CMS proposes cap on nonstandard ACA plans, network adequacy standard changes for 2024

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来源: FierceHealthcare

The Centers for Medicare & Medicaid Services wants to reduce the number of plan options for consumers shopping on HealthCare.gov, proposing a limit on nonstandardized plans.

The Biden administration wants to limit to two the number of nonstandardized Affordable Care Act (ACA) exchange plans an insurer can offer on HealthCare.gov in 2024 as part of an effort to make it easier for consumers to pick a plan.

The Centers for Medicare & Medicaid Services (CMS) released Monday the proposed Notice of Benefit and Payment Parameters rule governing the ACA exchanges for the 2024 coverage year. The proposed rule also includes key changes to network adequacy standards and will slightly lower user fees for 2024.

“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,” said CMS Administrator Chiquita Brooks-LaSure in a statement. “If finalized, this proposed rule does just that.”

For the 2023 coverage year, CMS introduced standardized plan options for consumers shopping on HealthCare.gov and small group markets. However, the agency has been concerned over the major increase of plans that have increased for consumers to choose from in recent years.

“The average number of plans available to consumers on the marketplace has increased from 27.1 in [plan year] 2019 to 131.4 in [plan year] 2023,” according to a release on the rule. “Having too many plans to choose from can limit consumers’ ability to make a meaningful selection when comparing plan offerings.”

CMS proposes to limit to two the nonstandardized plan options for each product network type and metal tier level, with an exception for catastrophic plans. This requirement only applies to HealthCare.gov, which residents in 38 states use to buy ACA plans. It does not apply to state-run marketplaces.

The requirement applies both to plans offered on HealthCare.gov and the small business marketplace.

The agency seeks to add to the standardized plan option requirements as well, including a proposal to no longer include a standard option for the non-expanded bronze plan tier. If finalized, plans would have to offer standardized options for every level except for non-expanded bronze.

CMS is also making changes to the network adequacy and essential community provider (ECP) standards that all individual market plans must meet. It proposed that substance use disorder treatment facilities and mental health facilities be included in ECP categories, which refer to providers that work in a high level of low-income or medically underserved individuals.

Health plans must have a certain number of ECPs in their network. CMS will continue the 35% provider participation threshold they have to meet for ECPs and extend that threshold to two ECP categories: family planning providers and health centers.

“These changes would increase provider choice and access to care for low-income and medically underserved consumers,” CMS said in a fact sheet on the proposed rule, which must be finalized by next April.

CMS also proposed that for 2024, the user fee for plans sold on the marketplace will decline from 2.75% to 2.5%. The user fees for plans sold on the small business marketplace will also decline from 2.25% to 2% in 2024.

“We anticipate these user fee rate decreases may exert downward pressure on insurance premiums, resulting in lower costs for consumers,” the fact sheet said.

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