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The Center for Medicare and Medicaid Services recently released its annual report Proposed rules Regarding the reform of the Affordable Care Act market. Here are the five elements of a comprehensive proposal, called notifications of benefits and payment parameters, to keep your attention:
1. The Biden administration wants a clear turnaround Trump era policy Sexual orientation and gender identity have been removed from the non-discrimination regulations of CMS. The clause will prevent exchanges, insurance issuers, agents and brokers from discriminating against consumers based on their sexual orientation or gender identity. The proposed rules also recommend requiring the design of basic health benefits guaranteed by the exchange plan based on clinical evidence. Katie Keith, a professor of health law at Georgetown University, said this could lead to plans that provide similar insurance for medically necessary care.
2. The CMS proposal requires federally funded exchanges and issuers of state-based exchanges operating on federal platforms to provide standardized plans-products with fixed deductibles and out-of-pocket and co-payment limits-and Each of their non-standardized products. Issuers do not need to provide standardized options for product network types, program levels, or service areas that have not yet provided a program.This will build on a 2017 Obama Administration Initiative, Which was later revoked by Trump CMS, which further actually required standardized planned products.
3. CMS hopes to maintain user fees from the 2022 plan year in 2023, which means that consumers will pay 2.75% of their monthly premiums for federal exchange user fees, and for the use of state-based transactions run through the federal platform 2.25% of the premium paid. The premium adjustment ratio in 2023 is about 1.44%. CMS will guide Agree to the proposed exchange rules. The maximum annual limit for cost sharing in 2023 is US$9,100 for self-insurance only and US$18,200 for other insurance. According to the guidelines, this is an increase of approximately 4.6% from the 2022 percentage.
4. The proposed rules make a number of changes to the 2023 risk adjustment model, including suggesting that insurance companies collect and disclose additional data to the registered data server of CMS. According to the proposal, insurance companies must collect data on the postal code, race, personal insurance medical reimbursement arrangements and subsidy indicators of the insured person. Keith said that if finalized, this move may give the Department of Health and Human Services room to formulate more policies based on evidence of health equity.
5. The agency also asked for opinions on how HHS can incentivize qualified health plans to incorporate health equity into their design and address social determinants of health issues. The agency will also accept comments on how insurance companies are responding to the health effects of climate change and how to let consumers choose less overwhelming plans. Comments on these issues and other parts of the rules will expire on January 27.
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