CMS releases 2024 benefit and payment final rule: 6 things to know

CMS released its 2024 Notice of Benefit and Payment Parameters Final Rule, which includes measures aimed at boosting behavioral healthcare access, increasing coverage accessibility and simplifying the health plan selection process, according to an April 17 news release shared with Becker's.

Six things to know:

1. The final rule creates two new essential community provider (ECP) categories — Substance Use Disorder Treatment Centers and Mental Health Facilities — in a move aimed at expanding access to behavioral healthcare, according to the news release.

2. The final rule includes measures to expand access to care by extending the requirement for plans to contract with at least 35 percent of available ECPs in a plan’s service area. The final rule extends it to apply to the Federally Qualified Health Centers and Family Planning Providers ECP categories.

3. People losing Medicaid or CHIP coverage will have a special enrollment period by default under the new rule, replacing the "Unwinding SEP" that was set to expire July 31, 2024.

4. Federally-facilitated marketplaces and state-based marketplaces will also have the option to set up a new SEP. Under the new rule, people losing Medicaid or CHIP coverage have an enrollment period starting 60 days before, and ending 90 days after, losing coverage.

5. Currently, enrollment assisters are generally banned from providing enrollment assistance upon initiating contact with coverage seekers. The new rule lifts that ban, which the administration said will make it easier to get help when enrolling in coverage, and may improve health literacy in rural and underserved communities.

6. The number of non-standardized plan options offered by qualified health plan issuers through federal and state marketplaces on the federal platform will be limited to four in each area for the 2024 plan year, in a move aimed at reducing choice overload.

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