2016-30433: Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2018; Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program

Summary

This final rule sets forth payment parameters and provisions related to the risk adjustment program; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges and State-based Exchanges on the Federal platform. It also provides additional guidance relating to standardized options; qualified health plans; consumer assistance tools; network adequacy; the Small Business Health Options Programs; stand-alone dental plans; fair health insurance premiums; guaranteed availability and guaranteed renewability; the medical loss ratio program; eligibility and enrollment; appeals; consumer-operated and oriented plans; special enrollment periods; and other related topics.

The agency’s own summary, as published.

What this changes

Amends 10 parts of the Code of Federal Regulations — the standing rules this notice rewrites.

• 45 CFR 144 Requirements Relating to Health Insurance Coverage
• 45 CFR 146 Requirements for the Group Health Insurance Market
• 45 CFR 147 Health Insurance Reform Requirements for the Group and Individual Health Insurance Markets
• 45 CFR 148 Requirements for the Individual Health Insurance Market
• 45 CFR 153 Standards Related to Reinsurance, Risk Corridors, and HHS Risk Adjustment Under the Affordable Care Act
• 45 CFR 154 Health Insurance Issuer Rate Increases: Disclosure and Review Requirements
• 45 CFR 155 Exchange Establishment Standards and Other Related Standards Under the Affordable Care Act
• 45 CFR 156 Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges
• 45 CFR 157 Employer Interactions with Exchanges and Shop Participation
• 45 CFR 158 Issuer Use of Premium Revenue: Reporting and Rebate Requirements