Birthing the Aspects of a Smarter Healthcare Plan

Despite all the intelligence at their disposal, human beings have shown that they just cannot avoid making mistakes. This dynamic, in particular, has already popped up on the surface quite a few times throughout our history, with each appearance practically forcing us to look for a defensive cover. We will, however, solve our conundrum in the most fitting way possible, and we’ll do so by bringing regulatory bodies into the fold. Having a well-defined authority across each and every area was a game changer, as it instantly gave us a safety cushion against our many shortcomings. Now, the utopia one would expect to emerge from such a development did arrive, but at the same time, it failed to stick around for long. Talk about what caused it to dissipate so soon, the answer will literally touch upon technology before it covers anything else. You see, the moment technology got its layered nature to take over the scene, it allowed every individual an unprecedented chance to fulfill their ulterior motives, even if it meant sacrificing others’ well-being. In case this somehow didn’t sound bad enough, the whole runner soon began to materialize on such a massive scale that it expectantly overwhelmed our governing forces and sent them back to square one. After a lengthy spell in the middle of nowhere, though, it seems like the regulatory contingent is finally ready for a comeback. The same has turned more and more evident in recent times, and truth be told, some newly-proposed amendments to a legislation should do a lot to solidify that trend moving forward.

The Centers for Medicare & Medicaid Services (CMS) has officially proposed some amendments for the Affordable Care Act, as the agency gears up to increase healthcare access, streamline the plan selection process. and simplify enrolling in coverage. To take care of the access bit, CMS has suggested adding two essential community provider (ECP) categories for 2024 i.e. mental health facilities and substance use disorder treatment centers. With ECPs pretty much designed to serve low-income groups, giving a contract to at least one qualified substance use disorder treatment center and one mental health facility in each county of the plan’s service area will be able to help a lot of medically underserved groups. However, the CMS, as you might have figured by now, is hoping to make a much wider impact. Hence, the agency is also keen to extend its requirement of contracting 35% ECPs in an area to other federally qualified health centers, and even family planning providers.

“These changes, in conjunction with a proposal to expand Network Adequacy requirements, would increase provider choice, advance health equity, and expand access to care for consumers who have low income, complex or chronic health care conditions, or who reside in underserved areas, as these consumers are often disproportionately affected by unanticipated costs associated with provider network status and limited access to providers,” CMS said.

While the previous amendment was more about increasing options, the new policy framework will also limit the number of non-standardized plan options that issuers can offer through the federal Marketplace, resetting it to two per product network type. The limitation, notably enough, does not cover catastrophic plans.

The CMS’ plan then brings its focus on simplifying the process of enrolling in coverage through the marketplace. Under the latest proposal, there will be a special enrollment period for people losing Medicaid or Children’s Health Insurance Program coverage. Talk about the length of this period, it will let consumers choose a Marketplace plan from 60 days before their coverage ends. In case your coverage has ended already, you’ll have upto 90 days for making the stated selection.

“CMS believes that this new proposed special rule would help mitigate coverage gaps when consumers lose Medicaid or CHIP while allowing for a more seamless transition into Marketplace coverage,” the agency stated.

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