CMS rolls out new network adequacy requirements, standardized plan options
The final rule establishes parameters and requirements issuers need to design plans and set rates for the 2023 plan year.
Consumers should find it easier to access quality, affordable insurance on HealthCare.gov during open enrollment this fall. The Centers for Medicare & Medicaid Services has announced new measures designed to make it easier to explore options and select plans.
“The Affordable Care Act has successfully expanded coverage and provided hundreds of health plans for consumers to choose from,” Health and Human Services Secretary Xavier Becerra said. “By including new standardized plan options on HealthCare.gov, we are making it even easier for consumers to compare quality and value across health care plans. The Biden-Harris administration will continue to ensure coverage is more accessible to every American by building a more competitive, transparent and affordable health care market.”
Related: Most people have access to to medium- or high-quality ACA marketplace plans
The final rule makes regulatory changes in the individual and small-group health insurance markets and establishes parameters and requirements issuers need to design plans and set rates for the 2023 plan year. The rule also includes regulatory standards to help states, the marketplaces and health insurance companies in the individual and small-group markets better serve consumers. Policy changes include:
Advancing standardized plan options. The rule helps simplify the consumer shopping experience by establishing standardized plan options for issuers offering Qualified Health Plans on HealthCare.gov. With standardized maximum out-of-pocket limitations, deductibles and cost-sharing features, consumers will be able to more directly compare other important plan attributes, such as premiums, provider networks, prescription drug coverage and quality ratings when choosing a plan.
Implementing new network adequacy requirements. The rule helps ensure that patients have access to the right provider, at the right time and in an accessible location.
Increasing value of coverage for consumers. CMS is updating the allowable range in metal coverage levels for non-grandfathered individual and small-group market plans. This change likely will require some plans to increase the generosity of their coverage, make it more comprehensive and lower costs for many consumers.
Increasing access for consumers and removing barriers to coverage. The final rule aims to protect consumers from discriminatory practices related to the coverage of essential health benefits by refining the CMS nondiscrimination policy.
Expanding access to Essential Community Providers. CMS is increasing the Essential Community Provider threshold from 20% to 35% of available ECPs in each plan’s service area to participate in the plan’s provider network.
“These steps increase the value of health care coverage on HealthCare.Gov and further strengthen the health insurance Marketplace,” CMS Administrator Chiquita Brooks-LaSure said. “This policy will make it easier for people to choose the best plan that meets their needs by standardizing plan options, like maximum out-of-pocket limitations, deductibles and cost-sharing features.”
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