The proposed provisions are part of the third installment of the payment notice for 2022.
The Centers for Medicare & Medicaid Services (CMS) on Monday issued a series of proposed provisions to build on the Affordable Care Act (ACA), expand health coverage access, and advance health equity. The provisions are the third installment of the payment notice for 2022.
The proposed rule aims to lengthen the annual open enrollment period for 2022 by an additional 30 days; create a new special enrollment period for certain low-income consumers; and expand the duties of Federally-facilitated Exchange (FFE) Navigators to offer additional help to consumers enrolling in plans.
The latest updates build upon and revisit several of the policies in the Notice of Benefit and Payment Parameters for 2022 (the 2022 payment notice), which was finalized in two phases. The proposed rule aims to provide greater access to coverage, improve affordability for consumers, and reduce burden for issuers and consumers.
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The proposal will be published in the Federal Register on July 1. If finalized, the rule would provide consumers greater access to coverage through greater education and outreach, improve affordability for consumers, reduce administrative burden for issuers and consumers, and improve program integrity. Each of these measures would strengthen the ACA or otherwise promote the policy goals outlined in President Joe Biden’s Executive Order in January. Comments on the proposed rule are due July 28.
The rule also proposes:
- Modifications to policies related to State Innovation Waivers (“section 1332 waivers”), which empower states to pursue new strategies for providing residents with access to coverage. This includes proposals related to the interpretation of the statutory guardrails and flexibilities in public notice and post-award public participation requirements under future emergent circumstances if certain criteria are met. The rule also includes proposals regarding the process for amending or extending approved section 1332 waivers.
- The ability of CMS to collect and dedicate additional revenue to fund consumer outreach and education through modest increases in user fee rates for issuers in FFE states and State-based Exchanges on the Federal platform (SBE-FP). CMS proposes to increase the FFE user fee rate to 2.75 percent of premiums and the SBE-FP user fee rate to 2.25 percent of premiums. This increase from the rates currently finalized in part one of the 2022 Payment Notice–2.25 percent and 1.75 percent, respectively would account for an increase in funding for consumer information and outreach and the FFE Navigator program. These proposed rates are lower than the current 2021 benefit year user fee rates, CMS noted in a fact sheet.
- Reinstatement of expanded duties applicable to Navigators in the FFEs to ensure that consumers have access to skilled assistance beyond applying for and enrolling in health insurance coverage. These include, for example, assistance with the process of filing Exchange eligibility appeals, understanding basic information about reconciliation of premium tax credits, and understanding basic concepts and rights related to health coverage and how to use it, such as locating providers and accessing care. Raising such awareness and supporting Navigators’ responsibilities remain key to reaching underserved communities where access to health insurance coverage has been low and disparities in health outcomes continue to rise.
For more information, see the CMS announcement, fact sheet, and the unpublished proposed rule.