Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2023

Final rule.

CFR Part: "45 CFR Parts 144, 147, 153, 155, 156, and 158"

RIN Number: "RIN 0938-AU65"

Citation: "87 FR 27208"

Document Number: "CMS-9911-F"

Page Number: "27208"

"Rules and Regulations"

Agency: "Centers for Medicare & Medicaid Services (CMS), HHS."

SUMMARY: This final rule includes payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs, as well as 2023 user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This final rule also includes requirements related to guaranteed availability; the offering of QHP standardized plan options through Exchanges on the Federal platform; requirements for agents, brokers, and web-brokers; verification standards related to employer sponsored coverage; Exchange eligibility determinations during a benefit year; special enrollment period verification; cost-sharing requirements; Essential Health Benefits (EHBs); Actuarial Value (AV); QHP issuer quality improvement strategies; accounting for quality improvement activity (QIA) expenses and provider incentives for medical loss ratio (MLR) reporting and rebate calculation purposes; and re-enrollment. This final rule also responds to comments on how the Department of Health and Human Services (HHS) can advance health equity through QHP certification standards and otherwise in the individual and group health insurance markets, and how HHS might address plan choice overload in the Exchanges.