CMS issues final benefit and payment parameters for 2024 marketplace plans
The final rule requires that issuers on state and federal ACA marketplaces offer standardized qualified health plans at every tier level and that agents and brokers document consumers' consent information.
The Centers for Medicare & Medicaid Services early this week issued the final rule for the 2024 Notice of Benefit and Payment Parameters, which finalizes standards for issuers and marketplaces, as well as requirements for agents and brokers who use the federal platform.
“We’ve made great progress with record insured rates, but affordable health care remains a concern across the nation,” CMS Administrator Chiquita Brooks-LaSure said. “As we continue to work toward accessible and equitable health care for all Americans, the 2024 Notice of Benefit and Payment Parameters Final Rule … will make it easier for consumers to access, choose and maintain the health coverage that best fits their needs.”
Beginning in plan year 2024, marketplace plans must use providers that comply with network adequacy standards, removing a proposed exception stating that adequacy regulations don’t apply to insurers who don’t use a provider network. The final rule also requires insurers to include at least 35% of providers in any given market in their networks and extend this participation threshold to federally qualified health centers and family planning providers.
Issuers also will be limited to offering four non-standardized options per product network type and metal level in any given service area, even though the CMS initially proposed a two non-standardized plan option limit. As a result, CMS estimates that the number of available non-standardized plans available to consumers will decrease to around 90.5 in plan year 2024.
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In addition, CMS finalizes a requirement that agents and brokers document the receipt of consent from the consumer prior to providing assistance.
CMS backtracked on a section of the proposed rule that aimed to reduce the risk of discriminatory benefit designs and minimize barriers to access for prescription drugs. The proposed rule said issuers of standardized plans must place all covered generic drugs in a generic cost-sharing tier and place all covered brand-name drugs in either the plan’s preferred brand or non-preferred brand cost-sharing tiers.
Both the non-standardized plan limit and drug proposals faced backlash from the insurance industry, with AHIP commenting that limiting plan options could drastically disrupt the marketplace and urging the Department of Health and Human Services to defer to insurers to establish prescription drug tiers.
Also in the rule, mental health facilities and substance abuse disorder treatment centers now will be included as essential community provider categories, and rural emergency hospitals will be added as a provider type.
“Today’s announcement of the 2024 Notice of Benefit and Payment Parameters Final Rule is a step forward toward creating a health care system that prioritizes equity, access and affordability,” HHS Secretary Xavier Becerra said. “HHS remains committed to removing barriers to care to ensure quality health care is within reach for everyone who needs it.”