CMS Proposed Rule: Notice of Benefit and Payment Parameters for 2022

Last week, the Centers for Medicare and Medicaid Services (CMS) released a propose rule for 2022 Notice of Benefit and Payment Parameters. The proposed rule would lower the user fee or Affordable Care Act (ACA) insurers to 2.25% of the premium for the coverage year 2022 and also would enable states to partner directly with the private sector to create websites that would directly compete with state or federally run websites.

CMS also proposes a definition for prescription drug rebates and other forms of price concession that would include any and all remuneration received by an insurers, manufacturers and retailers.

According to Fierce Healthcare, the agency also proposed to reduce the user fee for insurers on state-based ACA exchanges using HealthCare.gov to 1.75% of the premium. Furthermore, the agency asks that state-run exchanges use the same eligibility requirements for special enrollment periods. From CMS via Fierce:

The rule proposes to require all exchanges to conduct special enrollment period verification for at least 75% of new enrollments for consumers not already enrolled in coverage through the relevant exchange. Tightening those standards on [special enrollment period] eligibility and verification is expected to protect the risk pool and, in turn, lower premiums by preventing people from waiting until they are sick to enroll.

In terms of options for states to partner with private entities to create new websites as an alternative to the state-run websites, CMS says that it intends to leverage brokers and issuers the ability to serve as their own consumer-facing means to enroll consumers.

These platforms would enable a more curated, customized consumer experience designed to target diverse populations… Exchanges would remain responsible for making all eligibility determinations, performing required verifications of consumer application information, and meeting all statutory and regulatory requirements for the operation of an exchange.

Health Affairs reports that the changes to special enrollment periods for exchange enrollees to enter healthcare plans that are not traditionally offered during special periods. The agency requests comment on how to minimize consumer confusion or whether this policy could potentially result in adverse selection.

The rule could potentially codify the recent policy of relaxed enforcement for temporary premium credits for 2020 coverage, meaning that insurers can temporarily reduce premiums under certain requirements.

CMS Notice of Benefit and Payment Parameters for 2022 Proposed Rule Factsheet