Smart Benefits: CMS Proposes Improvements for Marketplace
Monday, November 30, 2015
The Notice includes several proposed policy changes that would apply to coverage available to consumers in 2017, including:
• Provider Network Adequacy Standard: To protect access to healthcare providers and delivery organizations in light of a broad shift toward narrow provider networks, CMS is proposing asking states to establish a provider network adequacy standard for plans in the federal marketplace, subject to minimum criteria established by CMS.
• Standardized Options: To make it easier for consumers to compare plans based on key provisions, CMS is proposing to give issuers the choice to offer plans with standardized options such as cost-sharing along with other plans with more variable plan designs so consumers can more easily choose the plan that’s right for them.
• Out-of-Pocket Costs: To reduce surprises, CMS is proposing a requirement that health plans in the federal marketplace count certain out-of-pocket expenses on unexpected out-of-network services towards a policy holder’s annual out-of-pocket maximum if they were performed in-network and advance notice wasn’t provided. For example, if a patient had surgery at an in-network facility and later learns the anesthesiologist wasn’t part of the health plan’s network, cost-sharing charges for the anesthesiologist’s services would count toward the out-of-pocket maximum.
CMS is seeking comment on these and many other proposals in the Notice, details of which can be found here.
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