CMS 2022 Payment Parameters Look to Boost Access to ACA Coverage

In its latest proposed update to the 2022 Payment Parameters, CMS has suggested steps to expanding access to coverage through the Affordable Care Act marketplace, steps which would impact the Navigator program, special enrollment periods, and even open enrollment.

CMS has recommended extending the length of the open enrollment period for the individual health insurance marketplace. This change would impact not only 2022, but rather it would be a permanent fixture of the enrollment cycle.

Specifically, the 2022 Payment Parameters seek to establish the open enrollment period as starting on November 1 and ending on January 15 of the following year. This change would apply to both on- and off-exchange health plans.

The agency has proposed bringing back previous standards that required federally-facilitated Affordable Care Act marketplaces to offer consumers details about how to connect with Navigators who could assist them after the enrollment period.

When enrollment period ends, some consumers may be left with questions about how to appeal eligibility decision that they received or how to utilize their new health benefits. While Navigators often are associated with open enrollment period support, they also can function as resources for consumers after the enrollment period has closed.

CMS wants to further expand the role of the Navigator program by adopting a broader interpretation of accepted Navigator activities.

Furthermore, in order to increase access to coverage through the Affordable Care Act, the agency recommended implementing a regular special enrollment period based on income.

In this scenario, those who wish to enroll in an Affordable Care Act health plan could receive an advance payment of the premium tax credit (APTC) if their incomes are 150 percent of the federal poverty level (FPL) or below. The special enrollment period would be open every month, as opposed to being triggered by a life event as is typical for special enrollment periods.

CMS also recommended a boost to the user fees for health plans on the federal platform, Healthcare.gov, to 2.75 percent. The proceeds from this user fee would contribute towards outreach and Navigator expenses.

The proposed update also clarified some of the confusion around APTC eligibility and separate-billing regulations for abortion services.

Additionally, CMS recommended repealing the exchange direct enrollment option.

Exchange direct enrollment platforms were a key part of the Trump administration’s strategy to reduce the strain on the federal platform, Healthcare.gov. The former administration enhanced direct enrollment pathways for the 2019 open enrollment season.

However, the Biden administration has indicated that it will take a different approach.

“We believe repealing the Exchange Direct Enrollment option will best support the health care priorities of the Biden-Harris Administration,” the fact sheet explained. “Since no state has yet expressed interest in implementing the Exchange Direct Enrollment option, we also believe that repealing it now will mitigate potential impacts to stakeholders.”

Lastly, the proposed third part of the 2022 Payment Parameters recommended changes regarding Section 1332 state innovation waivers.

“The Departments also propose to modify regulations to set forth flexibilities in the public-notice requirements and post-award public participation requirements for section 1332 State Innovation Waivers under future emergent situations, if certain criteria are met,” the fact sheet shared.

“The Departments also propose in this rule processes and procedures for amendments and extensions for approved waiver plans. Through section 1332 waivers, the Departments aim to assist states with developing health insurance markets that expand coverage, lower costs, and ensure that health care truly is accessible for all Americans.”

HHS released the first two finalized parts of the Notice of Benefit and Payment Parameters for 2022 separately, one in January 2021 and the other in May 2021.