2021-28317: Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2023
Public comment closed .
Get alerted when the next rule lands
New rules open for comment on their own schedule. Pick how you want to hear about them — we email you when one appears.
Publishing to members? Embed a live rule tracker on your own site — the proposed rules in your area and the comment deadlines closing on them, updating themselves. Free, one line of HTML.
Create a free account & build one →Summary
This proposed rule includes proposed payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs, as well as proposed 2023 user fee rates for issuers offering qualified health plans (QHPs) through federally- facilitated Exchanges and State-based Exchanges on the Federal platform. This proposed rule also proposes requirements related to prohibiting discrimination based on sexual orientation and gender identity; guaranteed availability; the offering of QHP standardized options through Exchanges on the Federal platform; requirements for agents, brokers, web-brokers, and issuers assisting consumers with enrollment through Exchanges that use the Federal platform; 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; re-enrollment, and requirements related to a new State Exchange improper payment measurement program. This proposed rule also seeks comment on how 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.
The agency’s own summary, as published.
What this changes
Amends 6 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 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
Rulemaking docket
We haven’t pulled this rulemaking’s full docket yet.
Don't miss the comment window
One Click Politics alerts you on every deadline, hearing, and rule change.
See all rules with comments due soon →