CMS benefit and payment final rule limits non-standardized plans

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The Centers for Medicare and Medicaid Services has announced the 2024 Notice of Benefit and Payment Parameters Final Rule that limits non-standardized plans in the Affordable Care Act marketplaces.

The final rule limits the number of non-standardized plan options offered by issuers of qualified health plans through the federal and state marketplaces on the Federal Platform to four in each area for the 2024 plan year. 

This will reduce plan choice overload while making it easier for consumers to select a health plan that fits their needs and budget, CMS said.  

The rule's changes advance health equity by strengthening network adequacy standards and creating a new special enrollment period for those who lose Medicaid or Children's Health Insurance Plan (CHIP) coverage, among others. 

While the administration previously announced a temporary special enrollment period for individuals losing Medicaid or CHIP until July 31, 2024, in recognition of the end of the continuous coverage requirement in Medicaid, the final rule establishes a permanent policy. 

Beginning Jan. 1, 2024, Federally-facilitated Marketplaces and State-based Marketplaces will have the option to implement a new special enrollment period for people losing Medicaid or CHIP coverage, allowing consumers to select a plan for marketplace coverage 60 days before, or 90 days after, losing Medicaid or CHIP coverage.  

The rule also expands access to behavioral healthcare by including two new essential community provider categories: Substance Use Disorder Treatment Centers and Mental Health Facilities.
  
It extends the requirement for plans to contract with at least 35% of available essential community providers in a plan's service area to apply to Federally Qualified Health Centers and Family Planning Providers. 

WHY THIS MATTERS

The special enrollment period will reduce gaps in health coverage, said CMS.

It gives requirements for agents, brokers, web-brokers and assisters that help consumers with enrollment through marketplaces that use the federal platform. 

The final rule allows assisters, who conduct direct outreach, education and schedule follow-up appointments, to provide enrollment assistance, which is currently prohibited if an initial interaction is initiated by the assister. 

Additionally, this policy change is expected to improve health literacy in rural and underserved communities and reduce burden on consumers, especially for consumers with a lack of access to transportation, have inflexible job schedules, and who are immunocompromised, CMS said.

THE LARGER TREND

These changes, in conjunction with other expanded Network Adequacy requirements in the final rule, increase provider choice, advance health equity and expand access to care for consumers who have low incomes, complex or chronic healthcare conditions, or reside in underserved areas, as these consumers are often disproportionately affected by unanticipated costs associated with out-of-network providers and limited access to providers, CMS said.
  
ON THE RECORD
 
"The Biden-Harris administration has worked tirelessly to expand access to health insurance and lower healthcare costs for America's families," said HHS Secretary Xavier Becerra. "Today's announcement of the 2024 Notice of Benefit and Payment Parameters Final Rule is a step forward toward creating a healthcare system which prioritizes equity, access and affordability."
  
"We've made great progress with record insured rates, but affordable healthcare remains a concern across the nation," said CMS Administrator Chiquita Brooks-LaSure.

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org

Rebecca Stametz will offer more detail in the HIMSS23 session "Geisinger's Journey with Digital Whiteboards: Measuring the Impact." It is scheduled for Thursday, April 20, at 10:15 a.m. - 10:35 a.m. CT at the North Building, Level 3, Hall B, Booth 8300-8313, Patient Engagement 365.