The Centers for Medicare and Medicaid Services released two new guidance documents impacting the insurance marketplace for 2018. 

The first guidance re-establishes a safe harbor protection that expired in 2016. Specifically, CMS will not use formal enforcement remedies if a qualified health plan (QHP) acts in food faith and makes reasonable efforts to address regulatory concerns in appropriate timeframes. This means CMS will not impose civil money penalties against or decertify QHPs. 

A second guidance  amends the 2018 Letter to Issuers in the federally facilitated marketplaces. 

The guidance notes that it is in keeping with President Trump’s executive order to provide greater flexibility to states by relying on state review of certain QHP certification requirements. Beginning in 2018, CMS will rely on state review for: licensure and good standing; network adequacy (see following item); service areas and prescription drug formulary outliers and non-discrimination in cost-sharing in federally facilitated marketplace states that do not perform plan management functions, such as New Jersey. 

Both guidance documents are consistent with President Trump’s efforts to move away from federal oversight of health insurers.