CMS Proposed Rule to Increase Americans’ Access to Health Coverage for 2022
The Centers for Medicare & Medicaid Services (CMS) today proposed
a series of provisions to follow through on President Biden’s
commitment to build on the Affordable Care Act (ACA), expand health
coverage access and advance health equity. These provisions are the
third installment of the payment notice for 2022.
The proposed rule includes a
variety of provisions to protect and expand Americans’ access to
high-quality, affordable health insurance. This includes proposals to
lengthen the annual open enrollment period for 2022 by an additional 30
days, create a new special enrollment period opportunity for certain
low-income consumers, and expand the duties of Federally-facilitated
Exchange Navigators to offer additional help to consumers enrolling in
plans. These actions demonstrate a strong commitment by the Biden-Harris
Administration to extend health insurance coverage to more Americans
and make it easier and more affordable to get covered.
These updates build upon and
revisit several of the policies in the Notice of Benefit and Payment
Parameters for 2022 (or “2022 payment notice”), which was finalized in
two phases. Today’s proposed rule furthers CMS’s work to provide
greater access to coverage, improve affordability for consumers and
reduce burden for issuers and consumers.
Strengthening the Exchanges and Improving Issuer Billing
The
proposed rule would give Exchanges the option of offering a new special
enrollment period to provide additional opportunities for certain
low-income consumers to access premium-free or very low-cost coverage
available to them because of the enhanced advanced premium tax credit (APTC) provisions included in
the American Rescue Plan Act of 2021. The proposed monthly special
enrollment period would align with President Biden’s Executive Order
14009 (issued January 28, 2021), which requires federal agencies to
identify and appropriately address policies that create barriers to
accessing ACA coverage.
Several other provisions in the proposed rule
would streamline operations for the Federally-facilitated Exchanges,
health insurance issuers, and other stakeholders who facilitate access
to coverage. For example, the proposed rule would streamline issuer
billing by repealing certain requirements that could have resulted in
burdensome and costly changes to issuer billing systems. It also
proposes to lengthen the annual open enrollment period for 2022 and
future coverage years by an additional 30 days, allowing consumers more time to review plan choices.
Additionally, the rule proposes modifications
to policies related to State Innovation Waivers (sometimes called
“section 1332 waivers”), which empower states to pursue new strategies
for providing residents with access to coverage. This includes proposals
related to the interpretation of the statutory guardrails and
flexibilities in public notice and post-award public participation
requirements under future emergent circumstances, if certain criteria
are met. The rule also includes proposals regarding the process for
amending or extending approved section 1332 waivers.
Advancing Accessibility
The proposed rule would enable CMS to collect
and dedicate additional revenue to fund consumer outreach and education
through modest increases in user fee rates for issuers in
Federally-facilitated Exchange states and State-based Exchanges on the
Federal platform. The proposed user fee rates, which are levied on
issuers each year, are still lower than the current 2021 benefit year
rates. The rate change for issuers on the Federally-facilitated Exchange
would also make additional revenue available that can be used to fund
Navigators, who help consumers – particularly the uninsured – understand
their options and enroll in health insurance plans. CMS
recently announced its plan to support Navigators and their important
work with the largest-ever funding allocation for Federally-facilitated
Exchange Navigators for the 2022 plan year.
The proposed rule would also reinstitute
expanded duties applicable to Navigators in the Federally-facilitated
Exchanges to ensure that consumers have access to skilled assistance
beyond applying for and enrolling in health insurance coverage. These
include, for example, assistance with the process of filing Exchange
eligibility appeals, understanding basic information about
reconciliation of premium tax credits, and understanding basic concepts
and rights related to health coverage and how to use it, such as
locating providers and accessing care. Raising such awareness and
supporting Navigators’ responsibilities remain key to reaching
underserved communities, where access to health insurance coverage has
been low and disparities in health outcomes continue to rise.
These actions demonstrate a strong commitment
by the Biden-Harris Administration to extend health insurance coverage
to the uninsured and improve Exchange operations. They also align with
the Administration’s commitment to protect and expand Americans’ access
to comprehensive, affordable health insurance, and to ensure that systemic
barriers to opportunities and benefits for people of color and other
underserved groups are not perpetuated, as described in President
Biden’s Executive Order 13985 on Advancing Racial Equity and
Support for Underserved Communities Through the Federal Government.
These proposals also will further support the Administration’s efforts
to build on the successes of the ACA to meet health care needs created
by the COVID-19 public health emergency, reduce individuals’ health care
costs and make our health care system less complex to navigate.
For further information on these and other provisions in the proposed rule, consult the fact sheet available at: https://www.cms.gov/newsroom/fact-sheets/updating-payment-parameters-section-1332-waiver-implementing-regulations-and-improving-health
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