2016-04439: Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017

Summary

This final rule sets forth payment parameters and provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also provides additional amendments regarding the annual open enrollment period for the individual market for the 2017 and 2018 benefit years; essential health benefits; cost sharing; qualified health plans; Exchange consumer assistance programs; network adequacy; patient safety; the Small Business Health Options Program; stand-alone dental plans; third-party payments to qualified health plans; the definitions of large employer and small employer; fair health insurance premiums; student health insurance coverage; the rate review program; the medical loss ratio program; eligibility and enrollment; exemptions and appeals; and other related topics.

The agency’s own summary, as published.

What this changes

Amends 7 parts of the Code of Federal Regulations — the standing rules this notice rewrites.

• 45 CFR 144 Requirements Relating to Health Insurance Coverage
• 45 CFR 147 Health Insurance Reform Requirements for the Group and Individual Health Insurance Markets
• 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 158 Issuer Use of Premium Revenue: Reporting and Rebate Requirements