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APIAHF Comments: CMS-9895-P: Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2025; Updating Section 1332 Waiver Public Notice Procedures...

Download PDF • 626KB

Publish Date: January 2024

Type: Testimony and Comments

Topics: ACA, CMS, Medicaid, medicare




31 CFR Part 33 and 45 CFR Part 155: Section 1332 Waivers

We support the proposed changes to Section 1332 waiver processes allowing states the opportunity to hold post-award forums and public hearings virtually and through digital platforms.  

42 CFR Parts 435 and 600: Medicaid Eligibility for the States, District of Columbia, the Northern Mariana Islands and American Samoa, and Administrative Practice and Procedure, Health Care, Health insurance, Intergovernmental Relations, Penalties, Reporting and Recordkeeping Requirements

We support the proposed changes to allow states to implement a less restrictive Medicaid income eligibility methodology for specific non-Modified Adjusted Gross Income (MAGI) populations and tailor income and/or resource disregards for discrete subpopulations in the same eligibility group.

45 CFR Part 155: Exchange Establishment Standards and Other Related Standards under the Affordable Care Act

Approval of a State Exchange (Section 155.105) and Election to Operate an Exchange after 2014 (Section 155.106)

We support the proposal to require that a state seeking to operate a state-based exchange must first operate a state-based exchange using the Federal platform (SBE-FP) for at least one plan year.

Additional Required Benefits (Section 155.170)

We strongly support the proposed change to allow that state-mandated benefits added after December 31, 2011 to be considered Essential Health Benefits (EHBs) and therefore not subject to defrayal.

Consumer Assistance Tools and Programs of an Exchange (Section 155.205)

We support the proposed changes to establish additional minimum standards for exchange call center operations, and the inclusion of such additional requirements in the state exchange blueprint application.

Requirement for Exchanges to Operate a Centralized Eligibility and Enrollment Platform on the Exchange’s Website (Sections 155.205(b) and 155.302(a)(1))

We strongly support the changes to Sections 155.205(b) and 155.302(a)(1), as they provide applicants with important flexibility during enrollment and take critical steps to protect QHP applicants from incorrect eligibility determinations made by non-marketplace entities.

Adding and Amending Language to Ensure Web-brokers Operating in State Exchanges Meet Certain HHS Standards Applicable in the FFEs and SBE-FPs (Section 155.220)

We support the proposed alignment of consumer protections across exchanges through a nationwide standard.

Failure to Reconcile (FTR) Process (Section 155.305(f)(4))

We support CMS’ efforts to promote continuity of coverage, encourage compliance with filing and reconciling requirements, minimize the risk of large tax liabilities for (APTC) recipients and avoid situations where enrollees become uninsured when their APTC is terminated.

Verification Process Related to Eligibility for Enrollment in a QHP through the Exchange (Section 155.315(e))

We support the proposed changes to Section155.315(e), permitting all marketplaces to accept applicants’ attestation of incarceration status without additional electronic verification.

Initial and Annual Open Enrollment Periods (Section 155.410)

We support the proposed changes to align state marketplace open enrollment periods and require that all state marketplaces adopt an open enrollment period that begins on November 1 of the calendar year preceding the benefit year and ends no earlier than January 15 of the applicable benefit year.

Effective Dates of Coverage (Section 155.420(b)) and Monthly Special Enrollment Period for APTC-Eligible Qualified Individuals with a Household Income at or Below 150 Percent of the Federal Poverty Level

We support the proposed changes at Section 155.420 to minimize potential coverage gaps by aligning effective coverage dates across all exchanges such that people enrolling in coverage during a special enrollment period (SEP) have coverage effective on the first day of the month after they make their plan selection.

Establishment of Exchange Network Adequacy Standards (Section 155.1050)

We support the proposed changes to require state-based marketplaces (SBMs) and SBE-FPs to establish quantitative time and distance standards for all QHPs that are at least as stringent as the network adequacy standards in federally-facilitated exchanges (FFEs).

Proposal Related to QHP Reporting on Telehealth Services

We appreciate the Federal government’s continued efforts to understand access to telehealth services to inform future policies and believe that community voices should be centered in future policy through strategies like regional listening sessions in multiple languages, trusted community partnerships, and infusing resources into communities with limited broadband access or digital literacy.


45 CFR Part 156: Health Insurance Issuer Standards under the Affordable Care Act, Including Standards Related to Exchanges

State Selection of EHB-Benchmark Plans for Plan Years Beginning on or after January 1, 2027 (Section 156.111)

In general, we support the proposed changes to reduce the burden on states when making updates to EHB benchmark plans.

Provision of EHB (Section 156.115)

We strongly support CMS’ proposal to remove the regulatory prohibition on issuers from including routine non-pediatric dental services as an EHB. Native Hawaiians and Pacific Islanders, and Asians (ages 20-49) have been reported to have some of the lowest access and utilization of dental services.

Prescription Drug Benefits (Section 156.122) and Coverage of Prescription Drugs as EHB

We support the adoption of the USP Drug Classification (DC) to replace the USP Medicare Model Guidelines (MMG).

Standardized Plan Options (Section 156.201)

We appreciate CMS’ continued efforts to ensure the availability of standardized plan options and to require issuers to differentially display standardized plans. Such plan options are an essential tool for increasing enrollment while optimizing affordability of coverage and access to services that can address health disparities in marketplace coverage.


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