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CMS Proposes New Exchange Redetermination Rules

The Centers for Medicare & Medicaid Services (CMS) is planning to amend health insurance marketplace (exchange) redetermination rules. Through a June 27 proposed rule, CMS outlines three methods for the marketplaces to review enrollee coverage eligibility for insurance purchased through the federally facilitated marketplace:

  1. existing procedures, including a notice sent by the marketplace, updated enrollee tax information and applicable life changes, and verification of changes by the marketplace
  2. alternative procedures specified annually by the secretary of the U.S. Department of Health and Human Services for the applicable plan year
  3. alternative procedures approved by the secretary based on a showing by the marketplace that the procedures would facilitate continued enrollment in eligible coverage, provide adequate program integrity protections, and provide clear information about the process to the qualified individual

CMS is accepting comments on this proposed rule until July 28. Please contact Xiaoyi Huang, JD, director of policy, at xhuang@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Matt Buechner is the policy and advocacy associate for America's Essential Hospitals.