Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2018
SUMMARY: This 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. It also 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.
EFFECTIVE DATE: To be assured consideration, comments must be received at one of the addresses provided below, no later than
ADDRESSES: In commenting, please refer to file code CMS-9934-P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission.
You may submit comments in one of four ways (please choose only one of the ways listed):
1. Electronically. You may submit electronic comments on this regulation to http://www.regulations.gov. Follow the "Submit a comment" instructions.
2. By regular mail. You may mail written comments to the following address ONLY:
Please allow sufficient time for mailed comments to be received before the close of the comment period.
3. By express or overnight mail. You may send written comments to the following address ONLY:
4. By hand or courier. Alternatively, you may deliver (by hand or courier) your written comments ONLY to the following addresses prior to the close of the comment period: a. For delivery in
(Because access to the interior of the
If you intend to deliver your comments to the
Comments erroneously mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.
For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT:
Ielnaz Kashefipour, (301) 492-4376, for matters related to standardized options.
SUPPLEMENTARY INFORMATION:
Inspection of Public Comments: All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following Web site as soon as possible after they have been received: http://www.regulations.gov. Follow the search instructions on that Web site to view public comments.
Comments received timely will also be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the
Table of Contents
I. Executive Summary
II. Background
A. Legislative and Regulatory Overview
B. Stakeholder Consultation and Input
C. Structure of Proposed Rule
III. Provisions of the Proposed HHS Notice of Benefit and Payment Parameters for 2018
A. Part 144--Requirements Relating to Health Insurance Coverage
I. Part 156--Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges
IV. Collection of Information Requirements
A. ICRs Regarding Upload of Risk Adjustment Data
B. ICRs Regarding Data Validation Requirements When HHS Operates Risk Adjustment
C. ICR Regarding the Interim and Final Discrepancy Reporting Processes for Risk Adjustment Data Validation When HHS Operates Risk Adjustment
D. ICR Regarding Standardized Options in SBE-FPs
E. ICR Regarding Differential Display of Standardized Options on the Web sites of Agents and Brokers and QHP Issuers
F. ICR Regarding Ability of States To Permit Agents and Brokers To Assist Qualified Individuals, Qualified Employers, or Qualified Employees Enrolling in QHPs
G. ICR Regarding Eligibility Redeterminations
H. ICR Regarding Termination of Exchange Enrollment or Coverage
I. ICR Regarding QHP Issuer Request for Reconsideration
J. ICR Regarding Notification by Issuers Denied Certification
K. ICR Regarding the Discrepancy Reporting Processes for the Reconciliation of the Cost-Sharing Reduction Portion of Advance Payments
L. ICRs Regarding Administrative Appeals
M. ICR Regarding Medical Loss Ratio
V. Response to Comments
VI. Regulatory Impact Analysis
A. Statement of Need
B. Overall Impact
C. Impact Estimates of the Payment Notice Provisions and Accounting Table
D. Regulatory Alternatives Considered
E. Regulatory Flexibility Act
F. Unfunded Mandates
G. Federalism
H. Congressional Review Act
Acronyms and Abbreviations
--This is a summary of a
Proposed rule.
CFR Part: "45 CFR Parts 144, 146, 147, 148, 153, 154, 155, 156, 157, and 158"
RIN Number: "RIN 0938-AS95"
Citation: "81 FR 61456"
Document Number: "CMS-9934-P"
Federal Register Page Number: "61456"
"Proposed Rules"
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