Final rule issued on notice of benefit and payment parameters for 2017

The Centers for Medicare & Medicaid Services (CMS) Feb. 29 issued a final rule on the notice of benefit and payment parameters standards for health insurance issuers and the health insurance marketplaces in 2017.

The final rule sets forth provisions related to the risk adjustment, reinsurance and risk corridors programs; cost-sharing parameters and cost-sharing reductions; and user fees for federally-facilitated exchanges.

Through the rule, CMS finalized changes to the network adequacy requirements to facilitate continuity of care when a provider leaves a plan’s network and confirmed its intentions to develop ratings of each Qualified Health Plan’s (QHP) network coverage that will be available to the public through HealthCare.gov.

It also directs plans to count the cost sharing charged to enrollees for certain out-of-network services provided at in-network facilities by an ancillary provider towards the enrollee’s annual limitation on cost sharing beginning in 2018, which is intended to help limit “surprise bills” to consumers. The agency also finalizes policy changes to the premium stabilization programs, including by recalibrating the risk-adjustment formula using more recent data.

CMS expanded current regulations related to patient safety standards for hospitals, but the agency allows flexibility. The final rule requires QHP issuers that contract with hospitals with more than 50 beds to verify that the hospitals either participate with a federally-listed patient safety organization (PSO) or implement “an evidence-based initiative to improve health care quality through the collection, management and analysis of patient safety events that reduces all cause preventable harm, prevents hospital readmission, or improves care coordination.”

Those hospitals choosing to work with a PSO must also demonstrate implementation of a mechanism for comprehensive, person-centered discharge, which CMS believes can be achieved by sharing its CMS Certification Number with QHP issuers. The rule establishes the annual open enrollment period for 2017 as Nov. 1, 2016 to Jan. 31, 2017.

CMS Feb. 29 also issued the final 2017 Letter to Issuers in the federally facilitated marketplaces and an FAQ on the moratorium on the health insurance provider fee for 2017. The letter provides issuers seeking to offer QHPs in the marketplaces or the Federally-facilitated Small Business Health Options Programs with operational and technical guidance to help them successfully participate in any such marketplace in 2017.