In the Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond final rule, the
Overall, the rule expands access to health insurance coverage through the Marketplaces by lengthening the annual Open Enrollment Period, restoring and expanding Navigator duties, and minimizing burden and confusion for consumers. These changes further the
Improving Access to Coverage
FFM and State-based Marketplace on the Federal Platform (SBM-FP) User Fees
For the 2022 benefit year, we finalize an increase of the FFM user fee rate to 2.75% of premiums and the SBM-FP user fee rate to 2.25% of premiums. This is an increase from the rates previously finalized in part 1 of the 2022 Payment Notice - 2.25% and 1.75%, respectively. These rates account for funding for consumer information and outreach, including the FFM Navigator program. These rates are still lower than the current 2021 benefit year user fee rates.
2022 Open Enrollment
The rule extends the annual individual market Open Enrollment Period for 2022 and future benefit years to allow consumers more time to review plan choices, seek in-person assistance, and enroll in a plan that best meets their needs. The annual Open Enrollment Period for all individual-market Marketplaces using the federal eligibility and enrollment platform and off-Marketplace individual market plans in states with such Marketplaces for 2022 and future benefit years will be
Monthly Special Enrollment Period (SEP) for Advance Payments of Premium Tax Credits (APTC)-Eligible Consumers with Household Income up to 150% of the Federal Poverty Level (FPL) whose Applicable Taxpayer has an Applicable Percentage of Zero
To provide more opportunities for certain low-income consumers to access coverage with low or no premiums after APTC, such as under the American Rescue Plan (ARP), Marketplaces will now have the option to provide a monthly SEP for APTC-eligible consumers with a projected annual household income no greater than 150% of the FPL. The rule will permit Marketplaces to provide a SEP for periods of time during which premium tax credits are available without the applicable taxpayer having to contribute toward their applicable portion of premiums before premium tax credits become available, such as those currently available under section 9661 of the ARP. Marketplaces on the federal platform will implement this SEP by providing eligible consumers with a pathway through the HealthCare.gov application during such periods of time.
To ensure consistent application of SEPs based on APTC eligibility across the Marketplaces, the final rule clarifies that, for purposes of the Sec. 155.420 SEPs, references to ineligibility for APTC refer to being ineligible for such payments, or being eligible for such payments but for a maximum of
The rule repeals the separate billing regulation that required individual market qualified health plan (QHP) issuers to send a separate bill for that portion of a policyholder's premium attributable to coverage for abortion services for which federal funding is prohibited. Specifically, we codify in its place the policy from the 2016 Payment Notice under which QHP issuers offering coverage of abortion services for which federal funding is prohibited have flexibility in selecting a method to comply with the separate payment requirement under section 1303 of the Affordable Care Act (ACA). We believe the changes offer issuers options for meaningful compliance with section 1303 of the ACA without imposing the operational and administrative burdens of the separate billing policy, and without causing additional consumer confusion and unintended losses of coverage. Reduced administrative burden and costs for issuers are also expected to result in lower premiums for consumers.
Exchange Direct Enrollment Option Repeal
The rule repeals the Exchange Direct Enrollment option. This option permitted a state Marketplace, SBM-FP, or an FFM state to facilitate enrollment of qualified individuals into individual market QHPs primarily through private-sector direct enrollment entities, including QHP issuers, web brokers, agents, and brokers, rather than the Marketplace's centralized website. Repeal of the Exchange Direct Enrollment option ensures that all available resources can be dedicated to support implementation of the health care provisions of the ARP and other new federal health care legislation, such as the consumer protections in the No Surprises Act, and aligns with recent executive actions designed to strengthen the ACA, increase enrollment in comprehensive coverage, and advance equity. The repeal also addresses concerns that the Exchange Direct Enrollment Option would lead to consumer confusion about coverage options and the availability of financial assistance, resulting in fewer consumers enrolled in comprehensive coverage and disruptions to coordination with other insurance programs.
Section 1332 Waiver Policies
The Departments are of the view that rescinding the 2018 guidance, repealing the codification of its statutory guardrail interpretations in part 1 of the 2022 Payment Notice, and finalizing new policies and interpretations align with the