CMS Issues Proposed Rule to Ensure Network Adequacy Standards For State-run Exchange Plans

The Centers for Medicare & Medicaid Services (CMS) announced a proposed rule aimed at raising network adequacy standards for state-based exchange plans among other changes for health plans, agents, and brokers. Along with requiring state-based exchanges to have the same network time and distance standards as the federal exchanges, the proposals provide states with greater flexibility to determine financial eligibility policies, which could allow for targeted expansions of Medicaid coverage; allow state-run exchanges to require insurers to cover adult dental care as an essential health benefit; and require a transition period before states can establish a state-based marketplace. The changes are included in the Department of Health & Human Services (HHS) Notice of Benefit and Payment Parameters (Payment Notice) proposed rule for 2025.

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