CMS Proposes 2027 Regulations on Health Insurance and Long-Term Care
The Centers for Medicare and Medicaid Services (CMS) recently unveiled a proposal for 2027 regulations, distinguishing between health insurance and long-term care benefits. As per the CMS guidelines, long-term care services, such as nursing home stays for custodial care, are not classified as "essential health benefits" under the current and proposed regulations. This means that health plans offered through the Affordable Care Act marketplace are not required to include long-term care, unless linked to medical conditions or short-term rehabilitation.
CMS has opened these proposed regulations for public commentary until March 11. The agency aims to enhance insurance plan adaptability while eliminating some standardized requirements. This includes improved oversight and tighter assessment of insurance agents and brokers to prevent misrepresentation and boost regulatory compliance requirements.
To manage costs, CMS recommends limiting federal subsidies for state-enforced benefits as a strategy to control rising health insurance premiums. The Health and Human Services Secretary indicated that these proposed changes aim to spur innovation in insurance coverage. Focus is placed on preventive measures and long-term health outcomes, while reducing premiums, expanding coverage options, and minimizing payer fraud.
The CMS Administrator stated that their goal is to cut down costs and boost taxpayer fund accountability. Moreover, the new regulations provide states with the flexibility to offer custodial long-term care services outside the essential health benefits, making states financially responsible if they choose to provide such services.
However, this state discretion to manage long-term care coverage faces challenges from prospective Medicaid funding reductions. Anticipated budget cuts could affect Medicaid reimbursements to skilled nursing facilities (SNFs), as state budgets experience pressure from decreased federal contributions and more stringent eligibility requirements.
A December report by CliftonLarsonAllen (CLA) noted that Medicaid accounted for 62.2% of nursing home reimbursements in 2024, underlining the program's significance within the healthcare industry. For additional insights or in-depth discussion, CMS welcomes feedback from industry stakeholders on these proposed changes as they prepare for future implementations.
For more detailed information on these developments, contact Skilled Nursing News, a leading source in the skilled nursing sector, part of the Aging Media Network. They provide comprehensive coverage and updates pertaining to these critical changes.