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Medicare and Medicaid Service Centers include: announced Affordable Care Act 2024 benefit notification and payment parameters final rule restricting plans that are not standardized in the marketplace.
The final rule limits the number of non-standardized plan options offered by eligible health issuers through the federal and state markets of the federal platform to four in each area for the 2024 plan year. .
This will reduce plan selection overload, while making it easier for consumers to choose a health plan that fits their needs and budget, CMS said.
This rule change strengthens the network’s eligibility criteria and helps improve health equity by creating new special coverage periods, especially for those who have lost Medicaid or Children’s Health Insurance Plan (CHIP) coverage. improve.
The administration previously announced a temporary special enrollment period for individuals who have lost Medicaid or CHIP through July 31, 2024, in recognition of the end of Medicaid’s ongoing coverage requirements, but the final rule will make it permanent. establish a policy.
Starting January 1, 2024, federally-backed marketplaces and state-based marketplaces will have the option to implement new special enrollment periods for people who have lost Medicaid or CHIP coverage, allowing consumers to: You will be able to choose a Marketplace coverage plan 60 or 90 days in advance. After that, you lose your Medicaid or CHIP coverage.
The rule expands access to behavioral health care by including two important new categories of community providers: substance use disorders treatment centers and mental health facilities.
This extends the plan’s requirement to contract with at least 35% of the essential community providers available within the plan’s service area to include federally-approved health centers and family planning providers.
Why this matters
According to CMS, the special registration period will close the health insurance gap.
It outlines the requirements for agents, brokers, web brokers and assistants who assist consumers in registering through marketplaces using the Federal Platform.
Although the final rule allows assistants who conduct direct outreach, education, and schedule follow-up appointments to provide enrollment assistance, if the initial interaction was initiated by an assistant, this is currently It is prohibited.
Additionally, this policy change is expected to improve health literacy in rural and underserved communities and reduce the burden on consumers. This is especially true for consumers with limited access to transportation, inflexible work schedules and weakened immune systems.
the bigger trend
These changes, along with other expanded network adequacy requirements in the final rule, will increase choice of health care providers, improve health equity, and help consumers with low-income, complex or chronic health conditions, or Expand access to care for consumers living in underserved areas. Consumers are often disproportionately impacted by unexpected costs associated with out-of-network providers and restricted access to providers, CMS said.
on record
“The Biden-Harris administration has worked tirelessly to expand access to health care and reduce healthcare costs for American families,” said HHS Secretary Xavier Becerra. “Today’s release of the 2024 Benefit Notification and Payment Parameters Final Rule is a step towards building a healthcare system that prioritizes equity, access and affordability.”
CMS administrator Chiquita Brooks-LaSure said:
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Rebecca Stametz provides more details in the HIMSS23 session “Geisinger’s Journey with Digital Whiteboards: Measuring the Impact.” Thursday, April 20, 10:15-10:35 CT, North Building, Level 3, Hall B, Booth 8300-8313, Patient Engagement 365.
