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Monday, Nov 23 2015

Full Issue

HHS Draft Rule For 2017 Insurance Includes Standards For Networks Of Doctors, Hospitals

The proposal would mandate the number of doctors and other health care providers to provide better access. It would also meet some of the concerns of insurers and offer states an easier way to handle their insurance marketplaces.

Federal health officials Friday proposed changes to the rules for health coverage sold through insurance exchanges, including a possible floor for how many doctors and other providers each plan must include. The rules are intended to make it easier for consumers to compare their options in the marketplaces created under the Affordable Care Act. They would define standard deductibles and co-payments, and allow insurers to sell plans with that specific benefit design. (Goldstein, 11/20)

The CMS has proposed mandating minimum network standards for health plans sold on the federal insurance marketplace in 2017 as part of an effort to handle the broad shift toward narrow provider networks. The Affordable Care Act requires that all medical policies on the exchanges have enough in-network hospitals and doctors for members so that 鈥渁ll services will be accessible without unreasonable delay.鈥 In addition, ACA-compliant plan networks must update their provider directories monthly and include at least 30% of essential providers. (Herman and Dickson, 11/20)

The next sign-up season for 2017 health coverage under the Affordable Care Act will begin just as the 2016 election campaigns draw to a close, under draft rules released by the Obama administration on Friday afternoon. The open enrollment period for people buying insurance on their own for 2017 will start Nov. 1, 2016, and end Jan. 31, 2017, federal officials outlined in the draft rules. In earlier iterations of regulations, they had suggested starting as early as Oct. 1, before appearing to settle on the same dates they are using for this year鈥檚 open enrollment period, which is now three weeks under way. (Radnofsky and Wilde Mathews, 11/20)

Federal regulators on Friday proposed potential solutions to some of the Obamacare problems that led UnitedHealth Group to warn it may exit the health exchanges in 2017, but the government also may make it tougher for insurers to limit the number of doctors and hospitals in their plan networks. The proposed rule from the Centers for Medicare and Medicaid Services would reduce insurers' administrative costs, maintain fee levels and improve the accuracy of a payment formula designed to minimize insurers' risks when taking on new customers. (O'Donnell, 11/21)

The Obama administration on Friday proposed a new type of partnership between state and federal health marketplaces in an attempt to address the mounting financial pressures on state-run exchanges. Under the new model, states would be allowed to use federal resources like call centers or website platforms while maintaining their own decision-making power. (Ferris, 11/20)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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