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Standardize and Streamline: CMS Proposes Standards for Qualified Health Plans and the Exchanges
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Change is on the horizon for the health plan marketplace.
In episode 17 of Complications: Health Policy Unraveled, host Stephanie Kennan describes the new standards proposed by the Centers for Medicare and Medicaid Services for qualified health plans in health insurance marketplaces. These changes include bringing state marketplaces in line with the federal health plan marketplace. Proposed changes are meant to increase eligibility, transparency and availability of services. Stephanie discusses the changes we can expect to come to the health insurance sector in 2025. Tune in to the episode to learn more.
Meet Your Host
Name: Stephanie Kennan
Title: Senior Vice President, Federal Public Affairs at McGuireWoods Consulting
Specialty: Stephanie Kennan helps clients navigate the legislative and executive branches of the federal government to solve problems involving a variety of healthcare policy issues. Her work focuses on providers, medical device manufacturers, drug manufacturers and associations concerned about Medicare and Medicaid reimbursement.
Connect: LinkedIn
Episode Highlights
[0:38] CMS recently proposed standards for qualified health plans offered through health insurance marketplaces.
[1:08] The proposed standards for states would include time and distance standards at least as stringent as those in the federal marketplace.
[2:11] CMS proposes that state marketplaces conduct network adequacy reviews similar to those performed in the federal marketplace.
[3:02] The proposal also includes changes to streamline marketplace operations to make eligibility requirements clearer and enrollment easier.
[4:45] The plan would also permit states to alter their eligibility requirements to expand Medicaid coverage.
[6:00] By removing the generosity standard, CMS wants states’ benchmark plans to provide a scope of benefits equal to that of a typical employer plan.
[7:21] In order to look more like the federal marketplace, CMS is proposing a requirement that states operate a centralized eligibility and enrollment platform on their marketplace websites.
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