In a new final rule, HHS has released the notice of benefit and payment parameters for 20222 and made updates to the State Innovation Waiver implementing regulations.
In an effort to provide additional flexibility, reduce regulatory burdens and improve affordability, HHS has amended provisions and parameters of the Patient Protection and Affordable Care Act (ACA). In a new final rule, HHS has lowered federally-facilitated Exchange (FFE) and State-based Exchange on the Federal Platform (SBE-FP) user fee rates for 2022. The rule also offers Direct Enrollment (DE) options for states and clarifies requirements to qualify as a Qualified Health Plan (QHP). Additionally, the rule finalized a proposal regarding State Innovation Waivers under section 1332 of the ACA to codify many policies and interpretations previously offered in agency guidance (Final Rule, 86 FR 6138, January 19, 2021).
Fees. Each year in the annual notice of benefit and payment parameters, HHS finalizes the user fee rates for issuers offering plans through the Exchanges using the federal platform. For the 2022 plan year, HHS has lowered the FFE user fee rate to 2.25 percent of total monthly premiums and the SBE-FP user fee rate to 1.75 percent of total monthly premiums. These reductions reflect enrollment, premium and HHS contract estimates for the 2022 plan year. The final rule also finalized a user fee rate for 2023 of 1.5 percent of total monthly premiums for FFE and SBE-FP states that elect in 2023 the direct enrollment option.
Direct enrollment. FFE’s DE program allows third-party entities such as issuers, agents and brokers, and web brokers, who are approved by HHS to assist consumers with QHP plan selection and enrollment through a non-Exchange website in a manner considered to be through the Exchange. The Classic DE and Enhanced Direct Enrollment (EDE) pathways are available in FFE and SBE-FP states and they have had success in improving the consumer experience. During the 2021 Open Enrollment Period, the number of consumers who enrolled through the EDE pathway more than doubled from the prior 2020 Open Enrollment Period.
Based on this success, HHS has established an option for any FFE or SBE-FP state to request the use of direct enrollment as the avenue through which individual market consumers and qualified individuals can shop for and purchase a QHP offered through the Exchange in the state, and apply and receive determination of eligibility for APTC and CSRs. Additionally, State Exchanges that do not rely on the federal eligibility and enrollment platform will be able to elect the Exchange DE option to engage approved private-sector entities as the pathway for consumers in their state to apply for, and enroll in, QHPs offered through the Exchange.
QHP requirements. The final rule also finalized revisions to the statutory description of network adequacy standards for plans seeking certification as QHPs. The rule clarifies that a plan that does not vary benefits based on whether the issuer has a network participation agreement with a provider that furnishes covered services is not required to comply with the network adequacy standards to qualify for certification as a QHP. Additionally, while QHP issuers are required by the regulation to accept a variety of payment methods to make coverage accessible to individuals without a bank account or credit card, the final rule also requires issuers to accept payments on behalf of an enrollee from an individual coverage HRA or QSEHRA.
State innovation waivers. Section 1332 of the ACA permits states to apply for a State Innovation Waiver to pursue innovative strategies for providing their residents with access to higher value, more affordable health coverage. The final rule provides states consistency and predictability by codifying the Department’s Interpretative guidance published in the Federal Register in 2018, regarding how the departments will apply section 1332 to determine whether applications will be approved. Under the rule, the comprehensive coverage guardrail will be met by a state waiver plan if the plan will provide consumers access to coverage options that are at least as comprehensive as the coverage options provided without the waiver, to at least a comparable number of people as would have had access to such coverage absent the waiver. The affordability requirement is met as long as the plan provides consumers access to coverage options that are at least as affordable as the coverage options provided without the waiver, to at least a comparable number of people as would have had access to such coverage absent the waiver. Additionally, departments will be required to periodically evaluate approve waivers to ensure the program is consistent with the applicable regulations.
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