By Kristen Ukeomah and Karen Davenport
In December, the Centers for Medicare & Medicaid Services (CMS) launched its proposed Notice of Benefits and Payment Parameters (NBPP) for plan 12 months 2024, an annual rule that governs the Affordable Care Act (ACA) medical health insurance Marketplaces and establishes requirements for well being insurers. The CHIR crew has reviewed the feedback submitted by choose stakeholder teams in response to the proposed rule. For the first weblog in our sequence, we checked out feedback submitted by well being insurers and consultant associations. In this second weblog, we summarize feedback from shopper advocacy organizations, together with:
While these organizations offered feedback on quite a lot of points, this weblog focuses on 4 main matters: community adequacy, door-to-door enrollment help, re-enrollment determination hierarchies, and standardized plans.
Network Adequacy
For plan 12 months 2024, CMS proposed requiring extra Marketplace plans to make use of supplier networks that adjust to community adequacy and important group supplier (ECP) necessities, eliminating a earlier exemption for plans with no supplier community. In addition, the 2024 NBPP would modify the ECP requirements by creating two new ECP classes for Mental Health Facilities and Substance Use Disorder (SUD) Treatment Centers. Moreover, HHS proposes a requirement for insurers to exhibit compliance with the wait time requirements established in 2023.
All of the buyer teams in our pattern help the supplier community requirement. NHeLP notes that non-network plans make it troublesome for federal regulators to make sure that plan enrollees have entry to care. In addition, all the teams in our overview approve of the 2 new ECP classes. Community Catalyst emphasizes the significance of ECPs for communities of colour and different underserved communities. AARP equally notes how the 2 new ECP classes will assist dismantle limitations to high quality take care of older Americans. Families USA strongly helps these additions, additional advocating for requirements associated to behavioral well being companies to individually study adequacy for adults and youngsters.
A few shopper teams additionally mentioned the appointment wait time requirements, usually supporting the coverage. ACS-CAN believes that quantitative requirements, like wait occasions, are important in figuring out the adequacy of a plan’s community. Families USA urges CMS to formalize steering round wait occasions in laws, versus altering these measures yearly.
Door-to-Door Assistance
CMS additionally proposed rescinding the prohibition on Navigators, Certified Application Counselors (CACs), and non-Navigator help suppliers (“Assisters”) from going door-to-door to assist customers enroll in medical health insurance. CMS asserts that prohibiting door-to-door outreach inhibits the power to help customers with restricted capability to journey, whether or not as a result of disabilities, being immunocompromised, or a scarcity of transportation.
Advocacy organizations shared a wide range of opinions concerning this proposal. Community Catalyst and NHeLP help the repeal of the prohibition, citing the important function assisters can play in Marketplace enrollment, significantly as thousands and thousands of individuals transition off of Medicaid. NHeLP factors out that door-to-door help would assist enroll hard-to-reach people and households, together with communities with out constant expertise entry, in addition to customers who don’t communicate English and people with disabilities.
However, different advocacy teams warn that door-to-door enrollment help, which can require people to share delicate private and monetary data with strangers, would open the door for scams, akin to identification theft. Families USA notes that though door-to-door outreach will be helpful for reaching particular communities, many Americans can’t distinguish true Navigators and assisters from rip-off artists. ACS-CAN additionally flags that individuals will probably reply negatively to somebody at their door showing to “sell insurance.” These organizations opposed this coverage, urging that, if CMS goes ahead with the proposal, the company ought to implement anti-fraud safeguards, akin to in depth public well being schooling on the best way to determine reliable assisters and a requirement for assisters to supply paper documentation the buyer. Advocacy organizations in favor of lifting the prohibition additionally advised establishing anti-fraud protections.
Re-Enrollment
If a shopper stays eligible for certified well being plan (QHP) protection however doesn’t actively select a plan throughout re-enrollment, a “re-enrollment hierarchy” prioritizes preserving the buyer in the identical plan or, if that plan just isn’t accessible, on the similar metallic degree. In the proposed 2024 NBPP, CMS introduced new insurance policies Marketplaces may use to robotically re-enroll sure Marketplace customers into QHPs designed to assist customers maximize potential out-of-pocket price financial savings. Under this strategy, bronze plan enrollees who’re income-eligible for cost-sharing reductions (CSRs) can be robotically moved to a silver plan, to allow them to enroll in a plan eligible for cost-sharing discount subsidies. If an enrollee’s QHP is not accessible, CMS proposed taking the buyer’s present supplier community into consideration when re-enrolling the buyer into a unique QHP. In addition, CMS requested feedback on whether or not Marketplaces ought to take into account internet premium and whole out-of-pocket prices when re-enrolling customers in future years.
Several advocacy organizations in our pattern no less than partially help these modifications. NHeLP cites analysis indicating that 30 p.c of households robotically renewed into protection can be higher off in a unique plan. Community Catalyst applauded the proposal, in addition to CMS’ effort to prioritize putting folks into plans with related supplier networks, noting that doing so may mitigate customers’ danger of incurring medical debt in the event that they had been to unintentionally obtain care from out-of-network suppliers. Similarly, ACS-CAN underscores the significance of sustaining in-network relationships for most cancers sufferers in energetic remedy and for survivors of uncommon cancers. NHeLP, nonetheless, suggests prioritizing affordability slightly than continuity of carriers and product traces when customers don’t affirmatively select a brand new plan, whereas Community Catalyst recommends that CMS deal with internet premiums and anticipated cost-sharing as separate variables for re-enrollment in future rulemaking.
Standardized and Non-Standardized Plans
In the 2023 plan 12 months, CMS instated a requirement that insurers providing QHPs within the Federally Facilitated Marketplace (FFM), or in State-based Marketplaces use the federal platform (SBM-FP), should additionally provide standardized—and simply comparable—cost-sharing and profit designs wherever they provide “non-standardized” plans. This implies that for each insurance coverage product, at each metallic degree, and in each geographic market an insurer affords non-standardized plans, they need to additionally provide a standardized plan.
For 2024, CMS intends to retain the standardized plan requirement with some modest modifications, akin to not requiring insurers to supply a standardized plan on the non-expanded bronze degree, and requiring insurers to position coated medicine into acceptable cost-sharing tiers. In a extra important change, nonetheless, CMS proposed limiting the variety of non-standardized plan choices insurers might provide. Under the proposed rule, insurers providing QHPs within the FFM and SBM-FPs would have the ability to provide solely two non-standardized plans per product community kind and metallic degree (apart from catastrophic plans) in any service space. CMS additionally supplied an alternate strategy to this numerical restrict on non-standardized plans, which might require insurers’ choices to be “meaningfully different” from each other. Under this strategy, CMS would group plans by county, insurer, metallic degree, product community kind, and deductible integration, requiring QHPs inside every group to have no less than a $1,000 distinction in deductibles.
All of the buyer advocacy teams in our pattern applaud the proposals to simplify the buyer procuring expertise by persevering with the standardized plan requirement and limiting “choice overload,” which may happen when customers face too many plan choices and battle to distinguish between merchandise. NHeLP notes that “the usual understanding that more is better for the consumer does not hold true in the Marketplace. On the contrary, the high number of plan options often leads to confusion among shoppers, which in turn gives way to consumer errors during plan selection.” Some organizations, akin to Community Catalyst, NHeLP, and ACS-CAN urge CMS to each restrict the variety of non-standardized plans insurers may provide and apply a significant distinction commonplace to a number of QHP choices.
A Note on Our Methodology
This weblog is meant to supply a abstract of feedback submitted by shopper advocacy organizations. This just isn’t meant to be a complete overview of all feedback on each provision within the Notice of Benefit and Payment Parameters proposed rule, nor does it seize each element of the reviewed feedback. To view extra stakeholder feedback, please go to https://www.regulations.gov/.