CMS proposes rule to expand Americans’ access to health coverage

July 5, 2021

The Centers for Medicare & Medicaid Services (CMS) proposed a series of provisions to expand health coverage access and advance health equity. These provisions are the third installment of the payment notice for 2022. 

The proposed rule includes a variety of provisions to protect and expand Americans’ access to high-quality, affordable health insurance. This includes proposals to lengthen the annual open enrollment period for 2022 by an additional 30 days, create a new special enrollment period opportunity for certain low-income consumers, and expand the duties of Federally facilitated Exchange Navigators to offer additional help to consumers enrolling in plans. 

These updates build upon and revisit several of the policies in the Notice of Benefit and Payment Parameters for 2022 (or “2022 payment notice”), which was finalized in two phases. Today’s proposed rule furthers CMS’s work to provide greater access to coverage, improve affordability for consumers and reduce burden for issuers and consumers. 

The proposed rule would give Exchanges the option of offering a new special enrollment period to provide additional opportunities for certain low-income consumers to access premium-free or very low-cost coverage available to them because of the enhanced advanced premium tax credit (APTC) provisions included in the American Rescue Plan Act of 2021. The proposed monthly special enrollment period would align with President Biden’s Executive Order 14009 (issued Jan. 28, 2021), which requires federal agencies to identify and appropriately address policies that create barriers to accessing ACA coverage. 

Several other provisions in the proposed rule would streamline operations for the Federally facilitated Exchanges, health insurance issuers, and other stakeholders who facilitate access to coverage. For example, the proposed rule would streamline issuer billing by repealing certain requirements that could have resulted in burdensome and costly changes to issuer billing systems. It also proposes to lengthen the annual open enrollment period for 2022 and future coverage years by an additional 30 days, allowing consumers more time to review plan choices. 

Additionally, the rule proposes modifications to policies related to State Innovation Waivers (sometimes called “section 1332 waivers”), which empower states to pursue new strategies for providing residents with access to coverage. This includes proposals related to the interpretation of the statutory guardrails and flexibilities in public notice and post-award public participation requirements under future emergent circumstances, if certain criteria are met. The rule also includes proposals regarding the process for amending or extending approved section 1332 waivers. 

The proposed rule would enable CMS to collect and dedicate additional revenue to fund consumer outreach and education through modest increases in user fee rates for issuers in Federally facilitated Exchange states and State-based Exchanges on the Federal platform. The proposed user fee rates, which are levied on issuers each year, are still lower than the current 2021 benefit year rates. 

The rate change for issuers on the Federally-facilitated Exchange would also make additional revenue available that can be used to fund Navigators, who help consumers – particularly the uninsured – understand their options and enroll in health insurance plans. CMS recently announced its plan to support Navigators and their important work with the largest-ever funding allocation for Federally facilitated Exchange Navigators for the 2022 plan year. 

The proposed rule would also reinstitute expanded duties applicable to Navigators in the Federally facilitated Exchanges to ensure that consumers have access to skilled assistance beyond applying for and enrolling in health insurance coverage. These include, for example, assistance with the process of filing Exchange eligibility appeals, understanding basic information about reconciliation of premium tax credits, and understanding basic concepts and rights related to health coverage and how to use it, such as locating providers and accessing care. Raising such awareness and supporting Navigators’ responsibilities remain key to reaching underserved communities, where access to health insurance coverage has been low and disparities in health outcomes continue to rise. 

CMS has the release