This Year, ‘Smooth Sailing’ Appears Likely for ACA Exchanges

by Leslie Small

For health insurers that operate in the Affordable Care Act exchanges, 2022 is shaping up to be a relatively stable, profitable year with few regulatory surprises, health policy experts tell AIS Health. Still, there will be some regulatory uncertainty that plans must grapple with as well as a newly proposed rule effective in 2023 that imposes tighter controls on benefits and network design than even the Obama administration attempted. 

Standardized plans will make a splash 

• That regulation is the Notice of Benefit and Payment Parameters (NBPP) 2023 Proposed Rule, released by the Biden administration on Dec. 28. Perhaps the biggest change included in the annual omnibus exchange rule — the move to require standardized ACA marketplace plans — was already known to the industry but still promises to make a significant impact. 
• Under the Obama administration, insurers were not forced to offer such plans, but they did get preferential display on HealthCare.gov. Now, insurers must offer a standardized plan at every product, network type and metal level, and throughout every service area, where they also offer non-standardized options. Plus, such plans will get preferential display. 
• Another major proposed change in the 2023 NBPP is the administration’s move to resume evaluating the adequacy of provider networks offered by qualified health plans on the federal exchange. 

CMS takes ‘strong stance’ on discriminatory benefits 

• Perhaps the most unexpected part of the NBPP is CMS’s proposal to create a “clear regulatory framework” for identifying discriminatory benefit design. That’s according to Katie Keith, a health care attorney and research professor who writes the Health Affairs series “Following the ACA.” 
• For example, plans will no longer be able to restrict coverage for things like hearing aids and in vitro fertilization based on age, unless clinically indicated, or for gender-affirming care for transgender individuals. In addition, the proposed rule will reinstate protections to ensure that LGBTQ+ people are explicitly protected from discrimination by exchanges, states, insurers, and agents and brokers. 
• “It’s going to be hugely important,” Keith says of the new requirements. “This is a really strong stance that they’re taking, that all of this stuff has to be justified medically.”
• ACA exchange insurers, she predicts, are “going to have to do a lot of work to look at their benefits and their exclusions, and some of their clinical utilization management techniques” to evaluate whether they’re truly evidence based.

From Health Plan Weekly