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  • Washington Highlights

    CMS Releases ACA Notice of Benefit and Payment Parameters for 2023 Proposed Rule


    Mary Mullaney, Director, Hospital Payment Policies

    The Centers for Medicare & Medicaid Services (CMS) released the Notice of Benefit and Payment Parameters for 2023 proposed rule on Dec. 28, 2021. The proposed rule includes proposals for issuers offering qualified health plans (QHPs) through federally facilitated Exchanges and state-based Exchanges on the federal platform. Exchanges are entities, established under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), through which qualified individuals and qualified employers can purchase health insurance coverage in QHPs.

    Highlights of the proposed rule include:

    • Requiring all issuers to offer standardized plan options for every product network type, metal type, and plan classification, as well as every service area where the issuer will offer Marketplace plans. Standardized plan options have a uniform cost-sharing structure.
    • Reestablishing federal network adequacy reviews in states utilizing the federally facilitated Exchanges. The standards used for these reviews would highlight key characteristics like time and distance to care, as well as appointment wait times.
    • Requiring issuers to include 35% of available essential community providers (ECPs) in their network for each plan’s service area. There is a proposal to add Substance Use Disorder Treatment Centers as eligible ECPs.
    • Prohibiting health insurance issuers from discriminating on the basis of sexual orientation and gender identity.
    • Refining the Essential Health Benefits nondiscrimination policy by requiring issuers to rely on clinical evidence as a basis of the health plan design. For example, plans could not be designed to burden people managing chronic conditions with inordinately high prescription costs, absent a clinical rationale.

    Comments on the proposed rule are due by 5 p.m. on Jan. 27.