– Comment by April 11.  Last week, the Centers for Medicare & Medicaid Services (CMS) released for public inspection the Marketplace Integrity and Affordability Proposed Rule, which proposes additional safeguards meant to protect consumers from improper enrollments and changes to their health care coverage, as well as to establish standards that aim to ensure the integrity of the Affordable Care Act (ACA) Marketplaces.  It was formally published on Wednesday, March 19, with comments due April 11.

Last week, the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention (CDC) released the new NCHS Urban-Rural Classification Scheme for Counties. For this update, the NCHS used delineations of metropolitan and micropolitan statistical areas from the Office of Management and Budget as well as estimates from the U.S. Census Bureau to classify counties and county equivalents into six categories – four metropolitan and two nonmetropolitan. This scheme allows researchers, policy makers, and others to study the health of U.S. residents according to how urban or rural their county is. Read more about how FORHP uses several federal data sources to define rural for programs.

Yesterday, the Economic Research Service (ERS) at the U.S. Department of Agriculture released a report indicating worsening health for working-age adults in rural areas in the U.S.  Using data from the Centers for Disease Control and Prevention, researchers found that the gap in mortality rates between rural and urban areas grew from a rural lead over urban areas of 6 percent in 1999 to a rural lead of 43 percent in 2019.

The team at Rural Health Value released a new resource, Introduction to Rural Clinically Integrated Networks (CINs), that defines CINs, describes common CIN characteristics, and explores the unique value-based care advantages a rural CIN may bring to its members.  The conclusion of the brief is that a collaboration of independent rural health care organizations, incorporated as a CIN, can achieve the scale and develop the infrastructure necessary to successfully participate in value-based care and payment opportunities. The Rural Health Value team is funded by the Federal Office of Rural Health Policy.

– Expect comments to be due early April. The Centers for Medicare & Medicaid Services (CMS) released the “Marketplace Integrity and Affordability Proposed Rule,” which proposes additional safeguards to protect consumers from improper enrollments and changes to their health care coverage, as well as establish standards to ensure the integrity of the Affordable Care Act (ACA) Marketplaces.  Key proposals include revising standards for income verification processes; modifying eligibility redetermination procedures; revising actuarial value standards for health plans; requiring Marketplaces to deny eligibility for advance payments of the premium tax credit (APTC) upon a tax filer’s failure to reconcile APTC for one year; shortening the annual Open Enrollment Period to November 1 through December 15; and eliminating the special enrollment period for persons with annual household incomes below 150% of the federal poverty level (FPL). Since 2018, the number of Marketplace plans in rural areas has grown, although the number of issuers in rural areas still lags behind the number in urban areas. Once CMS displays the proposed rule in the public Inspection section of the Federal Register, the public will have 30 days to submit comments.

Last week, the Centers for Medicare & Medicaid Services (CMS) announced rescission of previous guidance for Center Information Bulletins (CIBs) related to services and supports addressing health-related social needs (HRSN) for Medicaid and state Children Health Insurance Programs (CHIPs).  The rescinded guidance includes the 2023 CIB, Coverage of Services and Supports to Address Health-Related Social Needs in Medicaid and the Children’s Health Insurance Program, and the 2024 CIB, Coverage of Services and Supports to Address Health-Related Social Needs in Medicaid and the Children’s Health Insurance Program.  Rescinding this guidance does not negate programs that are currently approved.  Rather, it informs States and the public that CMS will review applications to cover HRSN services on a case-by-case basis.

The Centers for Medicare & Medicaid Services (CMS) alerted hospitals that the agency is planning a more systematic monitoring and enforcement approach to non-compliance with the Hospital Price Transparency requirements and, consistent with current policies, non-compliance will be addressed with swift enforcement. CMS posted a list of enforcement actions to date as well as a Hospital Price Transparency Enforcement Activities and Outcomes dataset with information related to enforcement actions taken by CMS.  All hospitals, including Critical Access Hospitals and Rural Emergency Hospitals, and hospital-based departments, which may include some Rural Health Clinics, are required to post their standard charges prominently on a publicly available website.

As President Trump seeks to purge the federal government of “woke” initiatives, agencies have flagged hundreds of words to limit or avoid, according to a compilation of government documents. Source: New York Times

All insurers offering plans on Pennie, Pennsylvania’s Health Insurance Exchange, now offer a PayNow feature. Customers can pay immediately at the conclusion of the enrollment process. This option for all plans was added in 2025. In addition, all plan Summary of Benefits documents are available in English and Spanish. With the uptick of enrollees reaching retirement age, Pennie has also added a new one-pager to the outreach toolkit to help retirees understand the enrollment process.

On March 10, CMS released a proposed rule ahead of the Federal Register on Health Insurance Marketplaces under the Affordable Care Act. The rule seeks to limit the Open Enrollment period for all exchanges to November 1 to December 15, require a $5 premium for enrollees who are auto-renewed into a zero-dollar premium plan, remove the option for auto-renews to move from Bronze to Silver plans and eliminate the low-income Special Enrollment Period for incomes at or below 150% of the federal poverty level. The Rule would also reduce the time for action of failure to reconcile from two years to one year, allowing insurers to require payments of past due premiums for prior coverage before new coverage can begin, and remove other insurer payment threshold flexibilities. Several changes would remove previous verification flexibilities to ease the enrollment process and rescind Qualified Health Plan eligibility for Deferred Action for Childhood Arrivals (DACA) recipients. While Pennsylvanians have benefited from any of these provisions under the Affordable Care Act, Pennie, Pennsylvania’s Health Insurance Exchange Board, is reviewing the proposed changes and will provide a comment letter.