The rule updates essential community provider requirements for qualified health plans and adds a special enrollment period for those losing Medicaid or CHIP coverage.

The proposed rule updates essential community provider requirements for qualified health plans and adds a special enrollment period for those disenrolled from Medicaid or CHIP.

CMS issued the 2021 final notice of benefit and payment parameters rule and letter to issuers updating regulatory and financial standards for plans offered on the health insurance marketplaces. CMS provides detailed options for issuers to adopt value-based designs for marketplace plans.

In its March report to Congress, the Medicaid and CHIP Payment and Access Commission included chapters analyzing Medicaid disproportionate share hospital payments, state readiness to report on core quality measure sets, and Section 1115 waiver evaluations.

CMS issued the 2021 notice of benefit and payment parameters proposed rule and draft letter to issuers updating regulatory and financial standards for plans offered on the health insurance marketplaces. CMS is not proposing any changes to network adequacy standards.

The new guidance outlines the types of rules association health plans must follow under the Employee Retirement Income Security Act and reiterates that states and the Department of Labor have a joint responsibility to regulate such plans.

The Department of Labor has issued a final rule expanding the definition of "employer" for purposes of establishing association health plans.

The Centers for Medicare & Medicaid Services noted that the provisions aim to increase flexibility, improve affordability, strengthen program integrity, empower consumers, promote stability, and reduce regulatory burden in the individual and small group marketplaces.

Hospitals have until Aug. 22 to petition the Centers for Medicare & Medicaid Services for inclusion on the list for the 2020 plan year.

In a March 6 comment letter, America's Essential Hospitals urged federal officials to ensure association health plans have proper oversight and cover all necessary services for beneficiaries.

Hospitals serving low-income, underserved patients have until Dec. 22 to submit a petition for inclusion on the Centers for Medicare & Medicaid Services’ final 2019 essential community provider list.

The association emphasized access to essential community providers within qualified health plan networks in its comments on the 2019 draft letter to issuers.

The calendar year 2019 draft letter to plans offered through federally facilitated marketplaces also provides deadlines for qualified health plan certification.

The association encouraged the Centers for Medicare & Medicaid Services to ensure that state plans cover essential health benefits and include sufficient access to essential community providers.

America’s Essential Hospitals expressed concerns about proposed changes that could harm the integrity of qualified health plan networks.

The proposed rule aims to provide flexibility by targeting network adequacy reviews & inclusion of essential community providers in qualified health plans.

CMS finalized a proposal to continue the current methodology, which qualified health plans use to satisfy the minimum essential community provider standard.

America's Essential Hospitals expressed continued concerns about qualified health plan network adequacy in federally facilitated marketplaces.

The letter provides operational and technical guidance to issuers of qualified health plans through the federal health insurance marketplace for 2018.

Hospitals eligible for the essential community providers list are participants in the 340B and DSH programs, critical access hospitals, and others.

Comments on the proposed Notice of Benefit and Payment Parameters for 2018 are due by Oct. 6.

HHS finalizes 2017 Notice of Payment and Benefit Parameters rule and letter to issuers offering qualified health plans on the federally facilitated marketplace.

Comments urge CCIIO to require that ACA marketplace plans include willing essential community provider (ECP) hospitals and ensure payment rates support access to care.

Dec. 23 letter provides operational, technical guidance to qualified health plans (QHPs) and outlines network adequacy standards for plans offered through the federally facilitated health insurance marketplace.

Model law would update requirements for insurance carriers in the health insurance marketplaces, particularly regarding provider directories, mental health services, telehealth, and nondiscrimination.

The association submitted comments to CCIIO and NAIC calling for more robust standards for including ECPs in health insurance marketplaces.

America's Essential Hospitals urged HHS to improve ECP standards in the marketplaces to ensure patients have access to quality, affordable health care.

CMS, NAIC documents contain important health insurance marketplace provisions, including cost-sharing requirements. Comments due to CMS Dec. 22, to NAIC by Jan. 12, 2015.

The association submitted comments to the Departments of Labor, Health and Human Services, and the Treasury regarding their request for information on provider nondiscrimination.

The association said that CMS should implement the QRS in a way that protects consumer access to ECPs in the marketplaces. It also urged CMS to ensure the measures used in the QRS are endorsed by the National Quality Forum and risk adjusted for socioeconomic factors.

Association members explained what makes an essential hospital and the key issues facing essential hospitals to their policymakers on the Hill. The event also included reflections from senior Capitol Hill and administration staff and two award ceremonies that recognized members of Congress and congressional staff for their commitment to essential hospitals.

For 2015, each qualified health plan (QHP) network must include at least 30 percent (up from 20 percent in 2014) of all available ECPs in its service area to meet network adequacy requirements. CMS is also implementing a reasonable access review standard.

America’s Essential Hospitals protects access to care among marketplace plans. The association urged CCIIO to ensure an adequate number of ECPs are included in QHP networks. It also asked CCIIO to ensure patients have access to all hospital services in their plan’s network.

These FAQs further clarify the Nov. 4, 2013 FAQ, which stated that the U.S. Department of Health and Human Services encourages issuers to reject premium payments from third parties such as hospitals, other health care providers, and other commercial entities.

Responding to input from America’s Essential Hospitals to strengthen the essential community provider (ECP) requirements, CCIIO notes an enhanced ECP standard. America’s Essential Hospitals is pleased CCIIO recognizes that more protection is needed for ECP patients’ access to care but believes that the requirements should be strengthened further.

Of particular interest to members of America's Essential Hospitals, we are pleased to see CCIIO account for the concerns raised by our member hospitals and enhance its essential community provider standard.

Held nearly 100 meetings, educated Congress about work to ensure patient access to high quality care

Siegel, Gremminger highlighted the importance of delaying, reconsidering scheduled Medicaid DSH cuts

Despite standards, inclusion of essential hospitals and other providers not certain

Letter urges HHS to place a special emphasis on robust essential community provider participation

Plans must meet standards for quality measures, improvement strategies, consumer information

Urges CMS to keep nation's safety net in mind as agency fine tunes marketplace framework