CMS proposes ACA expansion on behavioral health, special enrollment
The Centers for Medicare and Medicaid Services (CMS) has proposed changes in the 2024 Notice of Benefit Payment Parameters Proposed Rule that aim to improve access to care. The revisions impact insurers operating on the Affordable Care Act marketplace.
Broadly, the revisions in the rule aim to improve healthcare access and expand healthcare options through more providers, with particular focus around behavioral healthcare. The proposed rule comes during the open enrollment period for the 2023 plan year. Open enrollment ends Dec. 15.
“We know that access to affordable healthcare 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% increase compared to last year,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “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 includes two new major essential community provider categories in behavioral healthcare, substance use disorder treatment centers and mental health facilities. The proposal also extends the current overall 35% provider participation threshold to two major ECP categories, including federally qualified health centers and family planning providers. CMS aims to increase provider choice, advance health equity and expand access to care for low-income consumers or those with complex or chronic health conditions. CMS will achieve this in conjunction with a proposal to expand Network Adequacy requirements.
CMS also intends to make picking a health plan easier by updating designs for standardized plan options and limiting the number of non-standardized plan options offered by issuers of qualified health plans through the federal and state marketplaces. The changes will likely improve the problem of too many options. For example, the average number of plans available to consumers jumped from 25.9 in plan year 2019 to 113.6 in plan year 2023.
“Having too many plans to choose from can limit consumers’ ability to make a meaningful selection when comparing plan offerings,” CMS stated. “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.”
Plus, the proposed rule addresses the need for more people to sign up for health insurance if they lose eligibility for Medicaid. An estimated 18 million people will lose Medicaid coverage once the public health emergency for COVID-19 ends sometime next year. CMS is proposing a new rule for the special enrollment of people losing Medicaid or Children’s Health Insurance Program (CHIP) coverage. Consumers would have 60 days before or 90 days after their loss of Medicaid or CHIP to select a marketplace plan.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."