CMS releases final Market Stabilization Rule

On April 13, 2017, the Centers for Medicare and Medicaid Services (CMS) released the final Patient Protection and Affordable Care Act; Market Stabilization Rule. The final rule is aimed at stabilizing the individual and small group markets by tightening enrollment standards and providing increased flexibility related to standards for Qualified Health Plans (QHPs), as outlined in detail below. The final rule also seeks to provide greater deference to state regulation of health insurance.

Upon issuing the final regulations, CMS also released:

·         Finalized timelines for QHP certification and the rate review process for 2018 coverage;

·         Updated Actuarial Value (AV) Calculator for 2018; and

·         FAQ on Compliance Standards and QHP certification guidance for Issuers in the Federally-facilitated Marketplaces (FFMs)

PCG subject matter experts have created a comprehensivesummary to assist regulators as they seek to understand what the rule changes and updated timelines mean for the coverage and markets in their states. The team also hosted a webinar on Thursday, April 20th to review the final rule. For a copy of the webinar recording or the presentation slides, please email