Strengthening Affordable Care Act (ACA)

The Biden-Harris 2020 Administration released the 2024 Notice of Benefit and Payment Parameters Proposed Rule, which aims to further advance the administration’s efforts to build on Healthy Care Act (ACA) efforts to provide and expand access to quality healthcare options for millions of Americans. This proposed rule would increase access to healthcare services, simplify choice and improve the plan selection process, and make it easier to enroll in coverage.

Expanding Access to Behavioral Health

Today, I would like to discuss the Department of Health and Human Services’ proposed rule on behavioral health care. The current administration has made expanding access to behavioral health care a top priority. As part of that effort, the proposed rule includes two new major essential community provider (ECP) categories: Substance Use Disorder Treatment Centers and Mental Health Facilities. The rule also furthers access to providers by including a proposal to extend the current overall 35 percent provider participation threshold to two major ECP categories: Federally Qualified Health Centers and Family Planning Providers.

These changes, in conjunction with a proposal to expand Network Adequacy requirements, would advance health equity and mobility for consumers who have low income, complex or chronic healthcare conditions or who reside in underserved areas. Providers will be able to choose from a broader range of participating health plans and have a better understanding of their network.

Improving Health Plan Selection Process

This rule includes proposals to make it easier for consumers to pick a health plan that best fits their needs and budget. It updates designs for standardized plan options and limits the number of non-standardized plan options available through the Federally-facilitated Marketplaces (FFMs) and State-based Marketplaces on the Federal Platform (SBM-FPs).

Consumers should be able to make better-informed decisions when comparing plan offerings on the Marketplaces. Streamlining the plan selection process would make it easier for them to evaluate plan choices available on the Marketplaces and to select a health plan that best fits their unique health needs.

Ease of Enrollment

The proposed rule would give the Marketplaces the option to implement a new rule for the special enrollment period for people losing Medicaid or Children’s Health Insurance Program (CHIP) coverage. This option would mean that consumers would have 60 days before, or 90 days after, their loss of Medicaid or CHIP coverage to select a Marketplace plan.

The proposed rule takes steps to improve the Marketplace experience for consumers by offering a wider range of options for coverage effective dates, including earlier coverage effective start dates for consumers attesting to a future coverage loss. Through these changes, CMS believes that eligible individuals will be able to seamlessly transition from other forms of coverage to Marketplace coverage as quickly as possible with no coverage gaps.

When you visit an enrollment assistance site, you’ll be able to ask questions, meet with a navigator or other assisters, and get assistance in enrolling into health insurance. You might also be eligible to receive assistance in selecting the right plan.

Enrollees who are eligible for lower-priced health plans could be automatically re-enrolled in a more costly QHP. Our proposal would ensure these consumers are automatically enrolled into their same plans or lower-cost, more generous plans when available. This would lower their healthcare costs by taking advantage of these savings.