The Centers for Medicare & Medicaid Services late this afternoon issued a proposed rule on the notice of benefit and payment parameters standards for health insurance issuers and the Health Insurance Marketplaces.
The proposed rule sets forth payment parameters and provisions related to the risk-adjustment program; cost-sharing parameters and cost-sharing reductions; and user fees for federally-facilitated exchanges and state-based exchanges on the federal platform.
With respect to the risk-adjustment program, CMS proposes to make several changes, including to better account for partial-year enrollments and to use prescription drug data as one source of information on diagnoses. CMS also seeks feedback on suggestions made by issuers, consumers and providers to stabilize the marketplaces, including through additional changes to special enrollment period policies and outreach and education.
In addition, the agency provides additional guidance relating to standardized options; qualified health plans; consumer assistance tools; network adequacy; the Small Business Health Options Program; stand-alone dental plans; fair health insurance premiums; guaranteed renewability; the medical loss ratio program; eligibility and enrollment; appeals; and other related topics.
Comments are due to CMS within 30 days of publication in the Federal Register. AHA members will receive a Special Bulletin with further details tomorrow.