Dive Brief:
- CMS announced last week it is revising its previous guidance from May 16, 2014 that states that an issuer cannot impose a waiting period before beneficiaries can access a covered benefit.
- CMS officials determined waiting periods may discriminate against and/or discourage enrollment by those with "significant health needs or present or predicted disability."
- While that guidance stands, CMS has updated it by no longer excepting waiting periods for pediatric orthodontia due to the same reasoning.
Dive Insight:
The update means a change for any plans, on or off the exchanges, that have been imposing a waiting period for children's dental care, to avoid a violation of the essential health benefits (EHBs) requirements.
The update is immediately applicable to all plans required to provide EHBs. However, CMS concedes that for those plans that have already submitted their plans and rates to their state insurance departments for 2017, it could be difficult to make adjustments in time for the 2017 benefit year.
It asks issuers to "make such changes at the earliest possible opportunity," but specifies they will only be required to do so as of January 1, 2018.