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.

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.

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.

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 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.

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.

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.

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.

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.

Out-of-pocket expenses higher in ACA marketplaces and coverage worse for children, especially those with special needs, HHS reports.

Proposals would make required and recommended changes to how qualified health plans operate in Affordable Care Act marketplaces.

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

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.

Feb. 20 final rule and letter to issuers outline benefit and payment parameters for 2016 health insurance marketplace plans

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 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.

HHS reiterates that charitable foundations are not prohibited from making payments on behalf of enrollees in qualified health plans.

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.

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.

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.

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.

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.

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.