CMS to limit non-standard ACA plans, add special enrollment periods: 5 notes

CMS is upping its proposed number of non-standard ACA plans payers can offer in each region from two to four. 

In the final rule, published April 17, the agency upped the cap on non-standard plans, added new special exchange enrollment periods for people who have lost Medicaid coverage and established more stringent network requirements for plans. 

In a news release, CMS Administrator Chiquita Brooks-LaSure said the final rule is designed to make coverage "easier for consumers to access, choose and maintain." 

Here are five things to note from the final rule: 

  1. The agency will allow federal and state-based exchanges to establish permanent special enrollment periods, allowing people being disenrolled from Medicaid to enroll in an exchange plan 60 days before, and 90 days after, losing coverage. 

  2. The final rule establishes two new essential community provider categories: mental health facilities and substance abuse treatment centers. Exchange plans are required to contract with at least 35 percent of essential community providers in the area they serve. The final rule also extends the 35 percent requirement to Federally Qualified Health Centers and family planning providers. 

  3. CMS will delay implementing proposed appointment wait-time requirements for plans until 2025. 

  4. The agency will implement a the number of non-standardized plans payers can offer in a region to four, up from two in its proposed rule. A cap is necessary to prevent an overwhelming number of options for consumers, CMS said. The agency estimates the cap will bring the average number of plan options consumers have to 90.5 in 2024, down from 113.7 in 2023. 

  5. The final rule expands the abilities of assisters, who conduct outreach and education about marketplace plans, but cannot directly enroll people in plans under current rules. The final rule will allow assisters to enroll consumers, a change CMS said will reduce burdens on consumers with a lack of transportation or inflexible job schedules. 

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