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CMS proposes rule mandating minimum network standards for federal exchange health plans — 6 key points


The Centers for Medicare and Medicaid Services proposed a rule mandating minimum network standards for health plans sold through the federal exchange in 2017, according to California Healthline.

Here are six key points:

1. CMS' proposed rule would require states to implement CMS-approved quantitative measure so individuals with exchange plans have sufficient access to healthcare providers.

2. Under the rule, states have the option to either adopt default network adequacy standards the CMS set or draft their own network adequacy standards and submit the standards for U.S. Health & Human Services Department approval.

3. The standards could accurately assess a plan's network adequacy based on policyholder's maximum travel distances and times to access providers.

4. CMS proposed the Affordable Care Act's next open enrollment period to run from Nov. 1, 2016 to Jan. 31, 2017. The CMS is seeking stakeholders' comments and data about the special open enrollment periods under the ACA.  

5. In the proposed rule, CMS has more "standardized options" for exchange plans in each of the metal plan tiers. The suggested changes include:

  • All bronze-level plans sold through the exchanges in 2017 would have a $6,650 deductible;
  • All silver-level plans would have a $3,500 deductible; and
  • All gold-level plans would have a $1,250 deductible.

6. CMS will accept comments on the proposed rule until Dec. 21.

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