CMS pitches new regulations for state-run exchanges: 5 things to know

CMS is proposing several new regulations for the ACA marketplace in 2025, including tighter regulation of state-based marketplaces. 

In a proposed rule issued Nov. 15, the agency proposed several policies aimed at improving network adequacy and standardizing enrollment across marketplaces. 

Eighteen states and the District of Columbia will operate their own marketplaces in 2024, according to CMS. 

Here are five proposed changes to note: 

  1. Under CMS proposed rule, state exchanges would be required to implement the same network adequacy standards for plans as the federal exchange. The rule would not require states to apply appointment wait-time standards. 

  2. The agency is proposing adding an exception to the limit of non-standard plans insurers can offer, designed to incentivize plans targeted toward specific chronic conditions. 

  3. Beginning in 2025, state-based exchanges would have to institute an open enrollment that begins on Nov. 1 and lasts until at least Jan. 15, to keep the open enrollment period consistent across states. 

  4. States seeking to create their own exchange would have to operate as a state exchange on the federal platform for at least one year before transitioning to a fully state-operated platform. 

  5. The proposed rule would require state-based marketplaces to follow federal access standards for call centers, requiring enrollees to have access to a live call center representative during the marketplace's posted hours. 

See the full proposed rule here. 

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