States get more power over ACA essential health benefits with final rule

Healthcare DIVE April 9, 2018
Jeff Byers

Dive Brief:

CMS on Monday issued a final rule giving states flexibility in selecting essential health benefits under the Affordable Care Act. States can build their own set of benefits to be used as a benchmark plan for EHBs, subject to new requirements.
The rule allows states to loosen the current regulations on the medical loss ratio, which requires payers spend at least 80% of premium income on healthcare and quality improvement.
In addition, CMS issued new guidance to expand ACA’s hardship exemptions to including people who live in counties with no or only one insurer offering plans.

Dive Insight:

The sweeping rule is the latest in the...