State-run health insurance exchanges would have to ensure that provider networks are at least as adequate as those required on the federal marketplaces under a proposed rule the Centers for Medicare and Medicaid Services announced Wednesday.
Beginning in 2025, insurance policies sold through full-featured state-based exchanges and through state-operated marketplaces that use the federal HealthCare.gov enrollment platform would have to meet the time-and-distance measure of provider access that is applied to plans sold via fully federal exchanges. States can seek exemptions.
The 2025 Notice of Benefit and Payment Parameters proposed rule contains only modest changes to the health insurance exchanges. By contrast, the 2024 final rule issued in April, which created limits on how many different products insurers can offer and strengthened network adequacy requirements for mental health providers.
In addition to the new network adequacy provisions for state-based marketplaces, the proposed rule unveiled Wednesday would:
- Require that states creating their own marketplaces transition from the federal system by continuing to use HealthCare.gov for one year before launching their own enrollment platforms.
- Establish open enrollment periods for state-run exchanges that begin Nov. 1 and end no sooner than Jan. 15, which mirrors the sign-up period on federal exchanges.
- Permit insurers to seek exemptions to limits on their plan offerings to accommodate policies designed for people with chronic and high-cost conditions.
- Require brokers selling insurance in states with homegrown exchanges to adhere to federal standards regarding how benefits and financial assistance are described and how exchange-eligible policies are compared to unsubsidized "off-exchange" plans.
- Activate coverage for people who enroll during special enrollment periods on the first day of the month after they sign up.
- Allow state-run exchanges to require insurers to cover routine adult dental care as an essential health benefit.