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

On Friday, CMS released a set of proposed rules that would bolster standards for health insurers participating in the Affordable Care Act’s federal health insurance exchange, following widespread complaints from consumers, Modern Healthcare reports (Modern Healthcare, 3/15).

Under the proposed rules, CMS would step up its oversight of health plan networks offered through plans sold on the federal exchanges rather than relying predominately on reviews from state insurance regulators and private groups that accredit health care policies (Pear, New York Times, 3/14). Specifically, the agency would evaluate plans to ensure that they provide adequate access to hospitals, primary care physicians, oncologists and mental health providers.

In addition, plans sold on the exchanges would be required to include at least 30% of an area’s “essential community providers,” up from 20% proposed in 2014 (Millman, “Wonkblog,” Washington Post, 3/14). Those providers can include hospital, community health centers and HIV/AIDS clinics, among other provider centers.

The proposed rules also would:

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