FAQs address how moratorium on 2017 fee will impact plan year rate changes

CMS’ Center for Consumer Information and Insurance Oversight has issued frequently asked questions (FAQs) on the 2017 moratorium on the health insurance provider fee. The Consolidated Appropriations Act, 2016 (P.L. 114-113) suspended collection of the fee for the 2016 calendar year. Thus, health insurance issuers are not required to pay the fee in 2017.

Section 9010 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) charges a fee to each covered entity engaged in the business of providing health insurance. Under the recent legislation, the moratorium applies to the payment that would be due in the 2017 calendar year based on 2016 data.

2017 plan year rate changes. The FAQs indicate that the fee is part of administrative costs for health insurance plans. Because the fee is not being collected for the 2017 fee year, administrative costs for plans in all impacted markets are expected to be adjusted appropriately to account for the moratorium.

With regard to single risk pool filings in the individual and small group markets, administrative costs are one of the permissible plan-level adjustments to the index rate. It is expected that the 2017 plan-adjusted index rate will be adjusted downward to account for the moratorium of the fee where appropriate.

2018 fee year. The moratorium has no effect on the fee amount for the 2018 fee year. The legislation enacting the moratorium limited it to one year.

FAQs on the 2017 Moratorium on Health Insurance Provider Fee, February 29, 2016.

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