The Centers for Medicare & Medicaid Services May 7 issued a final rule that implements the standards governing health insurance issuers and the Health Insurance Marketplaces (or “exchanges”) for 2021.

In the rule, CMS finalized the benefit and payment parameters for qualified health plan issuers selling on the exchanges, as well as additional policies intended to lower premiums, promote program integrity, stabilize the individual and small group markets, enhance the consumer experience and reduce regulatory burden.

Also in the rule, CMS finalized value-based insurance design options that QHP issuers can choose to implement; updated how cost sharing calculations will account for drug manufacturer coupons; finalized small updates to medical loss ratio and special enrollment period rules; and increased the annual maximum out-of-pocket spending limits.

CMS did not finalize its proposal to require enrollees with no premium after a premium tax credit is applied to actively re-enroll or face reduced subsidies, consistent with AHA’s comments on the proposed rule.

Download the Special Bulletin for a summary of the key issues.

Related News Articles

Headline
Rural health clinics and other qualified community-based outpatient care centers can apply for American Rescue Plan Act funding to expand the number of full-…
Headline
The Health Resources and Services Administration yesterday awarded rural health clinics about $49,500 each for outreach to increase COVID-19 vaccinations in…
News
The House Energy and Commerce Committee today advanced two AHA-supported bills to enhance maternal health care quality and outcomes, including in rural areas…
Headline
The Health Resources and Services Administration’s Small Rural Hospital Improvement Program yesterday provided states $398 million from the American…
Headline
The Federal Communications Commission today released a final rule summarizing guidance adopted last month for participants in its $100 million Connected…
Chairperson's File
In Bellingham, Wash., the PeaceHealth clinic is using community health workers, or promotoras, to help educate farmworkers in rural communities about the…