The Centers for Medicare and Medicaid Services (CMS) insists that Exchange Sold Health Plans should be based on a set of requirements. As such, it has released a list of requirements that these plans should be based on for the year 2017. The draft letter of the requirements is given out to the issuers in the federally facilitated marketplaces.
The draft letter consists of a set of requirements that CMS expects for the plans. These plans are sold on federal health insurance. These plans were instituted by the Affordable Care Act. CMS would also monitor the health insurance exchanges and would ensure that public comments on the draft letter are evaluated and studied in time.
Previously, CMS proposed a set of rules for the plans that are sold on the exchanges meant for 2017. Sources claim that the draft letter on the requirements is a follow up of these proposed rules.
What Are The Points That The Draft Letter Emphasizes On?
The draft letter emphasizes on a number of points such as technical provisions, insurance provisions, the deadlines by which the plans and the approval processes need to be completed, etc. Similarly, the letter encourages the evaluation of the standardized options made available for the exchanges. Meanwhile, CMS made it clear that the proposed plan option is not mandatory for the insurance companies, as well as for medical billing companies in New York and other parts of the country. They can take it as an optional addition to their existing plan offerings.
When the new provision takes effect, the insurers can provide their clients with standard plan option at metal levels. These options can further be standardized at par with the in-network cost sharing, premiums and network make up. The details about the standardized plan options would be published on the exchange websites. Consumers can refer them and choose what sounds suitable for them.
The draft letter also speaks about the network adequacy standards for the plans meant for the coming plan years. CMS has the authority to decide on the network adequacy standard for each state. It would be based on the quantifiable network adequacy metric. The health insurance industry and medical billing companies in New York are currently using these types of metrics at the moment.
Both the time and the distant standards are enforced by the state are at par with the FFM standards. The draft letter contains details about the metric meant for demographic areas and specialty cases. When a provider leaves a network that they are part of, they has to do it with a certain procedure within the network communication system. The draft explains it with details.