The proposed rule would require all marketplaces issuers to offer standardized plan options for every product network type, metal type and plan classification. (Photo: Getty)
The Biden administration last week issued a proposed rule that it said will make it easier for millions of consumers to find affordable, comprehensive health coverage in 2023. The proposed rule aims to improve shopping for health care coverage, establish rules to ensure people can access care and advance health equity for consumers purchasing Marketplace coverage.
"Today's rule is part of the Biden-Harris Administration's ongoing efforts to ensure an equitable health-care system as we continue to make coverage more accessible and affordable," said Xavier Becerra, Health and Human Services secretary. "We are building a more competitive, transparent and affordable health care market. At the end of the day, health care should be a right for everyone, not a privilege for some."
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The 2023 payment notice proposed rule would require all issuers in federal and state Marketplaces to offer standardized plan options for every product network type, metal type and plan classification, as well as in every service area where the issuer will offer Marketplace plans.
The Centers for Medicare & Medicaid Services proposes to reestablish federal network adequacy reviews in states using the federally facilitated Marketplace. The standards used for these reviews would highlight key characteristics such as time and distance to care, as well as appointment wait times.
The proposed rule also would explicitly prohibit health insurance issuers from discriminating on the basis of sexual orientation and gender identity. Additionally, this proposal refines the Essential Health Benefits nondiscrimination policy by requiring issuers to rely on clinical evidence as a basis of health plan design. For example, plans could not be designed to burden people managing chronic conditions with inordinately high prescription costs unless there is a clinical rationale.
The proposed rule also includes a variety of other provisions intended to streamline marketplace operations and reduce health care costs. These include scaling back pre-enrollment verification for special enrollment periods to include only the period for loss of minimum essential coverage.
The 30-day comment period on the proposed rule began on December 28. To view the proposed rule in its entirety, visit the Federal Register.
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Alan Goforth
Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.
