.
  • Modifying or recreating a state’s EHB benchmark plan every year, likely bringing about burdensome regulatory requirements and needed consumer education of the included benefits for the year.

States’ default option would be their current benchmark plan, and no action would be necessary to continue with that option. States would need to submit documents for EHB plan changes by March 16, 2018 for the 2019 plan year and July 1, 2018 for the 2020 plan year.

CMS says it is considering “establishing a Federal default definition of EHB that would better align medical risk in insurance products by balancing costs to the scope of benefits.” This could include a “national benchmark plan standard for prescription drugs,” CMS notes, that could “provide a consistent prescription drug default across States.” The agency says it will publish more details on such an approach, which it characterizes as “longer term.”

The proposed rule also modifies other components of health care including risk adjustment, medical loss ratio, exchange user fee and flexibilities and more.

Comments on the proposed rule are due Monday, November 27, 2017.