Jan 05, 2022
The HHS Notice of Benefit and Payment Parameters 2023 Proposed Rule would prohibit health insurance issuers from discriminating on the basis of sexual orientation and gender identity. Restoring these protections for covered services can lead to improved health outcomes in the LGBTQI+ community, according to HHS. The protections had been removed from the list of non-discrimination protections in 2020.
The proposed rule also refines the Essential Health Benefits nondiscrimination policy by requiring issuers to rely on clinical evidence as a basis of health plan design. For example, plans cannot be designed to burden people who are managing chronic conditions. So they cannot have inordinately high prescription costs without a clinical rationale.
The proposed rule would help increase access to health care for low-income and medically underserved consumers, particularly through essential community providers (ECPs). Issuers would need to include 35% of available ECPs in their network for each plan’s service area. The rule would also add Substance Use Disorder Treatment Centers as eligible ECPs.
It also includes a variety of provisions to streamline Marketplace operations and reduce health care costs. These include scaling back pre-enrollment verification for special enrollment periods (SEPs) to include only the SEP for loss of minimum essential coverage. Additionally, changes to certain individual market plan variants mean subsidized enrollees would see even lower premiums in 2023 and beyond.
All issuers in the Federally facilitated Marketplace and State-based Marketplaces on the Federal Platform would have to offer standardized plan options for every product network type, metal type, and plan classification, as well as in every service area where the issuer will offer Marketplace plans.
The comment period on the proposed rule will be open for 30 days. To view the proposed rule, visit the Federal Register.
