CMS proposes new rule for ACA plans: 5 things to know

CMS is proposing a new rule to streamline options on the ACA marketplace and add more provider network requirements. 

CMS issued a fact sheet Dec. 12 explaining the agency's proposed changes for 2024. Here are five proposed changes to note: 

  1. The agency proposes all plans must comply with essential community provider and network adequacy requirements. Requiring all plans to use a network would "better ensure consumer access to a sufficient choice of providers and would guarantee consumers have access to information on the availability of in-network providers," the agency said. 

  2. CMS also wants to add two new categories of providers to network adequacy requirements: mental health facilities and substance use disorder treatment centers. The agency also wants to require 35 percent provider participation for federally qualified health centers and family planning facilities. 

  3. CMS wants to prevent overwhelming customers with options. The average customer on the marketplace has over 100 options to choose from currently, a number that "limits consumers' ability to make a meaningful selection when comparing plan offerings," CMS said. 

  4. The agency proposed two ways of reducing plan numbers. The first is to limit the number of nonstandard plan options payers can offer to two per product network and metal level. The other proposal is to apply a meaningful difference standard to plans. Two plans in the same group would need to have a difference of at least $1,000 in deductible to both be offered to consumers. 

  5. CMS wants to add a special enrollment period on the marketplace for people who are losing Medicaid or CHIP coverage. The special enrollment period would allow people to transition more smoothly from Medicaid to marketplace coverage, CMS said. 

Read the full proposed rulehere.

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Top 40 articles from the past 6 months