America’s Essential Hospitals has urged federal officials to ensure that Affordable Care Act (ACA) marketplace health plan standards protect access to all needed services for covered people and participation by hospitals qualified as essential community providers (ECPs).

The association made its recommendations to the Centers for Medicare & Medicaid Services in a Nov. 27 comment letter on proposed Notice of Benefit and Payment Parameters for 2019.

The annual rule proposes standards for the ACA health insurance marketplace for plan year 2019. The proposal, if finalized, would increase state flexibility in administering qualified health plans (QHPs) and operating small business health options programs.

In its comments to CMS, America’s Essential Hospitals recommended the agency:

  • ensure that state definitions of essential health benefits include all necessary services to covered individuals;
  • conduct network adequacy reviews that ensure patients have access to all hospital services within their plan’s network; and
  • amend the ECP standard to require QHP issuers to offer contracts in good faith to every willing ECP hospital in each county of a plan’s service area.

Contact Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.