The Centers for Medicare & Medicaid Services (CMS) released the Patient Protection and Affordable Care Act 2023 Notice of Benefit and Payment Parameters final rule. The rule finalizes regulatory changes in the individual and small group health insurance markets and establishes parameters and requirements issuers need to design plans and set rates for the 2023 plan year. The rule also aims to improve enrollment policies for qualified health plans offered on the federal Marketplace to ensure consumer access to quality and affordable coverage and to advance health equity.
As the Association for Clinical Oncology (ASCO) recommended in comments to CMS, beginning in plan year 2023, issuers in the Federally facilitated Marketplace (FFMs) and State-based Marketplaces on the Federal Platform (SBM-FPs) will be required to offer standardized benefit plans at each metal level where a non-standardized plan is offered. CMS will differentially display the standardized plans, enabling consumers, especially those with limited English proficiency, complex medical needs, and low health literacy, to compare plans more easily during the selection process.
ASCO applauds CMS for finalizing the “guaranteed availability” proposal, which will prevent insurers from requiring payment of past-due premiums before accepting an applicant for new coverage. Eliminating barriers to health coverage that disproportionately affect low-income individuals will advance health equity.
In plan year 2023, CMS will conduct network adequacy reviews in all states with a FFM based on time and distance standards. In plan year 2024, CMS will evaluate qualified health plans (QHPs) for compliance with appointment wait time standards. CMS will also require QHPs to submit information on whether providers participating in their network offer telehealth services.
ASCO applauds CMS for refining the essential health benefit (EHB) nondiscrimination policy to ensure that benefit designs are based on clinical evidence and do not discriminate based on age, health conditions, and sociodemographic factors. The Association supports policies based on clinical evidence and that ensure all individuals with cancer have equitable access to health insurance coverage.
ASCO previously supported CMS’ proposal to prohibit a health insurance issuer from employing marketing practices or benefit designs that would discourage the enrollment of sexual and gender minority individuals and to restore protections for sexual and gender minority individuals established under the Obama administration. While CMS did not address stakeholder comments or update regulations in the final rule, the Department of Health and Human Services is developing a proposed rule addressing prohibited discrimination based on sex in health coverage under section 1557 of the ACA. To ensure consistency with policies and requirements that will be included in the section 1557 rule, CMS will address nondiscrimination proposals related to sexual orientation and gender identity at a later time.
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