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The Centers for Medicare and Medicaid Services and the Treasury Department recently proposed a new rule intending to expand access to health coverage for individuals currently in or interested in entering the Marketplace.
There have been many uncertainties in the healthcare industry lately, however, there have been steady transformations across the board from 2020 into 2021. One area where this can continue to be seen is within the Affordable Care Act (ACA) Marketplaces. A recent Kaiser Family Foundation report found insurer participation on the ACA Marketplaces in 2021 increased for the third straight year, with companies both entering the market or expanding their footprints within states.
In an effort to increase demand with eligible populations and increase supply with newly participating health plans, The Centers for Medicare and Medicaid Services (CMS) and the Treasury Department recently proposed a new rule intending to expand access to health coverage for individuals currently in or interested in entering the Marketplace.
Key proposals within this new rule are expected to significantly impact both Exchanges and members. How can health agencies scale their current operations to meet these shifting demands and be prepared for future changes? First, we must examine key differences that this new Rule is bringing about.
The Rule represents the third installment of the Health & Human Services (HHS) Notice of Benefit and Payment Parameters for 2022 and differs from its predecessors in its efforts to reverse policies enacted during the Trump Administration and implement a range of new ones.
Among the proposed changes are:
These changes are anticipated to bring about a number of shifts:
All of this translates to massive movements within enrollment numbers. How can Exchanges best prepare for this outcome to ensure a seamless experience?
As for the states that are operating or considering designing, building, and operating a State- based Marketplace solution, the $20 million in grants available through the American Rescue Plan should be used for first principle reasoning to address not only current, but future challenges now that the ACA is here to stay. Among the questions for states to consider: should we own or partner? Should we build on-premise or move to cloud? Are we using the right technology stack?
Investing in an adaptable and configurable technology solution will allow issuers and Exchanges to meet ever-changing regulations with ease while reducing processing time, administrative overhead, and human error. However, it’s important to note that the timeframe for effective implementation of a technology solution is closing for SBMs and the payers that wish to connect with them – considerations must be made now if organizations want to ensure timely adaptation to the changing ACA requirements.
Shifting legislation and changing market demands mean health plans needs to remain prepared to confront any situation. By understanding where key changes will be made and choosing a technology solution that can support frequent adjustments, health agencies will be well-prepared for both the short and long term.
Eugene Sayan is CEO and founder of Softheon.