Today, the Biden-Harris Administration released the 2024 Notice of Benefit and Payment Parameters Proposed Rule that aims to further advance the Administration’s efforts to build on the Affordable Care Act’s (ACA) efforts to provide and expand access to quality health care options for millions of consumers. The proposed rule would increase access to health care services, simplify choice and improve the plan selection process, and make it easier to enroll in coverage.
“The Biden-Harris Administration has taken historic action to expand access to health care, and the Affordable Care Act Marketplace provides millions of Americans vital coverage,” said HHS Secretary Xavier Becerra. “As we make a final push now during Open Enrollment, we are encouraged that so many people are signing up for Marketplace health plans. Already we are working to build on this success.”
“We know that access to affordable health care is a concern across the nation. During the first several weeks of Affordable Care Act Marketplace Open Enrollment, we have already seen 5.5 million people select a Marketplace health plan, an 18% increase compared to last year” said CMS Administrator Chiquita Brooks-LaSure. “Continuing to propose policies that help make it easier for consumers to choose and maintain the health coverage that best fits their needs is vital. If finalized, this proposed rule does just that.”
Increasing access to health care services
The Biden-Harris Administration has made expanding access to behavioral health care a top priority. As part of that effort, the proposed rule includes two new major essential community provider (ECP) categories that are critical to delivering needed behavioral health care: Substance Use Disorder Treatment Centers and Mental Health Facilities. The rule also furthers access to providers by including a proposal to extend the current overall 35% provider participation threshold to two major ECP categories: Federally Qualified Health Centers and Family Planning Providers. These changes, in conjunction with a proposal to expand Network Adequacy requirements, would increase provider choice, advance health equity, and expand access to care for consumers who have low income, complex or chronic health care conditions, or who reside in underserved areas, as these consumers are often disproportionately affected by unanticipated costs associated with provider network status and limited access to providers.
Simplifying choice and improving the plan selection process
In response to public feedback, the rule includes proposals to make it easier for consumers to pick a health plan that best fits their needs and budget by updating designs for standardized plan options and limiting the number of non-standardized plan options offered by issuers of qualified health plans (QHPs) through the Federally-facilitated Marketplaces (FFMs) and State-based Marketplaces on the Federal Platform (SBM-FPs). The average number of plans available to consumers on the Marketplace has increased from 25.9 in PY2019 to 113.6 in PY2023. Having too many plans to choose from can limit consumers’ ability to make a meaningful selection when comparing plan offerings. Streamlining the plan selection process would make it easier for consumers to evaluate plan choices available on the Marketplaces and to select a health plan that best fits their unique health needs.
Making it easier to enroll in coverage
The proposed rule would give the Marketplaces the option to implement a new rule for the special enrollment period for people losing Medicaid or Children’s Health Insurance Program (CHIP) coverage. This option would mean that consumers would have 60 days before, or 90 days after, their loss of Medicaid or CHIP coverage to select a Marketplace plan. CMS believes that this new proposed special rule would help mitigate coverage gaps when consumers lose Medicaid or CHIP while allowing for a more seamless transition into Marketplace coverage.
The proposed rule also changes the current coverage effective date requirements so that Marketplaces have the option to offer earlier coverage effective start dates for consumers attesting to a future coverage loss. CMS believes that these changes would ensure qualifying individuals are able to seamlessly transition from other forms of coverage to Marketplace coverage as quickly as possible with no coverage gaps.
The proposed rule will now allow assisters[1] to conduct door-to-door enrollment to increase consumer engagement and advance health equity. Assisters currently conduct door-to-door outreach, education, and schedule follow-up appointments, but are prohibited from providing enrollment assistance upon an initial interaction at the consumers’ residence. Removing this prohibition will make it easier for consumers to get help when enrolling into coverage.
Under current re-enrollment processes, enrollees who are eligible for lower priced health plans could be automatically re-enrolled in a more costly QHP. This rule includes a proposal that would ensure these consumers are automatically enrolled into their same plans or a lower-cost, more generous plans when available, lowering their health care costs by taking advantage of these savings.
For more information on the proposed rule, consult the fact sheet.
To review the Notice of Benefit and Payment Parameters for 2024 Proposed Rule, visit the CMS website. The 45-day public comment period will begin once published in the Federal Register.
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[1] Assisters includes Navigators, Non-Navigator Assistance Personnel, Certified Application Counselors (CACs), and CAC Designated Organizations (CDOs).