The Centers for Medicare and Medicaid Services will require insurers on Affordable Care Act exchanges to include mental health and substance abuse providers. their plans, among other things.
The final rule, published Monday, eases CMS’s proposed limits on how many plan option exchange insurers can offer and waives agency proposals. to standardize how carriers promote their drug formulations and differentiate between similar packages in a given market. It also reduces the fees insurance companies pay to market their products on federal and state exchanges.
It allows state-based marketplaces to implement a special enrollment period for enrollees who lose coverage of their Children’s Health Insurance Plan or Medicaid with a 60-day period before and 90 days after the loss of coverage. to subscribe to market plans. The effective date of coverage will be the first day of the following month.
That follows a similar move CMS reinforced in January for Healthcare.gov for members who lost coverage as states began withdrawing their Medicaid rolls for the first time in two and a half years.
The agency has also finalized plans to reduce the number of coverage options available and remove misleading plan names. CMS will require carriers to submit marketing names for their plans for federal or state approval.
Providers can have 16 services or four non-standard plans, one for each in bronze, silver, gold, and platinum categories, excluding benefits such as dental and vision. CMS has proposed limiting the number of non-standard plans that carriers can offer to two per category, and does not offer an option to exclude dental and vision services.
The agency’s limit on plan services comes as the number of plans available to consumers has skyrocketed from 27 in 2019 to 131 in 2023, according to federal data. CMS said it hopes the final rule will cut the average number of plans available on exchanges to 90.5 next year.
The final rule of the 2024 Notice of Benefits and Billing Specifications also includes provisions to crack down on broker sales tactics, increase navigator registration flexibility, reduce insurance company exchange fees, etc. Here’s what to know.
- CMS will require insurance companies to market their coverage for substance use disorders, mental health treatment, federally qualified medical centers and accounting providers. family planning by organizing providers into separate categories and instructing insurers to include at least 35% of such clinicians in any particular market within their network .
- Regulators have abandoned plans to require carriers to standardize how they pay for generic, brand-name and specialty drugs. The agency canceled the plan after facing opposition from insurers who said it would eliminate the ability to regulate their drug formulations. CMS said it will continue to investigate the market impact on the proposal.
- The agency abandoned its proposed plan to require a “meaningful difference” standard between insurers, which would require plans offered by the same company within the same company. region and at the same metal level for the difference in deductibles belong to more than $1,000.
- Federally funded navigators can go door-to-door to conduct registration, outreach, and consumer registration during their first meeting.
- The broker must confirm with the client the income and other personal information before submitting the application. CMS aims to extend the time it takes for the Department of Health and Human Services to resolve consumer complaints against brokers. Brokers must retain any electronic or telephone interaction they have with clients for at least 10 years.
- The user fees that insurers pay to market their products have fallen by nearly 0.5% across both the federal and state markets. Carriers will pay a 2.2% premium for plans sold in the federal market and a 1.8% premium for plans sold in the state market. The original CMS sought to halve.
- CMS will update the risk-adjusted data that plans must file for 2024 and charge insurers per member to calculate how much they owe or are owed under the federal program. The risk-adjusted program requires plans that insure healthier customers pay out to insurers whose policyholders are sicker and more expensive.
- The agency will modify the automated application process for low-income consumers to direct those eligible for cost-sharing reductions to silver plans with a similar provider network to those that qualify. their current currency.
