CMS finalizes rule for qualified health plans in 2025, imposing stricter time and distance network adequacy standards, and operational improvements for state-based marketplaces; changes aim to simplify enrollment and enhance healthcare services access

Sample article from our Government & Public Policy

April 3, 2024 (press release) –

The Centers for Medicare & Medicaid Services April 2 released its final rule for qualified health plans offered through the health insurance marketplaces for 2025. Beginning in plan year 2025, CMS will require plans participating in state-based marketplaces to comply with time and distance network adequacy standards that are at least as stringent as those for the federally facilitated marketplace. CMS also finalized several other changes to standardize and streamline operations, particularly for state-based marketplaces. In addition, CMS finalized policies intended to make it easier to enroll in coverage and improve access to services such as dental benefits and prescription drugs.

In January, AHA voiced support for the agency’s proposals to strengthen network adequacy standards, standardize and streamline marketplace operations, ease the enrollment process and improve access to certain health care services in the proposed rule

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