Updated Regulation to Help Strengthen Coverage Offered by Marketplace Plans

The Centers for Medicare & Medicaid Services (CMS) released the Notice of Benefit and Payment Parameters final rule, which is an updated regulation that applies to insurance plans sold through federally facilitated and state-based exchanges on the federal platform (commonly known as marketplace or exchange plans). The rule goes into effect on July 1, 2022, and includes changes intended to help strengthen coverage. These changes incorporate several of ASHA’s recommendations [PDF], specifically those that:

• protect the essential health benefit of rehabilitative and habilitative services and devices;
• ensure an adequate network of providers based on time and distance from patients with telehealth as a supplement—not a substitute for—adequate, in-person provider networks;
• require plan issuers to address the reduction of health disparities as part of their quality improvement strategy; and
• limit cost sharing through parity between primary care visits, speech therapy, and the occupational and physical therapy benefit categories except in Delaware, Louisiana, and Oregon.

Additional changes that audiologists and speech-language pathologists should be aware of include:

• a clarification that section 1557 of the Affordable Care Act (ACA) will be interpreted and enforced to prohibit discrimination based on sexual orientation and gender identity in all aspects of health insurance coverage; and
• a requirement that insurance issuers offer standardized plan options at every type, “metal level”, and service area for which they offer non-standardized options.

More information is included in the HHS Notice of Benefit and Payment Parameters for 2023 Final Rule Fact Sheet.

Questions?

For questions about Health Insurance Marketplace Plans, please contact Rebecca Bowen at rbowen@asha.org.