Blue Cross Blue Shield Association Office of Policy & Representation Issues Public Comment on Centers for Medicare & Medicaid Services Proposed Rule

WASHINGTON, Dec. 25 -- Kris Haltmeyer, vice president for legislative and regulatory policy in the Office of Policy and Representation with the Chicago, Illinois-based Blue Cross Blue Shield Association, has issued a public comment on the Centers for Medicare and Medicaid Services proposed rule entitled "Patient Protection and Affordable Care Act: HHS Notice of Benefit and Payment Parameters for 2022 and Pharmacy Benefit Manager Standards". The comment was written on Dec. 22, 2020, and posted on Dec. 23, 2020:

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The Blue Cross Blue Shield Association (BCBSA) appreciates the opportunity to provide comments on the Proposed Rule: "Patient Protection and Affordable Care Act; Health and Human Services (HHS) Notice of Benefit and Payment Parameters for 2022," as issued in the Federal Register on Dec. 4, 2020 (85 Fed. Reg. 78572).

BCBSA is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield (BCBS) companies (Plans) that collectively provide health care coverage for one in three Americans.

For more than 90 years, Blue Cross and Blue Shield companies have offered quality health care coverage in all markets across America - serving those who purchase coverage on their own as well as those who obtain coverage through an employer, Medicare and Medicaid. Given our experience and commitment to the local communities BCBS Plans serve, we know what it takes to make health insurance markets work for consumers.

BCBSA has long advocated for common sense solutions to ensure a robust, competitive private marketplace that offers individuals a broad range of choices to meet their needs at the best possible prices. Overall, we support many of the provisions outlined in the Proposed Rule and appreciate the Centers for Medicare & Medicaid Services' (CMS) efforts to improve efficiency and limit policy changes that could increase premiums for the 2022 benefit year.

Our key recommendations for the Final Rule are as follows:

* Risk Adjustment Model Specifications. BCBSA opposes the implementation of the proposed changes to the model specifications for the 2022 benefit year. CMS should use an open forum and white paper approach when proposing these types of changes to the risk adjustment model.

* State Flexibility Requests. BCBSA opposes the proposed 50 percent reduction in risk adjustment transfers for the Alabama individual market. We believe the evidence and analysis submitted for the Alabama request fall short of substantiating the transfer reduction requested.

* Exchange Direct Enrollment (DE) Option. BCBSA has long supported direct enrollment and enhanced direct enrollment, with an increasing number of BCBS Plans investing in the technology, making it possible for Plans to assist consumers with eligibility updates, verifications, renewals and many other post-enrollment activities, shifting these customer service functions off of Healhcare.gov.

As CMS considers the exchange direct enrollment option, it is critical that states offer at least one primary website that allows consumers to compare products, net premiums and cost-sharing, and enroll in all available qualified health plans (QHPs) in one place. Consumers should not be required to complete separate eligibility applications on different partner websites in order to compare their premium and cost-sharing responsibilities for different QHPs available in their service area, nor should they be directed to separate websites to finalize their enrollment after comparing and selecting a QHP.

Lastly, we recommend CMS commit to work through operational details with issuers and partners developing the direct enrollment technology prior to approving any direct enrollment exchanges.

* Special Enrollment Periods. BCBSA supports the majority of the proposed special enrollment period (SEP) changes, including SEPs for individuals losing advance premium tax credit (APTC) eligibility or employer contributions to their COBRA coverage, the proposed verification requirements, and the proposed flexibility for individuals who do not receive timely notice from their employer. We continue to recommend CMS limit the ability for consumers to enroll in coverage retroactively due to adverse selection issues and operational complexity.

* Reduction in User Fees. BCBSA appreciates the reduction of user fees for the 2022 plan year and supports the user fee levels proposed. If finalized at a higher level than proposed, any difference should be specifically used for consumer outreach and enrollment services.

* Timeline for Collection of Health and Human Services-Risk Adjustment Data Validation (HHS-RADV) Adjustments. BCBSA strongly supports the proposed realignment of RADV adjustment payments and collections, medical loss ratio (MLR) and pricing timing.

We appreciate your consideration of our comments and urge CMS to adopt the attached detailed recommendations.

If you have any questions, please contact me at 202.626.4814.

View attachment at: https://www.regulations.gov/contentStreamer?documentId=CMS-2020-0151-0058&attachmentNumber=1&contentType=pdf

Sincerely,

Kris Haltmeyer

Vice President, Legislative & Regulatory Policy

Office of Policy & Representation

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The proposed rule can be viewed at: https://www.regulations.gov/document?D=CMS-2020-0151-0005

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