The departments of the Treasury and Health and Human Services July 1 published a proposed rule on Affordable Care Act (ACA) payment parameters and marketplaces for the 2022 plan year. The rule would extend open enrollment, add a new special enrollment period (SEP), expand navigator responsibilities, and modify Section 1332 innovation waivers.
The proposed rule would extend annual open enrollment by 30 days, to Nov. 1–Jan. 15.
The rule also calls for a new monthly SEP for qualified individuals or dependents of a qualified individual who are eligible for a premium tax credit and whose household income is no greater than 150 percent of the federal poverty level. This change would allow eligible consumers to select marketplace coverage that starts the first day of the following month. This SEP would be optional for state exchanges.
This SEP also would help consumers who lose Medicaid coverage regain affordable health coverage. Current rules allow a 60-day SEP triggered by the loss of Medicaid coverage; the departments propose to allow enrollment beyond the 60-day limit following the loss of Medicaid eligibility.
Expanding Navigator Duties
Navigators help consumers review health coverage options and complete eligibility and enrollment forms. The proposed rule would reinstate requirements that navigators in federally-facilitated marketplaces provide information and assistance with certain post-enrollment topics, including:
- filing appeals of marketplace eligibility determinations;
- marketplace-related components of the premium tax credit reconciliation process and availability of IRS resources, including ensuring access to their Forms 1095-A as well as how to report errors on the form;
- referrals to licensed tax advisers and tax preparers;
- coverage claim denials; and
- basic concepts and rights related to health coverage, such as key terms, how to evaluate options, identifying in-network options, and coverage of preventive services without cost-sharing.
The proposal to expand navigators’ responsibilities aligns with an $80 million increase in grant funding for navigators in fiscal year 2022.
1332 Innovation Waiver Changes
The ACA created Section 1332 waivers for states to seek additional flexibility to pursue various strategies that provide affordable health coverage within a defined set of guardrails. The proposed rule rescinds guidance from the previous administration and modifies Section 1332 innovation waiver guidance on public notice requirements, procedures for amendments, and other issues.
America’s Essential Hospitals will monitor developments on this topic. The Centers for Medicare & Medicaid Services is accepting comments on the proposed rule until July 28.
Contact Senior Director of Policy Erin O’Malley at firstname.lastname@example.org or 202.585.0127 with questions.