CMS proposes rule to increase access to health coverage in 2022
The agency also issued a rule meant to speed the shift to value for home-based services.
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The Centers for Medicare and Medicaid Services is proposing a series of provisions meant to build on the Affordable Care Act by expanding access to health coverage, representing the third installment of the payment notice for 2022.
The provisions in the proposed rule include lengthening the annual open enrollment period for 2022 by an additional 30 days, creating a new special enrollment period opportunity for certain low-income consumers, and expanding the duties of federally-facilitated Exchange Navigators to offer additional help to consumers enrolling in plans.
These build on and revisit several of the policies in the Notice of Benefit and Payment Parameters for 2022 (or "2022 payment notice"), which was finalized in two phases.
WHAT'S THE IMPACT?
The proposed rule would give exchanges the option of offering a new special enrollment period to provide additional opportunities for certain low-income consumers to access premium-free or low-cost coverage – which is available to them because of the enhanced advanced premium tax credit (APTC) provisions included in the American Rescue Plan Act of 2021.
The proposed monthly special enrollment period would align with President Biden's Executive Order 14009, issued January 28, which requires federal agencies to identify and address policies that create barriers to accessing ACA coverage.
Several other provisions in the proposed rule seek to streamline operations for the federally-facilitated exchanges, health insurance issuers and others who facilitate access to coverage. For example, it would attempt to streamline issuer billing by repealing certain requirements that could have resulted in costly changes to issuer billing systems.
It also proposes to lengthen the annual open enrollment period for 2022 and future coverage years by an additional 30 days, allowing consumers more time to review plan choices.
On top of that, the rule also proposes modifications to policies related to State Innovation Waivers – sometimes called "section 1332 waivers" – which allow states to pursue new strategies for providing residents with access to coverage. These include proposals related to the interpretation of the statutory guardrails and flexibilities in public notice and post-award public participation requirements under future emergent circumstances, if certain criteria are met. The rule also includes proposals regarding the process for amending or extending approved section 1332 waivers.
ACCESSIBILITY
In part, the rule is also intended to allow CMS to collect and dedicate additional revenue to fund consumer outreach and education. It plans to do so through increases in user fee rates for issuers in federally-facilitated exchange states and state-based exchanges on the federal platform.
The proposed user fee rates, which are levied on issuers each year, are still lower than the current 2021 benefit year rates, according to CMS. The rate change for issuers on the federally-facilitated exchange would also make additional revenue available that can be used to fund Navigators, who help consumers – particularly the uninsured – understand their options and enroll in health insurance plans.
The proposed rule would also reinstitute expanded duties applicable to navigators in the exchanges, in an effort to ensure consumers have access to assistance beyond enrolling in health insurance coverage. These include, for example, assistance with the process of filing exchange eligibility appeals, understanding basic information about reconciliation of premium tax credits, and understanding basic concepts and rights related to health coverage and how to use it, such as locating providers and accessing care.
HOME HEALTH SERVICES
CMS wasn't done issuing proposed rules as the week began. The CY 2022 Home Health Prospective Payment System (HH PPS) proposed rule, also issued Monday, is meant to speed the shift from paying for home health services based on volume to paying based on value instead. The rule also seeks feedback on ways to attain health equity for patients through policy solutions, including enhancing reports on Medicare/Medicaid dual eligible, disability status, people who are LGBTQ+, religious minorities, people who live in rural areas, and people otherwise adversely affected by persistent poverty or inequality.
The rule also outlines nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) Model to incentivize quality of care improvements without denying or limiting coverage or provision of Medicare benefits for consumers. And it includes updates to payment rates and policies under the HH PPS.
The proposed rule also seeks to improve the Home Health Quality Reporting Program by removing or replacing certain quality measures, with an eye toward reducing burden and increasing focus on patient outcomes.
CMS would also begin collecting data on two measures promoting coordination of care in the Home Health Quality Reporting Program effective January 1, 2023, as well as measures under Long Term Care Hospital and Inpatient Rehabilitation Quality Reporting Programs effective October 1, 2022.
THE LARGER TREND
The Centers for Medicare and Medicaid Innovation developed the HHVBP Model, which began Jan. 1, 2016, to determine whether payment incentives for providing better quality of care with greater efficiency would improve the quality and delivery of home health care services to people with Medicare.
The HHVBP Model's current participants comprise all Medicare-certified home health agencies (HHAs), providing services across nine randomly selected states. The third annual evaluation report of the participants' performance from 2016 to 2018 showed an average 4.6% improvement in HHAs' quality scores and an average annual savings of $141 million to Medicare.
CMS announced on January 8 that the HHVBP model met the statutory requirements for expansion. CMS is proposing to expand the HHVBP Model nationwide effective January 1, 2022. By expanding the HHVBP Model, CMS seeks to improve the beneficiary experience by providing incentives for HHAs to provide better quality of care with greater efficiency.
ON THE RECORD
"Homebound Medicare patients face a unique set of challenges and barriers to getting the care they need," said CMS Administrator Chiquita Brooks-LaSure. "Today's announcement is a reaffirmation of our commitment to these older adults and people with disabilities who are counting on Medicare for the healthcare they need. This proposed rule would streamline service delivery and value quality over quantity – at a time when Americans need it most."
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
