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Centers for Medicare & Medicaid ServicesCMS Roundup

Today, the Centers for Medicare & Medicaid Services (CMS) provides an at-a-glance summary of news from around the agency.

*CMS Proposes Benefit and Payment Parameters for 2026 Marketplace Qualified Health Plans *

October 4: CMS released the 2026 Notice of Benefit and Payment Parameters proposed rule in the Federal Register [ https://www.federalregister.gov/public-inspection/2024-23103/patient-protection-and-affordable-care-act-notice-of-benefit-and-payment-parameters-for-2026-and ]. The 2026 rule outlines proposed requirements for Qualified Health Plans, including deductibles, out-of-pocket limits, and actuarial value levels, in addition to updating market-wide policies, such as risk adjustment calculations, special enrollment periods, and Marketplace user fees. Details can be found in this fact sheet [ https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-and-payment-parameters-2026-proposed-rule ].

*CMS Approves Essential Health Benefits Benchmark Plans for Two States and DC*

October 7: CMS approved Essential Health Benefits (EHB) benchmark plan applications for plan year 2026 and beyond for the states of Alaska and Washington, and the District of Columbia.

Alaska updated its EHB benchmark plan to include coverage for surgical and non-surgical temporomandibular joint disorder care, annual hearing exams and medically necessary hearing aids, and massage therapy. The state also expanded its existing coverage of chiropractic care (from 12 to 20 covered visits annually) and nutritional counseling (to include nutritional screening and counseling, and therapy for the management of obesity). 

Washington updated its EHB-benchmark plan to expand coverage for human donor milk, including medically necessary human donor milk in an inpatient setting, for an infant who is medically or physically unable to receive maternal human milk. The state also added coverage for a hearing aid benefit that includes an annual hearing exam and one hearing aid per ear every three years. Additionally, the state added coverage for an artificial insemination benefit.

The District of Columbia updated its EHB benchmark plans to expand coverage for infertility treatment to include all procedures consistent with established medical practices by licensed physicians and surgeons to treat infertility. This would include diagnosis, testing, counseling, medication, and surgery, as well as gamete intrafallopian transfer, in vitro fertilization, and standard fertility preservation services.

Each new EHB-benchmark plan selection and accompanying application documents can be found on the CMS EHB website [ https://www.cms.gov/marketplace/resources/data/essential-health-benefits ]. 

*CMS* *Releases Informational Bulletin Highlighting Initiative to Modernize Coverage Transitions Between State Medicaid and CHIP Agencies and the Marketplace*

October 10: CMS released an informational bulletin titled Notice of Technology and Process Upgrades for Account Transfer Functionality for States Served by Marketplaces on the Federal Platform [ https://www.medicaid.gov/federal-policy-guidance/downloads/cib10102024.pdf ]. The bulletin introduces Account Transfer 2.0, a multi-year CMS initiative to modernize coverage transitions between state Medicaid and CHIP agencies and Marketplaces on the federal platform. This initiative ensures that eligible individuals have a greater chance of maintaining continuous coverage as they move between insurance affordability programs. Additionally, the new services built by CMS enhance technical assistance to states and reduce state burden and cost for eligibility and enrollment systems. The bulletin highlights planned improvements to the existing account transfer process, anticipated benefits for state Medicaid and CHIP agencies, and opportunities for state engagement. The informational bulletin also reminds state Medicaid and CHIP agencies about the availability of enhanced federal financial participation for any related expenditures.

*CMS Shares Information and Resources in Observance of World Mental Health Day*

October 10: In observance of World Mental Health Day, CMS’ Office of Minority Health shared information and resources to raise awareness about mental and behavioral health in minority and underserved communities. Since 1992, this observance has promoted efforts to end the stigma and discrimination surrounding mental health by highlighting education and resources available to the public. Through the Coverage to Care [ https://www.cms.gov/priorities/health-equity/c2c ] initiative, particularly the Roadmap to Behavioral Health [ https://www.cms.gov/files/document/roadmap-behavioral-health-english.pdf ], CMS is working to help individuals understand which mental health, substance use, and other behavioral health care services are available to them.

*CMS Final Rule Establishes Medicare Appeals Process For Eligible Inpatients Reclassified as Outpatients During Hospital Stay *

October 11: CMS released a final rule establishing appeals processes for certain people with Traditional Medicare who are initially admitted to a hospital as an inpatient, but who are subsequently reclassified as outpatients receiving observation services during their 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 in this fact sheet [ https://www.cms.gov/files/document/medicare-appeal-rights-certain-changes-patient-status-final-rule-fact-sheet.pdf ].

*CMS Releases Tools and Resources as Annual Medicare Open Enrollment Period Begins *

October 15: The annual Medicare Open Enrollment period began October 15, 2024, and ends December 7, 2024, with coverage changes taking effect January 1, 2025. During this time, people with Medicare can compare coverage options, like Traditional Medicare and Medicare Advantage, choose health and drug plans for 2025, and learn about extra help available to those with limited income and resources to pay for Medicare drug coverage. Tools and resources are available at Medicare.gov [ https://link.mediaoutreach.meltwater.com/ls/click?upn=2NqviemW3YF4lD4W3GVIknO4Ca7AaaFBAdYjLcEyRoTzDpznupkIRTcmjsT26mP1e6v0_B0qqY2mKQCnAOf29ixqsrRWGZl9N2S2tuVqJiM4v13Yyv1YwL2VoWHpPxR96VK3fsPCPxYstzuKqv9eDCDQw4Uzz3d9dCGX2Qi6vUiP-2FCc-2FvrAHpKbL8X6vbe-2BCdBKeoHyztcP-2BvUumum3eQmU6GX0SovQyNLf-2FQCbMLx0qBeHwHWbB5Koa2s4tB3BZq4OOVG4QRThT8LL0xhnDZwSHYxKA9LbEKWRsBVp1m05CkZgpQKonG4v4bbj382fTpVJu8rrseggDUvptUjmEYVGFPaU-2BgiTm2XbxbM8PhuZ6N-2FB6zN6oyPSbrfTcsbrtovs047hCcRQ27WIw6DjY9hQ6DxWrBSL3F73fLWlFwf-2B8HGoa5hcA6XtIjHxmvLFozwIjYdvwJ79vJnmpM4xrq19Tf3Q-3D-3D ]. Another important resource for comparing plans is the 2025 Medicare Advantage and Part D Star Ratings; you can read about these ratings in this fact sheet [ https://www.cms.gov/newsroom/fact-sheets/2025-medicare-advantage-and-part-d-star-ratings ].

*CMS Touts Information and Resources in Observance of Health Literacy Month*

October 16: In observance of Health Literacy Month, CMS’ Office of Minority Health is sharing resources to help individuals make informed decisions about their health. Health literacy — the ability to find, understand, and use health information and services — affects nearly every aspect of life, from understanding health coverage options to managing chronic conditions and making choices about the care and services needed. Addressing health literacy can help improve health equity, as people who understand their health care options and how to access them are more likely to make informed health decisions and live longer, healthier lives. Resources include Coverage to Care [ https://www.cms.gov/priorities/health-equity/c2c ] and the Roadmap to Better Care [ https://www.cms.gov/files/document/c2c-roadmap-better-care.pdf ].

*CMS Implements System Changes for the Health Insurance Marketplace to Enhance Security*

October 17: CMS has implemented a system change for applications submitted to the Health Insurance Marketplace®, which includes the Federally Facilitated Marketplace platform and all the states that it supports, through a Classic Direct Enrollment (DE) or Enhanced Direct Enrollment (EDE) agent or broker pathway. The change requires agents and brokers to provide verifiable Social Security Numbers (SSNs) for all applicants who are not newborns. Currently, Marketplace applicants who do not enter an SSN at the time of submitting their eligibility application must provide additional information after application submission to maintain Marketplace coverage or financial assistance. This update streamlines the Marketplace application experience for consumers assisted by agents and brokers and reduce the likelihood that they will have to provide additional information after application submission. Until system updates are made in late December 2024, consumers who do not have SSNs can apply for coverage through the Marketplaces by submitting their own application on HealthCare.gov [ https://www.healthcare.gov/ ]; calling the Marketplace Call Center [ https://www.healthcare.gov/contact-us/ ]; or using an approved Classic DE or EDE [ https://www.cms.gov/marketplace/agents-brokers/direct-enrollment-partners ] partner website with a consumer pathway, with or without the help of an agent or broker.

*Other Recent Releases: *

October 9: Biden-Harris Administration Takes Next Step on Proposed Model to Lower Prescription Drug Costs for People with Medicare [ https://www.cms.gov/newsroom/press-releases/biden-harris-administration-takes-next-step-proposed-model-lower-prescription-drug-costs-people ]

October 10: CMS Announces Resources and Flexibilities to Assist with the Public Health Emergency in the State of Florida [ https://www.cms.gov/newsroom/news-alert/cms-announces-resources-and-flexibilities-assist-public-health-emergency-state-florida-2 ]

October 16: Biden-Harris Administration Takes Groundbreaking Action to Expand Health Care Access by Covering Traditional Health Care Practices [ https://www.cms.gov/newsroom/press-releases/biden-harris-administration-takes-groundbreaking-action-expand-health-care-access-covering ]

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CMS, an agency within the U.S. Department of Health and Human Services, serves the public as a trusted partner and steward, dedicated to advancing health equity, expanding coverage, and improving health outcomes. 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.

 

Get CMS news at cms.gov/newsroom [ https://www.cms.gov/newsroom ], sign up for CMS news via email [ https://www.cms.gov/About-CMS/Agency-Information/Aboutwebsite/EmailUpdates ], and follow CMS on X (Formerly Twitter) @CMSgov [ https://twitter.com/cmsgov ]







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