Today, the Centers for Medicare & Medicaid Services (CMS) provides a summary of information from around the agency.
CMS Proposes Benefits and Payment Agencies for 2026 Marketplace Health Plans
October 4: CMS released the 2026 Notice of Benefit and Payment Parameters proposed rule in the Federal Register. The 2026 Act clarifies proposed requirements for Qualified Health Plans, including deductibles, out-of-pocket limits, and actuarial value standards, as well as improving market policies, such as with risk adjustment figures, special registration periods, and Market user fees. Details can be found here data sheet.
CMS Approves Essential Health Benefit Plans for both States and DC
October 7: CMS accepted Essential Health Benefits (EHB) plan applications for plan years 2026 and beyond for the states of Alaska and Washington, and the District of Columbia.
Alaska has updated its EHB rate plan to include coverage for temporomandibular joint and nonsurgical orthopedic care, annual hearing screenings and medically necessary aids, and massage therapy. The state has also expanded its existing chiropractic care (from 12 to 20 covered visits annually) and nutritional counseling (including nutritional assessment and counseling, and treatment for obesity management).
Washington has updated its EHB-benchmark policy to extend coverage for human donor milk, including human milk that is medically necessary in an outpatient setting, for an infant who cannot access breast milk through medical or physical. The government also increased coverage for hearing aid benefits that include an annual hearing test and one hearing test every three years. In addition, the government increased protection for the benefit of artificial insemination.
The District of Columbia has updated its EHB standards plans to expand coverage for infertility treatment to include all medical procedures established by licensed physicians and surgeons to treat infertility. . This will include screening, testing, counseling, medication, and surgery, as well as intrafallopian gamete transfer, in vitro fertilization, and standard fertility preservation services.
Each new EHB-benchmark option and accompanying documentation can be found at CMS EHB website.
CMS Recommends Information Delivery Plan to Press Release Exchange between State Medicaid and CHIP Agencies and the Marketplace.
October 10: CMS released a bulletin titled: Notice of Technical and Operational Improvements for the Account Transfer Process for States Served by Federal Markets.. The announcement introduces Account Transfer 2.0, a multi-year effort by CMS to modernize the transfer of information between state Medicaid and CHIP agencies and the Marketplace on a federal platform. This plan ensures that eligible individuals have a greater chance of maintaining continuous coverage as they move between insurance coverage programs. In addition, new services built by CMS improve technical assistance to states and reduce the burden and cost of eligibility and enrollment processes. The announcement highlights proposed improvements to the existing account transfer system, expected benefits for state Medicaid and CHIP agencies, and opportunities for federal commitments. This information also reminds the state agencies of Medicaid and CHIP about the availability of enhanced participation of federal funds for any related costs.
CMS Shares Information and Resources to Celebrate World Mental Health Day
October 10: In celebration of World Mental Health Day, the CMS Office of Minority Health shared information and resources to raise awareness about mental health and behavior in underserved and underserved communities. protected. Since 1992, the festival has promoted efforts to end the stigma and discrimination surrounding mental health by highlighting education and resources available to the public. In the Protection from Supervision purpose, especially of A Roadmap to Behavioral HealthCMS works to help individuals understand what mental health, substance abuse, and other health care services are available to them.
CMS Final Rule Establishes Medicare Appeals Process for Eligible Patients Who Are Updated as Outpatients During a Hospital Stay.
October 11: CMS released a final rule that establishes appeals procedures for certain people with Traditional Medicare who are initially admitted to the hospital as an inpatient, but then readmitted as inpatients except those who receive care services during a hospital stay and who meet other eligibility criteria. This final rule implements a federal court order (Alexander v. Azar) that directed CMS to establish this appeals process. Details can be found here data sheet.
CMS Releases Tools and Resources as Annual Medicare Enrollment Period Begins
October 15: The annual Medicare Open Enrollment period began on October 15, 2024, and ends on December 7, 2024, with deductible changes taking effect on January 1, 2025. During this time, people those with Medicare can compare coverage options, such as Traditional Medicare and Medicare Advantage. , select health and drug plans for 2025, and learn about additional help available to those with limited income and resources to pay for Medicare drug coverage. Tools and equipment are available at Medicare.gov. Another important resource for comparing plans is the 2025 Medicare Advantage and Part D Star Ratings; You can read about these details here data sheet.
CMS Recommends Information and Resources in Celebration of Health Education Month
October 16: In celebration of Health Education Month, the CMS Office of Early Childhood Health is sharing resources to help people make informed decisions about their health. Health literacy – the ability to find, understand and use health information and services – affects almost every aspect of life, from understanding health care to managing chronic conditions and making decisions about needed care and services. Addressing health education can help improve health equity, as people who understand their health care options and how to access it are more likely to make informed health decisions. good and live a long, healthy life. Tools include Protection from Supervision and go The Path to Better Care.
CMS Introduces Administrative Changes to Health Insurance Marketplaces to Improve Coverage
October 17: CMS implemented a system change for applications submitted to the Health Insurance Marketplace®, which includes the Federally Facilitated Marketplace platform and all states it supports, through Classic Direct Enrollment (DE) or the Enhanced Direct Enrollment agent ( EDE) or broker route. The amendment requires agents and brokers to provide verified Social Security Numbers (SSNs) for all non-infant applicants. Currently, Marketplace applicants who do not enter an SSN at the time they submit their eligibility application must provide additional information after submitting the application to maintain Marketplace coverage or financial aid. This improvement simplifies the Marketplace application experience for buyers assisted by agents and brokers and reduces the likelihood that they will have to provide additional information after submitting an application. Until system updates are made by the end of December 2024, consumers without SSNs can apply for coverage in the Marketplace by submitting their application to. HealthCare.gov; to call Market Call Center; or use an approved one Classic DE or EDE a partner website with a customer path, with or without the help of an agent or reseller.
Other Recent Publications:
October 9: Biden-Harris Administration Takes Next Step on Proposed Model to Lower Prescription Drug Costs for People With Medicare.
October 10: CMS Publishes Resources and Procedures for Public Health Emergency Response in the State of Florida.
October 16: The Biden-Harris administration is taking bold steps to expand access to health care through comprehensive health care.
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CMS, an agency within the United States Department of Health and Human Services, serves the community as a trusted partner and administrator, committed to advancing health equity, expanding coverage, and improving health outcomes. good health. The agency protects public health by administering the Medicare program and working in partnership with state governments to administer Medicaid, CHIP, and the Health Insurance Marketplace.
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