Responding to the Department of Health and Human Services’ Notice of Benefit and Payment Parameters for 2023, AHIP, an organization for commercial insurers and and the Alliance for Community Affiliated Plans (ACAP), have raised apprehensions. According to them the proposed essential health benefits rules may cripple the growth in the sector. While payers have been supportive of some measures, they are largely wary of the impact the proposals could have on their industry.
- Not a first for Biden admin: This is not the first marketplace regulation for the Joe Biden Administration. In June last year, the HHS and Department of Treasury had finalized the third installment of the 2022 payment notice and that had mostly reversed the changes made in January last year, like letting states move away from HealthCare.gov. The latest proposals of the Federal government target a range of issues on the individual health insurance marketplace.
- Payers raise privacy concerns: The commercial insurers body, AHIP has flagged the HHS plan on collecting personal details of the enrollee. The HHS plans to collect additional data like ZIP code, plan ID, and subscriber indicators. AHIP has warned that such collection of data carries major risk of spreading. It has said that gathering such data would endanger privacy of enrollee even if such details are not made publicly accessible.
- Payers seek clarity: The payers have demanded more clarity on certain proposals instead of opposing it. The AHIP has sought more details on timing for reporting the HHS-Risk Adjustment Data Validation (RADV) calculations and the strategy around prescription drug categories (RXC) mapping for drugs with multiple indications.
- Concerns about limiting health plan options: Worried over limiting health plans, both payer organizations, ACAP and AHIP have spoken against the proposal to limit the number of health plans available to consumers. The groups fear that such a step would lead to stifling of healthy competition in the segment and in value-based insurance design. They also feel that such a move might end up increasing the number of plan options, creating more confusion among enrollees instead of streamlining it.
- ACAP backs transparency move: ACAP has, however, backed the proposed Federal recommendation to improve network adequacy and transparency. This is a major departure from its earlier stand where the organization had opposed standardizing network adequacy rules, in favor of leaving that responsibility to the states. Such a move is simply not possible now since a court vacated a federal review of network adequacy.