2019-00077: Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2020

Summary

This proposed rule sets forth payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs; cost-sharing parameters; and user fees for Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal Platform (SBE-FPs). It proposes changes that would allow greater flexibility related to the duties and training requirements for the Navigator program and proposes changes that would provide greater flexibility for direct enrollment entities, while strengthening program integrity oversight over those entities. It proposes policies that are intended to reduce the costs of prescription drugs. It includes proposed changes to Exchange standards related to eligibility and enrollment; exemptions; and other related topics.

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 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 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