The Biden administration is aiming to require insurers to offer standardized plan designs on the Affordable Care Act’s (ACA’s) exchanges.
As part of the Centers for Medicare & Medicaid Services’ (CMS’) 2022 Notice of Benefit and Payment Parameters rule, which was released late Tuesday, payers would have to offer standardized plan options for every product network type, plan tier type and plan classification.
CMS said the goal is to allow consumers to have an easier shopping experience. As standardized plans share a uniform cost-sharing structure, it’s simpler to compare across plans.
“We are building a more competitive, transparent and affordable health care market,” said Department of Health and Human Services Secretary Xavier Becerra. “At the end of the day, health care should be a right for everyone, not a privilege for some.”
In addition, CMS wants to reestablish mandated network adequacy reviews for plans on the federal exchange.
“The standards used for these reviews would highlight key characteristics like time and distance to care, as well as appointment wait times,” CMS said in a release.
The rule also aims to address health equity through several provisions. For one, insurers would be required to include 35% of essential community providers in each plan’s service area. Ensuring access to those facilities would improve access to coverage for people in underserved and low-income areas, CMS said.
The rule would also bar insurers explicitly from discriminating against patients based on sexual orientation or gender identity. Protections for these covered services were removed in 2020 under the Trump administration.
The rule also proposes streamlining the essential health benefits non-discrimination policy by requiring insurers to rely on clinical evidence in their plan designs. For example, a plan could not force inordinately high prescription costs on people with chronic conditions without a clinical backing.