The proposed rule builds on a CMS final rule on interoperability and patient access; it would leverage application programming interfaces to improve patients’ access to their electronic health information and reduce burden on providers related to prior authorization.
view more »CMS Finalizes 2021 Marketplace Rule, Letter to Issuers
May 11, 2020 ||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.
view more »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.
view more »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.
view more »CMS Publishes 2019 Essential Community Providers List
Mar 28, 2018 ||Hospitals have until Aug. 22 to petition the Centers for Medicare & Medicaid Services for inclusion on the list for the 2020 plan year.
view more »Final 2019 ECP Petitions Due Dec. 22
Dec 15, 2017 ||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.
view more »Association Comments on Draft 2019 Letter to Issuers in the Federally Facilitated Marketplace
Dec 12, 2017 ||The association emphasized access to essential community providers within qualified health plan networks in its comments on the 2019 draft letter to issuers.
view more »CCIIO Calls for State Flexibility in Letter to Issuers
Nov 30, 2017 ||The calendar year 2019 draft letter to plans offered through federally facilitated marketplaces also provides deadlines for qualified health plan certification.
view more »Association Comments on 2019 Marketplace Plan Standards
Nov 29, 2017 ||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.
view more »America’s Essential Hospitals expressed concerns about proposed changes that could harm the integrity of qualified health plan networks.
view more »CMS Extends Deadline for 2018 QHP Applications
Feb 21, 2017 ||CMS has pushed back by seven weeks, to June 21, the deadline for qualified health plans to apply to participate in the ACA health insurance marketplaces in 2018.
view more »The proposed rule aims to provide flexibility by targeting network adequacy reviews & inclusion of essential community providers in qualified health plans.
view more »CMS Finalizes Standards To Strengthen ACA Marketplaces
Dec 20, 2016 ||CMS finalized a proposal to continue the current methodology, which qualified health plans use to satisfy the minimum essential community provider standard.
view more »Association Letter Calls for Marketplace Network Adequacy
Dec 2, 2016 ||America's Essential Hospitals expressed continued concerns about qualified health plan network adequacy in federally facilitated marketplaces.
view more »CMS Releases Draft Letter to 2018 QHP Issuers
Nov 15, 2016 ||The letter provides operational and technical guidance to issuers of qualified health plans through the federal health insurance marketplace for 2018.
view more »Essential Community Provider Applications Due Oct. 15
Sep 20, 2016 ||Hospitals eligible for the essential community providers list are participants in the 340B and DSH programs, critical access hospitals, and others.
view more »CMS Proposes New Standards to Strengthen ACA Marketplaces
Sep 7, 2016 ||Comments on the proposed Notice of Benefit and Payment Parameters for 2018 are due by Oct. 6.
view more »Association Calls for Greater ECP Inclusion in Marketplaces
Jan 16, 2016 ||Comments urge CCIIO to require that ACA marketplace plans include willing essential community provider (ECP) hospitals and ensure payment rates support access to care.
view more »CCIIO Releases Draft Letter to 2017 QHP Issuers
Jan 6, 2016 ||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.
view more »HHS Says No Marketplace Qualified Plan Comparable to CHIP
Dec 9, 2015 ||Out-of-pocket expenses higher in ACA marketplaces and coverage worse for children, especially those with special needs, HHS reports.
view more »Proposals would make required and recommended changes to how qualified health plans operate in Affordable Care Act marketplaces.
view more »Network Adequacy Model Law Passes Hurdle Toward Adoption
Nov 17, 2015 ||Model law would update requirements for insurance carriers in the health insurance marketplaces, particularly regarding provider directories, mental health services, telehealth, and nondiscrimination.
view more »States Can Waive ACA Provisions with Alternative Coverage Plans
Jul 29, 2015 ||Plans must be budget-neutral and cover as many people as traditional ACA reforms. With these waivers, states may forgo certain ACA provisions including the marketplaces and individual mandate.
view more »Feb. 20 final rule and letter to issuers outline benefit and payment parameters for 2016 health insurance marketplace plans
view more »Association Calls for ECP Inclusion in Marketplaces
Jan 13, 2015 ||The association submitted comments to CCIIO and NAIC calling for more robust standards for including ECPs in health insurance marketplaces.
view more »Association Submits Comments on ECP Standards
Jan 6, 2015 ||America's Essential Hospitals urged HHS to improve ECP standards in the marketplaces to ensure patients have access to quality, affordable health care.
view more »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.
view more »On the Hill: GOP Leadership Elections, Stalled Appropriations, Hearings on Narrow Networks and MedPAC Report
Jun 17, 2014 ||The Labor/HHS appropriations bill vote was cancelled due to Republican threats to derail the process over ACA funding. House Majority Leader Cantor's loss has House Republicans vying for his seat. MedPAC shares its biannual report to Congress on Wednesday.
view more »HHS Clarifies Foundations Can Make Payments to QHPs
May 28, 2014 ||HHS reiterates that charitable foundations are not prohibited from making payments on behalf of enrollees in qualified health plans.
view more »Association Comments on Third-Party Premium Assistance Rule
May 13, 2014 ||Comments include requests to allow provider-supplemented premium assistance and cost-sharing for individuals obtaining marketplace coverage and to clarify that QHPs should accept premium and cost-sharing assistance from private, nonprofit foundations.
view more »CMS Proposes Marketplace Quality Standards
Mar 25, 2014 ||CMS proposes that QHP issuers collect enrollee satisfaction data for certain QHPs. This data will be one of the components used to determine QHP quality ratings. America's Essential Hospitals will submit comments on CMS' proposal for collecting enrollee satisfaction data.
view more »Administration RFI on Provider Nondiscrimination
Mar 24, 2014 ||Labor, Treasury, and Health and Human Services seek comments on the ACA’s provider nondiscrimination provision. Their request includes information on access, costs, other federal and state laws, and feasibility. Comments are due by June 10.
view more »CMS Releases Rule on QHP Payments by Third Parties
Mar 19, 2014 ||CMS stated that it encourages QHPs to reject payments from hospitals and other health care providers. The agency did not provide information about premium and cost-sharing payments made on behalf of QHP enrollees by private, nonprofit foundations. America's Essential Hospitals will submit comments to CMS urging the agency to allow such payments from private, nonprofit foundations.
view more »CCIIO Finalizes 2015 QHP Issuer Letter
Mar 19, 2014 ||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.
view more »CMS Releases New FAQs on QHP Premiums Paid by Third Parties
Feb 7, 2014 ||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.
view more »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.
view more »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.
view more »Our View: Protect Patient Access in Marketplace Plans
Oct 1, 2013 ||