HHS Releases 2024 Benefits and Payment Parameters Proposed Rule

These proposed rules focus on expanding access to healthcare options under the Affordable Care Act’s health insurance marketplaces. The Centers for Medicare and Medicaid Services (CMS) proposes that beginning January 1, 2024, Marketplaces have the option to implement a new special rule for consumers losing Medicaid or Children’s Health Insurance Program coverage. Of special note, CMS also proposes to permit assisters to conduct door-to-door enrollment to increase consumer engagement and advance health equity. Included in the proposed rule is to revise network adequacy and essential community provider (ECP) standards and expand access to care for low-income and medically underserved consumers by establishing two additional major ECP categories for Plan Year 2024 and beyond: Mental Health Facilities and Substance Use Disorder (SUD) Treatment Centers. Beginning in 2024, this rule would allow marketplaces the ability to modify auto re-enrollment for those eligible for cost-sharing reductions who would normally be auto-enrolled into a bronze plan but instead be automatically re-enrolled into a silver plan in the same product with a lower or equivalent premium. In addition, CMS proposes minor updates to standardized plans, including placing all covered generic drugs in a cost-sharing tier.

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