The 2024 Notice of Benefit and Payment Parameters Proposed rule aims to increase access to health care services in the Affordable Care Act (ACA) marketplace, simplify choice and improve the plan selection process, and reduce consumer barriers.
The Biden Administration released the proposed rule on Monday in the wake of an increase in people signing up for coverage on the marketplace during the open enrollment period
"We know that access to affordable health care is a concern across the nation. During the first several weeks of Affordable Care Act Marketplace Open Enrollment, we have already seen 5.5 million people select a Marketplace health plan, an 18 percent increase compared to last year,” said Chiquita Brooks-LaSure, administrator, Centers for Medicare & Medicaid Services (CMS) in the announcement. "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. If finalized, this proposed rule does just that."
The proposed rule would:
Increase access to health care services: The proposed rule adds two new major essential community provider (ECP) categories for the delivery of behavioral health care services: Substance Use Disorder Treatment Centers and Mental Health Facilities. It also extends the current overall 35 percent provider participation threshold to two major ECP categories: Federally Qualified Health Centers and Family Planning Providers. The Department of Health and Human Services (HHS) said 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, and/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.
Simplify choice and improve the plan selection process: If finalized, the proposed rule would make it easier for consumers to pick a health plan that best fits their needs and budget by updating designs for standardized plan options and limiting the number of non-standardized plan options offered by qualified health plans (QHPs) through the Federally-facilitated Marketplaces (FFMs) and State-based Marketplaces on the Federal Platform (SBM-FPs). The average number of plans available to consumers on the Marketplace has increased from 27 in 2019 to 131 in 2023. Having too many plans to choose from can limit consumers' ability to make a meaningful selection when comparing plan offerings. 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.
Make it easier to enroll in coverage: The rule would give the Marketplaces the option to implement a special enrollment period for people losing Medicaid or Children's Health Insurance Program (CHIP) coverage. This option would mean that consumers would have 60 days before, or 90 days after, their loss of Medicaid or CHIP coverage to select 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.
Change effective date requirements: The proposal also changes the current coverage effective date requirements so that Marketplaces can offer earlier coverage effective start dates for consumers attesting to a future coverage loss. CMS believes that these changes would ensure qualifying individuals are able to seamlessly transition from other forms of coverage to Marketplace coverage as quickly as possible with no coverage gaps.
Increase consumer engagement and advance health equity: Assisters would be able to conduct door-to-door enrollment to increase consumer engagement and advance health equity. Although assisters currently conduct door-to-door outreach, education, and schedule follow-up appointments, they may not provide enrollment assistance upon an initial interaction at the consumers' residence. Removing this prohibition will make it easier for consumers to get help when enrolling into coverage. In addition, under current re-enrollment processes, enrollees who are eligible for lower priced health plans could be automatically re-enrolled in a more costly QHP. This rule includes a proposal that would ensure these consumers are automatically enrolled into their same plans or a lower-cost, more generous plans when available, lowering their health care costs by taking advantage of these savings.
Revise network adequacy an essential community provider (ECP) standards: The proposal would provide that all individual market QHPs, including stand-alone dental plans, and all plans under the Small Business Health Option Program, across all marketplace-types must use a network of providers that complies with the network adequacy and ECP standards in those sections, and to remove the exception that these sections do not apply to plans that do not use a provider network. By requiring that all QHPs use a provider network will ensure consumer access to a sufficient choice of providers and would guarantee consumers have access to information on the availability of in-network providers, HHS said in a fact sheet.