HHS Releases 2023 Payment Notice, Medicaid Waiver Guidance

The Department of Health and Human Services (HHS) announced the Notice of Benefit and Payment Parameters 2023 proposed rule for the Affordable Care Act marketplace and released Medicaid waiver guidance for the state mobile crisis intervention waivers.

The Notice of Benefit and Payment Parameters 2023 proposed rule covers standardizing plan options, enforcing network adequacy, supporting community providers, and more.

“This year, we’ve implemented changes that have helped connect millions of people to health care coverage,” CMS Administrator Chiquita Brooks-LaSure said in the press release. “With this proposed rule, we are working to ensure the Marketplaces are a model for accessible, affordable, inclusive coverage—particularly for eligible individuals who have thought comprehensive coverage was out of reach.”

Under the proposed rule, federally-facilitated marketplaces and state-based marketplaces on the federal platform would only offer standardized plan options. According to HHS, this would streamline options for consumers, making it easier to navigate their healthcare coverage options and compare plans.

HHS also wants to reinstate federal network adequacy reviews. These reviews would evaluate factors that impact access to care for enrollees in the federally-facilitated marketplace. Experts have questioned whether the typical network adequacy metrics—such as distance from and amount of time to travel to a care site—can account for specialization in healthcare.

Additionally, issuers would have to include 35 percent of available essential community providers located in their service area in their networks, including substance use disorder treatment centers.

The proposed rule explicitly states that issuers cannot block access to coverage due to sexual orientation or gender identity. Moreover, it requires health plans to align health plan design—including out-of-pocket costs—with clinical evidence.

Lastly, the rule would make loss of minimum essential coverage the only necessary pre-enrollment verification for special enrollment periods.

HHS predicted that some of its changes would lower premiums for enrollees with Affordable Care Act subsidies.

“Today’s rule is part of the Biden-Harris Administration’s ongoing efforts to ensure an equitable health care system as we continue to make coverage more accessible and affordable,” said HHS Secretary Xavier Becerra. 

“We are building a more competitive, transparent and affordable health care market. At the end of the day, health care should be a right for everyone, not a privilege for some.”

The comment period for the proposed rule will close in 30 days.

HHS and CMS also released guidance on Medicaid state mobile crisis intervention services.

"These services are a vital resource for people in moments of crisis, and also connect individuals to the behavioral health services and support needed for long-term recovery," CMS Administrator Chiquita Brooks-LaSure stated in the press release for the Medicaid guidance.

"Effective mobile crisis intervention services ensure a qualified health professional is the first point of care for someone in crisis while helping to avoid unnecessary emergency room use and hospitalizations."

The American Rescue Plan allowed states to receive federal funding for mobile crisis intervention services. Similar to the Navigator grant funding, the money would be available for three years. When CMS announced the three-year funding structure for the Navigator grant, it explained that the design would give states a more stable income with which to establish new services.

The mobile crisis intervention teams would include a qualified behavioral healthcare specialist along with other substance use or mental healthcare providers. The mobile crisis intervention teams would be able to screen for mental healthcare needs, de-escalate situations involving individuals with mental healthcare needs, and refer patients to specialists or social services.

"Community-based mobile crisis intervention services, usually comprised of professional and paraprofessional staff, are able to respond quickly to crisis situations and provide individual assessment and crisis resolution,” the press release explained. 

“This new option will help states expand access to behavioral health professionals as the initial contact for someone in crisis. Providing immediate and appropriate care to someone in crisis may reduce the need for costly inpatient services.”