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. For example, QHPs will be required to ensure that routine primary care appointments are available within 15 business days of an enrollee’s request. The rule also sets a standard, starting in the 2024 plan year, requiring QHPs on to ensure that providers meet minimum appointment wait time standards. 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 requires QHPs on the Federally-facilitated Marketplace (FFM) to ensure that certain classes of providers are available within required time and distance parameters. The rule helps ensure that patients have access to the right provider, at the right time, in an accessible location. Implementing New Network Adequacy Requirements These plans will be differentially displayed on to help consumers make more informed choices about their coverage. Issuers offering QHPs on 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. They also include simpler cost-sharing structures that will allow consumers to more easily understand their coverage. 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. 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. 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. 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. 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. “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.” 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. “The recent Open Enrollment Period demonstrated the demand for high-quality, affordable health coverage. 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.” “By including new standardized plan options on, we are making it even easier for consumers to compare quality and value across health care plans. “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. 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). Today, 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 that best meets their needs. New measures will help consumers compare health insurance plan choices
0 kommentar(er)
