The rule, if approved, would go into effect in 2023, according to a Dec. 28 news release.
Five impacts:
1. The rule would require all insurers using a federal or state marketplace on the federal platform to offer standardized plan options across network, metal and plan type. The move aims to promote uniform cost-sharing structures to make plan comparisons easier for consumers.
2. HHS aims to reestablish network adequacy reviews in states with federally-facilitated marketplaces. The reviews would track time and distance to care, and other metrics like wait times.
3. Under the proposed rule, 35 percent of essential community providers in a coverage area would need to be in network. The rule also includes substance use disorder treatment centers as essential community providers.
4. The rule again bars insurers from discrimination on the basis of gender indendity or sexual orientation. The stipulation was removed in 2020.
5. The proposal changes the essential health benefits nondiscrimination policy to require clinical evidence as the backbone of plan design.
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