Press Release
☷HHS Announces New Policy to Make Coverage More Accessible and Affordable for Millions of Americans in 2023
U.S. Department of Health and Human Services ( By Press Release office)
Apr 28,2022
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New measures will help consumers compare health insurance plan choicesToday , the Department of Health and Human Services ( HHS ) , through the Centers for Medicare & Medicaid Services ( CMS ) , announced new measures that will allow consumers to more easily find the right form of quality , affordable health care coverage on HealthCare . gov that best meets their needs . These measures set the landscape for the upcoming HealthCare . Gov Open Enrollment Period , which will begin on November 1 , 2022 , and are part of the Biden - Harris Administration’s ongoing effort to strengthen and build on the Affordable Care Act ( ACA ) . “The Affordable Care Act has successfully expanded coverage and provided hundreds of health plans for consumers to choose from , ” said Health and Human Services Secretary Xavier Becerra . “By including new standardized plan options on HealthCare . gov , we are making it even easier for consumers to compare quality and value across health care plans . The Biden - Harris Administration will continue to ensure coverage is more accessible to every American by building a more competitive , transparent , and affordable health care market . ”“The recent Open Enrollment Period demonstrated the demand for high - quality , affordable health coverage . These steps increase the value of health care coverage on HealthCare . Gov and further strengthen the health insurance Marketplace , ” said CMS Administrator Chiquita Brooks - LaSure . “This policy will make it easier for people to choose the best plan that meets their needs by standardizing plan options , like maximum out - of - pocket limitations , deductibles , and cost - sharing features . ”The 2023 Notice of Benefits and Payment Parameters Final Rule ( final 2023 Payment Notice ) makes 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 includes regulatory standards to help states , the Marketplaces , and health insurance companies in the individual and small group markets better serve consumers . Major policies include the following:Advancing Standardized Plan Options In accordance with President Biden’s Executive Order 14036 on Promoting Competition in the American Economy , the rule helps simplify the consumer shopping experience by establishing standardized plan options for issuers offering Qualified Health Plans ( QHPs ) on HealthCare . gov . With standardized maximum out - of - pocket limitations , deductibles , and cost - sharing features , consumers will be able to more directly compare other important plan attributes , such as premiums , provider networks , prescription drug coverage , and quality ratings when choosing a plan . These standardized plan options expand the availability of coverage for services before consumers meet their deductibles , which will make it easier to access important services . They also include simpler cost - sharing structures that will allow consumers to more easily understand their coverage . Issuers offering QHPs on HealthCare . gov will be required to offer standardized plan options at every network type , at every metal level ( Bronze , Silver , Gold , and Platinum ) , and throughout every service area where non - standardized options are offered starting in 2023 . These plans will be differentially displayed on HealthCare . gov to help consumers make more informed choices about their coverage . Implementing New Network Adequacy RequirementsThe rule helps ensure that patients have access to the right provider , at the right time , in an accessible location . The rule requires QHPs on the Federally - facilitated Marketplace ( FFM ) to ensure that certain classes of providers are available within required time and distance parameters . For example , a QHP on the FFM will be required to ensure that its provider network includes a primary care provider within ten minutes and five miles for enrollees in a large metro county . The rule also sets a standard , starting in the 2024 plan year , requiring QHPs on HeathCare . gov to ensure that providers meet minimum appointment wait time standards . For example , QHPs will be required to ensure that routine primary care appointments are available within 15 business days of an enrollee’s request . Additionally , HHS will review additional specialties for time ( i . e . , the time it takes the enrollee to get an appointment ) and distance ( i . e . , the distance between the provider and enrollee ) – including emergency medicine , outpatient clinical behavioral health , pediatric primary care , and urgent care . OB/GYN parameters will also be aligned with the parameters for primary care . Increasing Value of Coverage for Consumers Under the rule , CMS is updating the allowable range in metal coverage levels for non - grandfathered individual and small group market plans . This change will likely require some plans to increase the generosity of their coverage , making it more comprehensive , and lower costs for many consumers . In addition , these changes will make it easier for consumers to compare plans at the various coverage metal levels ( Bronze , Silver , Gold , and Platinum ) and distinguish between the plan offerings . Increasing Access for Consumers and Removing Barriers to CoverageThe final rule aims to protect consumers from discriminatory practices related to the coverage of the essential health benefits ( EHB ) by refining the CMS nondiscrimination policy . Specifically , a benefit design that limits coverage for an EHB on a basis protected from discrimination under this rule ( such as age and health condition ) must be clinically - based to be considered nondiscriminatory . The rule also updates Quality Improvement Strategy Standards to require issuers to address health and health care disparities . Expanding Access to Essential Community Providers Under the final rule , for Plan Year ( PY ) 2023 and beyond , CMS is increasing the Essential Community Provider ( ECP ) threshold from 20% to 35% of available ECPs in each plan’s service area to participate in the plan’s provider network . The higher ECP threshold will increase access to a variety of providers for consumers who are low - income or medically underserved . CMS anticipates that most issuers will easilymeet the 35% threshold – for PY2021 , 80% of the QHPs on the FFM already met this standard . Further Streamlining HealthCare . gov OperationsThe rule sets the FFM and State - based Marketplaces on the Federal Platform ( SBM - FPs ) user fees for 2023 at the same level as 2022 . Maintaining FFM and SBM - FPs user fees at the 2022 level will ensure adequate funding for essential Marketplace functions such as consumer outreach and education , eligibility determinations , and enrollment process activites . CMS finalizes two of the three proposed model specification changes to the risk adjustment models , improving risk prediction for the lowest and highest risk enrollees . To view the final rule in its entirety , please visit: https://www . cms . gov/files/document/cms - 9911 - f - patient - protection - final - rule . pdfTo view the final rule Fact Sheet , visit: https://www . cms . gov/newsroom/fact - sheets/hhs - notice - benefit - and - payment - parameters - 2023 - final - rule - fact - sheetTo learn more about how standardized plans can support consumer decision - making and improve competition , please see the HHS Assistant Secretary for Planning and Evaluation ( ASPE ) Issue Brief: https://aspe . hhs . gov/reports/standardized - plans - health - insurance - marketplaces
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