Obama Administration Delays Implementation of Star Ratings, Transparency Requirements for Marketplace Health Plans

In guidance published Friday afternoon, the federal agency administering the Affordable Care Act (ACA) health insurance marketplaces announced a more gradual implementation of the Quality Rating System (QRS) for participating health plans than originally envisioned. Under federal rules, star ratings were supposed to be available during the open enrollment period for the 2017 coverage year. These ratings are designed to help inform consumers about prospective health plans’ performance on key quality and consumer satisfaction metrics. However, the administration’s announcement now makes the display of the QRS optional for state-based marketplaces. For the federally facilitated marketplaces, the ratings will be piloted in only 5 states (Michigan, Ohio, Pennsylvania, Virginia and Wisconsin). It is unclear when they will be rolled out nationwide.

In other Friday afternoon developments, the administration made clear in its final proposal for the collection of health plan data that it continues to slow-walk implementation of the ACA transparency provisions. These provisions require non-grandfathered health plans both inside and outside the marketplaces to disclose detailed claims and other data to help policymakers, regulators and the public better understand how health coverage is working for people. Although the law required that market-wide transparency data reporting be initiated as early as 2010 (and in 2014 for marketplace plans), the final proposal released Friday makes clear that the 2018 coverage year is likely to be the first time data will be available, and the transparency will be well short of the scope envisioned by the ACA. The administration is signalling that by 2019, they may collect more detailed and more granular data on claims and claims practices. As we documented in an issue brief for the Robert Wood Johnson Foundation last year, this is the kind of data that ultimately could allow regulators to better understand market trends and how consumers are using insurance to access and pay for health care services. Under current rules, however, it will be close to the end of the decade before anyone can benefit from it.

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