CMS Plans to Revamp Exchange Experience for Consumers and Insurers

A US Health and Human Services Department (HHS) proposal aims to ease the concerns of consumers who remain frustrated with the health insurance exchanges (HIEs). The plan includes a variety of new insurance standards that would improve the consumer experience of shopping for a health insurance plan on the state and federal exchanges.

One strategy is to implement a 5-star quality rating system that would simplify how consumers find and select value-based exchange health plans. The goal would be to have quality ratings displayed for all exchange health plans by 2017.

Insurers would additionally be required to have contracts with at least 30% of “essential community providers” in their service area, and to display information regarding which of their physicians were accepting new patients. They also would need to provide links to covered prescription medications lists, and how much patients would pay out-of-pocket for each. These rules would ultimately increase transparency and access for patients transitioning to new plans.

“We are concerned that some enrollees, particularly those with certain complex medical conditions, are having trouble accessing in a timely fashion clinically appropriate prescription drugs, such as prescription drugs that are combination drugs not covered by their plans’ formularies,” regulators from the Centers for Medicare & Medicaid Services (CMS) wrote.

Other regulatory changes would include an amendment to insurers’ medial loss ratios. Payers who participate in federally run exchanges can use a 1.0004% increase in claims and quality improvement costs for plans sold on or off the HIE.

CMS and HHS administrators anticipate that these new regulations will reduce consumers’ anxieties by providing and encouraging “improved consumer protections regarding essential community providers, network adequacy, access to needed prescription drugs, and coverage of care during transitions.”

Around the Web

White House Tightens Health Plan’s Standards After Consumers Complain [The New York Times]

CMS Proposes Rules To Increase Oversight of Exchange Health Plans [California Healthline]