In its latest updates, CMS has finalized the following rules, enhancing healthcare access, quality and transparency:
- The 2025 Notice of Benefit and Payment Parameters final rule enables states to include routine, adult dental coverage as Essential Health Benefits starting in 2027 and aligns network adequacy standards for Marketplaces beginning in 2026.
- A final rule streamlines eligibility and enrollment for Medicaid, the Children’s Health Insurance Program (CHIP), removing CHIP coverage limits and waiting periods, banning premium-based lockouts and standardizing renewal processes.
- The Ensuring Access to Medicaid Services and the Medicaid and CHIP Managed Care Access, Finance and Quality final rules introduce new care access standards, set maximum appointment wait times for certain services and mandate transparency in Medicaid payment rates.
- The Policy and Technical Changes final rule updates Medicare Advantage and Part D, improving care coordination, introducing mid-year notices for unused supplemental benefits and requiring health equity analyses of utilization management processes.
- An HHS final rule enhances health equity by strengthening ACA protections against discrimination based on sex, including sexual orientation and gender identity, in certain health programs and activities.
- A final rule redefines short-term, limited-duration insurance, improving disclosure for these and fixed indemnity policies to distinguish them from comprehensive ACA-covered plans.
- A final rule updates, modernizes, clarifies and strengthens protections under Section 504 of the Rehabilitation Act, which prohibits discrimination on the basis of disability in programs and activities that receive funding from HHS. It addresses discrimination in medical treatment, establishes enforceable standards for accessible diagnostic equipment and ensures web, mobile and kiosk accessibility.
Additionally, CMS has proposed the following rules and is actively soliciting comments:
- The FY 2025 Hospital Inpatient Prospective Payment System proposed rule would add 252 new ICD-10-CM codes, covering conditions such as internal and external nasal valve collapse and synovitis and tenosynovitis of unspecified, multiple and other sites. The comment deadline is June 10.
- A proposed rule focuses on healthcare accreditation, aiming to increase transparency and accountability by standardizing criteria with Medicare conditions, reducing conflicts of interest and updating performance standards. The comment period closed on April 15.
Questions? Contact [email protected].
