CMS proposes several provisions to increase coverage, equity under ACA
Proposals would lengthen the annual open enrollment period; create a new special enrollment period; and expand the duties of navigators.
A series of provisions proposed by the Centers for Medicare & Medicaid Services this week would expand coverage and advance health equity under the Affordable Care Act.
The proposals would lengthen the annual open enrollment period for 2022 by an additional 30 days; create a new special enrollment period opportunity for certain low-income consumers; and expand the duties of federally facilitated exchange navigators to offer additional help to consumers enrolling in plans.
Related: HHS: Record 31 million Americans have health care coverage through ACA
“With the ACA and American Rescue Plan, the Biden-Harris administration is expanding access to affordable health insurance coverage for millions — for many, perhaps for the first time,” CMS Administrator Chiquita Brooks-LaSure said. “The success of the special enrollment period opportunity clearly shows the demand for quality, affordable coverage. These latest steps aim to better fund outreach efforts and eliminate barriers to coverage. We’re making high-quality, low-cost coverage more accessible than ever.”
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 available to them because of the enhanced advanced premium tax credit provisions included in the American Rescue Plan Act of 2021. The proposed monthly special enrollment period would align with Biden’s executive order that requires federal agencies to identify and appropriately address policies that create barriers to accessing ACA coverage.
Several other provisions in the proposed rule would streamline operations for federally facilitated exchanges, health insurance issuers and other stakeholders who facilitate access to coverage. The rule also proposes modifications to policies related to state innovation waivers, which empower states to pursue new strategies for providing residents with access to coverage.
The proposed rules would enable CMS to collect and dedicate additional revenue to fund consumer outreach and education through modest increases in user fee rates for issuers in federally facilitated exchange states and state-based exchanges on the federal platform. It also would reinstitute expanded duties applicable to navigators in the federally facilitated exchanges to ensure that consumers have access to skilled assistance beyond applying for and 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. Raising such awareness and supporting navigators’ responsibilities remain key to reaching underserved communities, where access to health insurance coverage has been low and disparities in health outcomes continue to rise.
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