On April 9, 2018, the Centers for Medicare & Medicaid Services (CMS) released its final 2019 Notice of Benefits and Payment Parameters (Notice). This annual rule sets standards for commercial insurance in the Exchanges and in some instances the markets outside of the Exchanges for 2019.
CHA spearheaded a joint comment letter from eight allied children’s groups on the 2019 Draft Notice and also joined with disability advocacy groups and other safety net providers on separate joint comment letters. The comments urged CMS to reconsider its proposed revisions to the essential health benefits (EHBs), opposed the delegation to states and accrediting entities of regulatory oversight of provider networks in Exchanges plans; and opposed reductions in the minimum threshold for inclusion of essential community providers (ECPs) in networks.
The final Notice and supporting guidance do not reflect most of the joint comments. Key provisions of the Notice with potential implications for children include:
- Increased state and insurer flexibility to determine the EHBs.
- A shift in responsibility from CMS to the states for the review of network adequacy in plans sold through the federally facilitated Exchanges.
- A reduction in the minimum percentage (from 30 to 20 percent) of available ECPs that must be in an Exchange plan network.
- A new special enrollment period for pregnant women who lose their pregnancy-related Children’s Health Insurance Program coverage following the birth of their child.