2020-26534: Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2022 and Pharmacy Benefit Manager Standards; Updates To State Innovation Waiver (Section 1332 Waiver) Implementing Regulations
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This proposed 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 includes proposed changes related to special enrollment periods; Navigator program standards; direct enrollment entities; the administrative appeals processes with respect to health insurance issuers and non-federal governmental group health plans; the medical loss ratio program; acceptance of payments by issuers of individual market Qualified Health Plans; and other related topics. It proposes clarifications to the regulation imposing network adequacy standards with regard to Qualified Health Plans that do not use provider networks. It proposes changes to the regulation requiring the reporting of certain prescription drug information by qualified health plans or their pharmacy benefit managers. It also proposes a new direct enrollment option for Federally-facilitated Exchanges and State Exchanges. This proposed rule also proposes changes related to section 1332 State Innovation Waivers.
The agency’s own summary, as published.
What this changes
Amends 8 parts of the Code of Federal Regulations — the standing rules this notice rewrites.
- 31 CFR 33 Waivers for State Innovation
- 45 CFR 147 Health Insurance Reform Requirements for the Group and Individual Health Insurance Markets
- 45 CFR 150 CMS Enforcement in Group and Individual 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
- 45 CFR 184 Pharmacy Benefit Manager Standards Under the Affordable Care Act
Rulemaking docket
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