As part of the Biden-Harris Administration’s ongoing commitment to increasing health data exchange and investing in interoperability, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services. CMS proposes to modernize the health care system by requiring certain payers to implement an electronic prior authorization process, shorten the time frames for certain payers to respond to prior authorization requests, and establish policies to make the prior authorization process more efficient and transparent. The rule also proposes to require certain payers to implement standards that would enable data exchange from one payer to another payer when a patient changes payers or has concurrent coverage, which is expected to help ensure that complete patient records would be available throughout patient transitions between payers.
Covered California joined leading health officials in San Diego to encourage enrollment in a quality insurance plan and improve access to address an increased need for behavioral health care across the state.
“The pandemic took a toll on us in so many ways, including our behavioral and mental health, which are critical to our ability to live happy, healthy and productive lives,” said Jessica Altman, executive director of Covered California. “Getting the right behavioral health care starts with making sure people have health insurance with access to quality providers, and that can be done right now through Covered California’s open enrollment.”
Advocates To CMS: Fix Rate Misalignment In Next Exchange Reg
A coalition of patient advocates is urging HHS to address high out-of-pocket costs by demanding that insurers selling marketplace coverage strictly adhere to the Affordable Care Act’s rate-setting requirements. Insurers have strayed from the mandate in recent years by underpricing silver-tier plans and overpricing the more-generous gold-level products, the advocates say, highlighting an issue that experts have been raising for years and that some states are already addressing at the local level.
But health experts also say that HHS must fix misalignments in the risk adjustment program - and that exchanges must have strong consumer decision support tools -for a policy fix to be sustainable.
By clarifying and enforcing the ACA’s single risk pool requirement, HHS could significantly reduce consumers’ cost-sharing burdens while also discouraging gaming, the advocates say.
via MNsure, Minnesota's ACA exchange (via email for now):
More Minnesotans can access discounts and find less expensive plans through MNsure
ST. PAUL, Minn.—During MNsure’s open enrollment period happening now, thousands of Minnesotans who haven’t been able to access premium tax credits in the past are newly eligible for these discounts and can shop for more affordable 2023 health coverage through MNsure, where Minnesotans choose medical and dental insurance, thanks to the ‘family glitch’ fix.
In the past, a family’s eligibility for tax credits from MNsure depended on whether their job-based coverage was affordable for the employee, no matter how much it cost to cover the whole family. This meant some family members fell into the ‘family glitch’: that is, they were ineligible for Affordable Care Act subsidies even though they need them to afford quality coverage. Because they couldn’t access these important tax credits, many families in this situation have been paying more for coverage and some have been going without health insurance entirely.
Department Releases Study and Begins Rulemaking Process to Require Health Benefit Plans Cover Abortion Services Without Exceptions that Limit Coverage; Requests that Insurers Implement Change for 2023
TRENTON — The New Jersey Department of Banking and Insurance today announced that it has released a study on access to comprehensive reproductive health care that found a need for regulatory action to require coverage for abortion services under health benefits plans regulated by the department, and has begun the formal rulemaking process to implement the requirement. The department performed this study as part of the implementation of the historic Freedom of Reproductive Choice Act signed by Governor Phil Murphy earlier this year, which codifies the constitutional right to freedom of reproductive choice in New Jersey.
This report provides a summary of information for week one of the beWellnm health insurance individual Marketplace Open Enrollment Period for plan year 2023 (OEP 2023). The report contains data from the beWellnm eligibility and enrollment platform for OEP 2023, and includes an overview of the following:
plan selections
new enrollees
enrollees renewing coverage
Customer Engagement Center call volumes
website traffic
Enrollment
This section contains enrollment data through November 26, 2022.
1. Total Plan Selections (net): Count of unique individuals who have selected a Plan Year (PY) 2023 Marketplace medical plan. Count includes all new and re-enrolling consumers (defined in Indicators 2 and 3), regardless of whether the consumer has paid the first month premium. Count does not include plans that were canceled or terminated.: 34,518
The Maine Department of Health and Human Services (DHHS) Office of the Health Insurance Marketplace (OHIM) will release biweekly updates on plan selections through CoverME.gov, Maine’s Health Insurance Marketplace.
Plan selections provide a snapshot of activity by new and returning consumers who have selected a plan for 2023. “Plan selections” become “enrollments” once consumers have paid their first monthly premium to begin insurance. These numbers are subject to change as consumers may modify or cancel plans after their initial selection.
The deadline to select a plan for coverage beginning January 1, 2023 is December 15, 2022. Consumers who select a plan after that date will have coverage beginning February 1, 2023.
DENVER— Since November 1, more than 57,500 people have used Connect for Health Colorado’s marketplace to enroll in a health insurance plan. That’s 7,000 enrollments ahead of the same time period last year. Approximately 78 percent of those who have enrolled so far are qualifying for financial help that reduces the cost of plans.
Connect for Health Colorado’s Chief Executive Officer, Kevin Patterson, released the following statement:
“I’m so pleased that people are getting covered early in the enrollment period and that we’re continuing to see enrollment growth year over year. That tells me that our marketplace is giving people the options they’re looking for, at prices that are within their budget. For those who are waiting to sign up, I urge that you make an appointment with an enrollment specialist and enroll by December 15 to begin the new year with peace of mind.”
Set a Goal: Enroll Statewide Events Dec. 3-15 Feature Extended Hours
BALTIMORE (Nov. 29, 2022) — Maryland Health Connection will have trained experts to help Marylanders understand their options and enroll in a health plan for 2023 at upcoming statewide events. Shoppers can take advantage of free assistance at a local Set a Goal: Enroll event. Help is also available virtually or by phone with weekend and extended hours.
Last year, the average Maryland Health Connection customer buying private health insurance saved $289 a month on their monthly premium. Many Marylanders ages 18-34 can get special discounts for 2023 health plans — on top of other savings available through Maryland Health Connection.
“We are pleased that our navigators, who are so knowledgeable and helpful, are providing extra help in December to help Marylanders choose and enroll in a private health plan for the new year,” said Michele Eberle, executive director of the Maryland Health Benefit Exchange.
