Consumer / Employer, Payers

CMS Releases Proposed Rule to Advance ACA Coverage in 2024

CMS hopes the changes will increase healthcare access for underserved populations, streamline the plan selection process and simplify enrolling in Marketplace coverage.

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule Tuesday for Affordable Care Act (ACA) plans in 2024. The agency hopes the changes will increase healthcare access, streamline the plan selection process and simplify enrolling in coverage.

To advance access to care, CMS is proposing adding two essential community provider (ECP) categories for 2024: mental health facilities and substance use disorder treatment centers. An ECP is a provider that mostly serves low-income and medically underserved populations. Adding these categories will improve healthcare access by requiring medical qualified health plan issuers to offer a contract to at least one substance use disorder treatment center and at least one mental health facility that qualify as ECPs in each county of the plan’s service area, a CMS spokesperson said in an email.

Additionally, CMS currently requires health plans to contract with 35% of all ECPs in their area. In the new proposed rule, this requirement would be extended to 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,” CMS said in a news release.

To help Americans select health plans, CMS is also proposing limiting the number of non-standardized plan options that issuers can offer through the federal Marketplace to two per product network type and metal level in any service area. This excludes catastrophic plans. The agency said that the average number of plans available on the Marketplace increased to 113.6 in plan year 2023, compared to 25.9 in plan year 2019.

“Having too many plans to choose from can limit consumers’ ability to make a meaningful selection when comparing plan offerings,” CMS said. “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.”

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CMS is also looking to make it easier for Americans to enroll in coverage through the Marketplace. The proposed rule would add a special enrollment period for those losing Medicaid or Children’s Health Insurance Program coverage. These consumers would have 60 days before their coverage ends or 90 days after to choose 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 agency stated.

About 5.5 million people have selected a Marketplace health plan so far in the 2023 ACA open enrollment period, an 18% increase from the year prior. CMS hopes to continue that increase, said Chiquita Brooks-LaSure, CMS Administrator.

“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,” Brooks-LaSure said in the release. “If finalized, this proposed rule does just that.”

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